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 TRANSPORTATION LICENSE INSIGNIA [TLI] EFFECTIVE JULY 1, 20____ TO JUNE 30, 20____ This application must be filed in DUPLICATE and accompanied by a fee of $30.00 per vehicle to be used in the transportation of alcoholic beverages. Fees must be in the form of company check or money order payable to the “Division of A.B.C.” A COPY OF THE MOTOR VEHICLE REGISTRATION CARD ISSUED TO EACH VEHICLE MUST ALSO ACCOMPANY THIS APPLICATION. 1. 2. 3. 4. Name of Licensee:____________________________________________________ New Jersey Transportation License No.________ - 20 - _______ - ______ Company Mailing Address:_____________________________________________ Contact Name:__________________ 5. Contact Phone:____________________ 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 vehicles 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. 33:1-1(p), of any vehicle for which an insignia is issued. __________________________________________ Title and Signature of Licensee ____________________________ Date SIGN, DATE AND INCLUDE VALID REGISTRATION American LegalNet, Inc. www.FormsWorkflow.com