Agency Operations 6606 Tussing Road Reynoldsburg, OH 43068 - 9009 LIQ - 19 - 0005 March 19, 2019 An Equal Opportunity Employer and Service Provider LESC 877 - 813 - 0013 Fax 614 - 728 - 1281 TTY/TDD 800 - 750 - 0750 com.ohio.gov Application for Tasting of Alcoholic Beverages by a Manufacturer, Broker, or Supplier Please complete this form and email it to Sandy.Wilson3@com.state.oh.us . All beverages must be qualified for sale in Ohio. Five working days (excluding Saturday and Sunday) notice to the Division is required prior to the tasting. No admission charge, donation, or fee to attend a tasting is permissible. Servings of beer cannot be more than four ounces. Servings of wine or mixed beverages cannot be more th an two ounces. Servings of spirituous liquor cannot be more than one ounce. The location of the tasting MUST be closed to the general public. The individual responsible for conducting the tasting must have the proper permits or registration in conjunction with the beverages being tasted and will be responsible for compliance with all applicable laws and rules. For Division Use Only: Tasting is : Approved Rejected Signature: Date: Manufacturer or Distribut or Conducting the Tasting Company Name : Phone Number: Company Address : C ity : S tate : ZIP: Name of Manufacturer, Distributor or Broker Representative Responsible for Compliance: Solicitor's Number : Signature of Applicant : Fax Number: Email Address: Group or Organization for Whom Tasting is being Conducted Name: A ddress : City : S tate : ZIP: Name of Individual Representing Group or Organization: Place where Tasting will be Conducted Facility Name: Room #, If applicable: A ddress: C ity: State: ZI P : Date, Time, and Specifics of Tasting Date of Tasting: Hours of Tasting: Number Invited to Attend: Type of Tasting : B eer W ine M ixed Beverage Spirituous Liquor Indicate below or attach a list of the type(s) and brand(s) to be sampled : American LegalNet, Inc. www.FormsWorkFlow.com