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Application For Limited Transportation Permit 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 Permit, 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 PERMIT [LTP]
EFFECTIVE OCTOBER 1, 20____ TO SEPTEMBER 30, 20____
This permit will authorize the transportation of alcoholic beverages from
points within New Jersey, including piers of import, to points outside of
this State, and from points outside of New Jersey to piers of export
within New Jersey.
Transportation must be in vehicles which display New
Jersey Limited Transportation Insignia issued to permittee.
This application must be accompanied by a fee of $500.00 in the form of a
company check, check or money order payable to the Division of ABC. This
application must also be accompanied by the permittee’s request for
Limited Transportation Insignia.
1.
Name of Applicant:___________________________________________________
2.
Trade Name[s], if any, under which business may be conducted:
_____________________________________________________________________
3.
Applicant’s Federal Taxpayer ID No.:_________________________________
4.
Address of Applicant:________________________________________________
5.
Mailing Address:_____________________________________________________
6.
Contact Name:_______________________ 7. Contact Phone:_______________
8.
IF APPLICANT IS A PARTNERSHIP, provide following information
concerning each partner: (Attach additional pages, if necessary.)
NAME
ADDRESS
SOCIAL SECURITY NO.
9.
IF APPLICANT IS A CORPORATION, in what State incorporated___________.
Provide following information concerning all officers and directors
of the corporation: (Attach additional pages, if necessary.)
NAME
ADDRESS
SOCIAL SECURITY NO.
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10.
Has your business previously held a Limited Transportation Permit?
If yes, provide Permit Number______________________.
11.
Identify the location where vehicles to be used under the authority
of this permit are garaged:
_____________________________________________________________________
12.
Please provide a full description of your business:
_____________________________________________________________________
13.
Does your business hold an alcoholic beverage license in New Jersey
or in any other State?_______
If yes, please identify the type of
license and the issuing authority of that license:
_____________________________________________________________________
BEFORE FILING APPLICATION, PLEASE EXECUTE THE FOLLOWING AFFIDAVIT:
STATE OF
)
ss.
COUNTY OF
)
)
__________________________, being duly sworn according to law, upon
his/her oath, deposes and says that he/she is the individual applicant or
partner in the partnership applicant or __________________________ of the
corporate applicant;
(Title)
that the applicant hereby consents to inspection and search of any vehicle
operated under the authority of this permit, without warrant and at all
hours, by the Director, his/her deputies, investigators and authorized
agents;
that he/she is the person whose signature appears below and that the
contents of this application represent complete disclosure of fact, and
that the contents of this application are true.
___________________________________________
TITLE/SIGNATURE OF APPLICANT
DATED:______/______/______
Sworn to and subscribed before me this
_______ day of ____________________, 2______
____________________________________
TITLE/SIGNATURE OF OFFICER
ADMINISTERING OATH
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