New Mexico Regulation and Licensing Department Toney Anaya Building PO Box 25101 Santa Fe, New Mexico 87504-5101 (505) 476-4875 Fax (505) 476-4595 www.rld.state.nm.us/alcoholandgaming ALCOHOL AND GAMING DIVISION DIRECT WINE SHIPPER PERMIT APPLICATION 1 Year Permit Fee: $50.00 Application # _________________ Expires June 30th each year and all Application Fees are Non-Refundable NMSA §60-6A-11.1. A. A Licensee with a Winegrower's License or a person licensed in a state other than New Mexico that holds a Winery License may apply to the director for and the director may issue to the applicant a direct wine shipment permit. B. A direct wine shipment permit shall be valid for a permit year. A permittee shall renew a direct wine shipment permit annually as required by the department to continue making direct shipments of wine to New Mexico residents. C. A Permittee may ship: (1) not more than two nine-liter cases of wine monthly to a New Mexico resident who is twenty-one years of age or older for the recipient's personal consumption or use, but not for resale; and (2) wine directly to a New Mexico resident only in containers that are conspicuously labeled with the words: "CONTAINS ALCOHOL - SIGNATURE OF PERSON 21 YEARS OR OLDER REQUIRED FOR DELIVERY". Qualified Applicants, please submit the following: · Copy of your State Liquor License, List License #_____________________________ · · Fee of $50.00 ­ New Mexico Wine Growers do not pay an application fee Attach proof of NM CRS # from NM Taxation & Revenue Department (apply on-line at www.tax.newmexico.gov, or call (505) 827-0700) Applicant Name: ______________________________________________________________________ DBA Name: __________________________________________________________________________ Physical Address: ______________________________________________________________________ Mailing Address: ______________________________________________________________________ Phone Number: ____________________ Fax: ____________________ Cell: ______________________ E-Mail: ______________________________________________________________________________ I, the undersigned, swear that I am authorized, under the active License attached, to obtain this permit and that the information on this application form is true and correct, to the best of my knowledge. Print Name: ___________________________________________ Title: __________________ Authorized Signature: ___________________________________ Date: __________________ ALCOHOL & GAMING DIVISION USE ONLY: Payment| Application Fee $_______________ Received on: _______________ Receipt No. __________________ Approved Disapproved, ________________________________________________________________ Processed By: __________________________________________________ Date: _________________________ Assigned Permit Number: _________________________ Approved Permit Sent on: _____________________ By: Email 1st class mail Fax Revised 5/3/2016 American LegalNet, Inc. www.FormsWorkFlow.com