Application For H Permit Form. This is a Ohio form and can be use in Department Of Commerce Statewide.
Tags: Application For H Permit, DLC 4147, Ohio Statewide, Department Of Commerce
OHIO DEPARTMENT OF COMMERCE DIVISION OF LIQUOR CONTROL 6606 Tussing Road, Reynoldsburg, Ohio 43068-9005 For Questions call (614) 644-3155 Office hours 8:00 a.m. to 5:00 p.m. http://www.com.ohio.gov/liqr PERMIT FEE - $300.00 - APPLICATION PROCESSING FEE $100.00 APPLICATION FOR "H" PERMIT § 4303.22 H permit. Permit H may be issued for a fee of three hundred dollars to a carrier by motor vehicle who also holds a license issued by the public utilities commission to transport beer, intoxicating liquor, and alcohol, or any of them, in this state for delivery or use in this state. This section does not prevent the division of liquor control from contracting with common or contract carriers for the delivery or transportation of liquor for the division, and any contract or common carrier so contracting with the division is eligible for an H permit. Manufacturers or wholesale distributors of beer or intoxicating liquor other than spirituous liquor who transport or deliver their own products to or from their premises licensed under this chapter and Chapter 4301. of the Revised Code by their own trucks as an incident to the purchase or sale of such beverages need not obtain an H permit. Carriers by rail shall receive an H permit upon application for it. This section does not prevent the division from issuing, upon the payment of the permit fee, an H permit to any person, partnership, firm, or corporation licensed by any other state to engage in the business of manufacturing and brewing or producing beer, wine, and mixed beverages or any person, partnership, firm, or corporation licensed by the United States or any other state to engage in the business of importing beer, wine, and mixed beverages manufactured outside the United States. The manufacturer, brewer, or importer of products manufactured outside the United States, upon the issuance of an H permit, may transport, ship, and deliver only its own products to holders of B-1 or B-5 permits in Ohio in motor trucks and equipment owned and operated by such class H permit holder. No H permit shall be issued by the division to such applicant until the applicant files with the division a liability insurance certificate or policy satisfactory to the division, in a sum of not less than one thousand nor more than five thousand dollars for property damage and for not less than five thousand nor more than fifty thousand dollars for loss sustained by reason of injury or death and with such other terms as the division considers necessary to adequately protect the interest of the public, having due regard for the number of persons and amount of property affected. The certificate or policy shall insure the manufacturer, brewer, or importer of products manufactured outside the United States against loss sustained by reason of the death of or injury to persons, and for loss of or damage to property , from the negligence of such class H permit holder in the operation of its motor vehicles or equipment in this state. TYPE OR PRINT LEGIBLY ALL QUESTIONS MUST BE ANSWERED SECTION A Motor vehicle carrier or railroad carrier name: DBA (doing business as): City: Business Address: State: Name of Contact Person: Title: Mailing Address (If different from above): Business Phone #: Check type of Business: RAILROAD MOTOR TRUCK LINE FOR DIVISION USE ONLY Coder: County: Zip Code: CLASS REMARKS: REVIEWER ACTION: RCPT# Taxing District: Permit Number Business Type DLC 4147 EOE/ADA SERVICE PROVIDER FOR TTY USERS DIAL ORS 1-800-750-0750 REV. 9/2010 American LegalNet, Inc. www.FormsWorkFlow.com SECTION B 1) If you are a motor carrier you will need to submit a copy of your license issued by the Ohio Public Utilities Commission. 2) Are you licensed by another state to: a) Import from outside the United States beer, wine or mixed beverages? b) Manufacture, brew, or produce, beer, wine or mixed beverages? YES NO YES NO If you answered YES, you must submit a copy of a liability insurance certificate or policy indicating property damage coverage of no less than $1,000.00 and no less than $5,000.00 for loss sustained by injury or death. SECTION C - (COMPLETE THIS SECTION ONLY IF YOU ARE LOCATED OUTSIDE THE STATE OF OHIO) YES NO 1. Do you operate a terminal or place of business in Ohio? If YES, please indicate below the location of such terminal(s) or place of business: 2. If you answered NO on the previous question, please indicate the principle city you will be making deliveries or pick-ups: NOTE: Your permit certificate is issued for a permit period that expires October 1st each year and is renewed annually on that date. If your permit is issued after April 1st, you will receive a 50% refund of the class fees paid, not including the $100.00 application fee. DELIBERATE MISREPRESENTATION OF ANY OF THE INFORMATION ON THE APPLICATION CAN RESULT IN THE DIVISION'S REFUSING TO APPROVE THIS APPLICATION. THE FOLLOWING MUST BE SIGNED BY THE APPLICANT AND NOTARIZED: State of Ohio, County, ss I, being first duly sworn, according to law, depose and say that the statements (Please Print) and answers made in the foregoing application are true. ___________________________________________________________________________ _____________________ (Title) ( Signature) (Residence Address) (City) (State) (Zip Code) _______________ (Date) (Area Code & Telephone Number) (To be completed by Notary Public) Sworn to before me and subscribed in my presence this ______________day of _____________________________________, 20 _____________. ________________________________________ (Notary Public) _______________ (Notary Expiration) NOTE: ALL DOCUMENTS WILL BECOME PART OF THE PERMIT FILE AND NOT RETURNED PAGE 2 American LegalNet, Inc. www.FormsWorkFlow.com