New Mexico Regulation and Licensing Department ALCOHOL AND GAMING DIVISION T o n ey A na ya B uil d i n g ▪ 2 5 5 0 C er r il l o s R oa d ▪ S a nt a F e, N e w M ex i c o 8 7 5 0 5 (5 0 5 ) 4 7 6 -4 8 7 5 ▪ F a x ( 5 0 5) 4 7 6- 4 5 9 5 ▪ ww w.rl d. stat e. n m .u s / AG D NON-RESIDENT LIQUOR LICENSE APPLICATION APPLICATION FEE OF $200.00 MUST BE SUBMITTED AS WELL AS APPLICABLE FEES LISTED BELOW. All application fees are non-refundable. 3 YEAR LICENSE FEES (PRORATED) Pursuant to Section 60-6A-16 of the Liquor Control Act, non-resident licenses and carrier registrations shall be prorated so that: Licenses issued before the end of the first year of the three year (3) license period are subject to the full amount of the license fee. Licenses issued on or after the end of the first year and before the end of the second year are subject to two-thirds of the license fee. Licenses issued on or after the end of the second year are subject to one-third of the license fee. To calculate your fee, find the estimated total billing to New Mexico wholesalers in the first column, then select fee from the appropriate License Period column. For example, if estimated total billing annually is $100, 000 and the license period you are applying in is covered by the dates 07/01/11 to 06/30/13, the fee is $1200. Remember to add the $200 application fee to the prorated license fee. Total Billing $49,999 annually or less $50,000 annually $100,000 annually $200,000 annually $500,000 annually $1,000,000 annually $3,000,000 annually License Period 07/01/10- 06/30/13 $300 $900 $1800 $2700 $3750 $5250 $10,500 License Period 07/01/11 - 06/30/13 $200 $600 $1200 $1800 $2500 $3500 $7000 License Period 07/01/12 - 06/30/13 $100 $300 $600 $900 $1250 $1750 $3500 60-7A-4. Sale, shipment and delivery unlawful. It is unlawful for any person on his own behalf or as the agent of another person, except a licensed New Mexico wholesaler or manufacturer or the agent of either, to directly or indirectly sell or offer for sale for shipment into the state or ship into the state unless such person or his principals has secured a nonresident license. For the purpose of tax revenue control, no holder of a nonresident license may solicit, accept or fill an order for distilled spirits or wine from a holder of any type of wholesaler's license unless the nonresident licensee is the Primary American source of supply for the brand of distilled spirits or wine that is ordered. As used in this section, "Primary American Source of Supply" means the distiller, the producer, the owner of the commodity at the time it becomes a marketable product, the bottler or the exclusive agent of any of those. To be the "Primary American Source” of supply, the nonresident licensee must be the first source -the manufacturer or the source closest to the manufacturer, in the channel of commerce from whom the product can be secured by American wholesalers. Revision date: 01/2011 American LegalNet, Inc. www.FormsWorkFlow.com Alcohol and Gaming Division NON RESIDENT LIQUOR LICENSE APPLICATION REMEMBER TO INCLUDE: $200 Application fee plus three year prorated license fee Copy of Non resident manufacturer or wholesaler license Primary American Source of Supply letter (if applicable) Copy of the Federal Basic Permit Copies of label approvals Application # ________________ All should be issued in the name of the applicant. Owner Name: _________________________________________________________________________________ DBA: ________________________________________________________________________________________ Mailing Address: _______________________________________________________________________________ Physical Location: ______________________________________________________________________________ Phone number _____________________________ Fax number A nonresident manufacturer or wholesaler who qualifies may apply for and be issued a nonresident license. Include a copy of your non resident manufacturer or wholesaler license from the state in which you are licensed, copies of the Federal Basic Permit, letter of appointment stating Primary American Source of Supply (if applicable) and label approvals issued in the name of the applicant with this application. Estimated annual gross billings to New Mexico wholesalers $ Name and license number of New Mexico Wholesaler that will be distributing this product: List every liquor license in which the applicant holds any direct or indirect interest: I swear that the information on this application form is true and correct to the best of my knowledge _______________________________________________ Signature Title ______________________________________________ Print Name ____________________________________ Date ALCOHOL AND GAMING DIVISION USE ONLY: ______ Approved – Date _____ Disapproved – Date _________________________________________ _____________________________________________ License #_____________________ New Mexico Regulation and Licensing Department ALCOHOL AND GAMING DIVISION Page 2 of 2 Revision date: 01/2011 American LegalNet, Inc. www.FormsWorkFlow.com