Application For Limited Transportation Insignia
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Application For Limited Transportation Insignia Form. This is a New Jersey form and can be use in Division Of Alcoholic Beverage Control Statewide.
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Tags: Application For Limited Transportation Insignia, New Jersey Statewide, Division Of Alcoholic Beverage Control
STATE OF NEW JERSEY
DEPARTMENT OF LAW AND PUBLIC SAFETY
DIVISION OF ALCOHOLIC BEVERAGE CONTROL
P.O. BOX 087, 140 EAST FRONT STREET
TRENTON, NJ 08625-0087
APPLICATION FOR LIMITED TRANSPORTATION INSIGNIA [LTC]
EFFECTIVE OCTOBER 1, 20____ TO SEPTEMBER 30, 20____
This application must be filed in DUPLICATE and accompanied by a fee of
$75.00 per vehicle to be used in the transportation of alcoholic
beverages. Fees must be in the form of a company check, check or money
order payable to the “Division of ABC.”
1.
Name of Permittee:___________________________________________________
2.
Address of Permittee:________________________________________________
3.
Contact Name:__________________ 4. Contact Phone:____________________
5.
NJ Limited Transportation Permit No.:________________________________
VEHICLE
MAKE/MODEL/YEAR
VIN
(LAST 5 DIGITS)
OWNED OR
LEASED
INSIGNIA NO.
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
The licensee asserts that the vehicle described in this application will be operated
under its exclusive control by its bona fide employees and shall be used for the
transportation of alcoholic beverages solely for the licensee=s own business.
The
licensee hereby consents to inspection and search, without warrant, and at all hours,
by the Director, his authorized agents and by other officers as defined by R.S. 33:11(p), of any vehicle for which an insignia is issued.
________________________________________
TITLE AND SIGNATURE OF LICENSEE
______________________________
DATE
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