Application For Label Registration Form. This is a Ohio form and can be use in Department Of Commerce Statewide.
Tags: Application For Label Registration, DLC 1511, Ohio Statewide, Department Of Commerce
Ohio Department of Commerce Division of Liquor Control, Beer and Wine Section 6606 Tussing Road, P.O. Box 4005 Reynoldsburg, Ohio 43068-9005 (614) 644-2411 Fax (614) 644-2480 http://www.com.ohio.gov/liqr Division Use Only Reg. Date: New Label _____ of _____ Check No. Application for Product/Label Registration Amount $ See Page 2 “Specific Instructions / Document Checklist” for additional documents that MUST accompany your application Please Print Legibly or Type: Dba: Company Name: Company Address: City: State: Zip Code: Check here if this is a new mailing address Telephone Number: Ohio Out of State Supplier Permit #: Contact Person: Email/Phone: Type of Application: New Product/Label - $50.00 Filing Fee - Allow 30-45 business days for processing Label Revision - No Fee or Previous Approval Date: New Size Container - Previous Approval Date (required) - No Fee Answer questions 1-6 below: 5. List the Alcoholic Content for Beer, Wine or Mixed Beverages: (REQUIRED) 1. Brand Name (REQUIRED): % alcohol by volume: 2. Varietal (wine only): 6. Are you registering a brand recently acquired from another company? 3. Fanciful Name (if any): YES 4. Appellation (wine only): NO If YES, provide the name of former company: PLEASE AFFIX ONE COMPLETE SET OF LABELS BELOW – (if necessary use separate sheet) I hereby declare the above information is true and correct. Title: Print Name: Signature: ____________________________________________________ DLC 1511 Rev. (3/10) Date: ___________________________________________________ An Equal Opportunity Employer and Service Provider TTY Users Dial ORS 1-800-750-0750 American LegalNet, Inc. www.FormsWorkFlow.com SPECIFIC INSTRUCTIONS / DOCUMENT CHECKLIST FOR PRODUCT / LABEL REGISTRATION Your application may be returned if you do not comply with or submit the following: Name, address, telephone # and contact person Enter the company name and current mailing address. A telephone number must appear on the application in case any clarification is needed. Filing of Application The application MUST be executed and filed by the person, firm, or corporation that will bottle or import the beer, malt beverage, wine, or mixed beverage. Type of Application Check the appropriate box: “New” or “Revision.” Alcohol Content Provide the alcohol content for all product types (Item #5). Alcohol content for all product types MUST be shown as % of alcohol by volume. Federal Certificate Federal Certificate of Label Approval (COLA) from the U.S. Department of Treasury, Alcohol and Tobacco Tax and Trade Bureau (TTB) MUST be submitted for all applicable products. Territory Designation (DLC 1539) This form is required to designate a wholesale distributor and specify the exclusive sales territory for all products registered by a manufacturer or supplier. If the applicant is also the holder of an S permit issued by the State of Ohio, and will not sell its products through an Ohio wholesale distributor, it is not necessary to submit this territory designation form. Supplier Appointment Letter If the applicant is importing a product for a foreign or domestic (US) manufacturer, submit a letter from the manufacturer appointing the applicant as their importer or designated agent. Label Information - MUST accommodate Supplier Application DLC1551 Glue one complete set of labels for which approval is requested to the front of this application. If the labels are on can flats or on some other material for which gluing is impractical, affix one photo to the application. Fee Structure Provide a $50.00 registration fee in the form of a company check, cashier’s check or money order, made payable to the Division of Liquor Control for each product/label registered with the Division of Liquor Control . Please complete this application in its entirety and attach all supporting documentation in order to avoid having your application returned. If you have any questions please contact 614-644-2411. Submit your completed application, accompanying documents, and fee(s) to the: Ohio Division of Liquor Control Attn: Beer and Wine Section 6606 Tussing Road P.O. Box 4005 Reynoldsburg, OH 43068-9005 American LegalNet, Inc. www.FormsWorkFlow.com