Ohio Department of Commerce Division of Liquor Control Beer & Wine Section 6606 Tussing Rd., P.O. Box 4005 Reynoldsburg, OH 43068-9005 614-644-2411 APPLICATION FOR TASTING BY A MANUFACTURER OR DISTRIBUTOR * BEER/WINE/LOW PROOF MIXED BEVERAGES * INSTRUCTIONS INSTRUCTIONS • • • • • • • Please complete this form and return it to the above address All beverages must be qualified for sale in Ohio Five (5) 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 (4) ounces. Servings of wine or mixed beverages cannot be more than (2) ounces 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. MANUFACTURER OR DISTRIBUTOR CONDUCTING THE TASTING (APPLICANT) (APPLICANT) COMPANY NAME ADDRESS CITY STATE NAME OF MANUFACTURER, DISTRIBUTOR OR BROKER REPRESENTATIVE RESPONSIBLE FOR COMPLIANCE ZIP CODE SOLICITOR’S NUMBER AREA CODE AND PHONE NUMBER SIGNATURE GROUP OR ORGANIZATION FOR WHOM TASTING IS BEING CONDUCTED NAME OF GROUP OR ORGANIZATION AREA CODE AND PHONE NUMBER ADDRESS CITY STATE NAME OF INDIVIDUAL REPRESENTING GROUP OR ORGANIZATION ZIP CODE SIGNATURE OF INDIVIDUAL REPRESENTING GROUP OR ORGANIZATION PLACE WHERE TASTING WILL BE CONDUCTED FACILITY NAME AND ADDRESS ROOM NUMBER IF APPLICABLE CITY STATE ZIP CODE DATE, TIME, AND SPECIFICS OF TASTING DATE OF TASTING: HOURS OF TASTING: TYPE OF TASTING: BEER NUMBER INVITED TO ATTEND: WINE MIXED BEVERAGE ******** IF MORE THAN ONE CATEGORY OF BEVERAGE IS TO BE TASTED, INDICATE EACH ******** BEVERAGE FOR DIVISION USE ONLY: TASTING IS: APPROVED REJECTED DIVISION OF LIQUOR CONTROL OFFICIAL DATE COMMENTS: DLC 1536 (Rev 6 -03) An Equal Opportunity Employer and Service Provider TTY Users Dial ORS 1 -800-750-0750 American LegalNet, Inc. www.FormsWorkflow.com