APPLICATION FOR TASTING BY A MANUFACTURER OR LIQUOR BROKER/SUPPLIER SPIRITUOUS LIQUOR EXCEEDING 42 PROOF Ohio Department of Commerce Division of Liquor Control Office of the Superintendent 6606 Tussing Rd., P.O. Box 4005 Reynoldsburg, OH 43068-9005 614-644-2472 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 spirituous liquor cannot be more than one (1) 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. MANUFACTURER OR LIQUOR BROKER/SUPPLIER CONDUCTING THE TASTING (APPLICANT) BUSINESS PHONE NUMBER: NAME OF COMPANY: CITY: ADDRESS OF COMPANY: STATE: ZIP CODE: NAME OF MANUFACTURER, DISTRIBUTOR OR BROKER REPRESENTATIVE RESPONSIBLE FOR COMPLIANCE: _______________________________________________________ SOLICITOR'S NUMBER: SIGNATURE OF APPLICANT GROUP OR ORGANIZATION FOR WHOM TASTING IS BEING CONDUCTED NAME OF GROUP OR ORGANIZATION: CITY: ADDRESS OF COMPANY: STATE: ZIP CODE: NAME OF INDIVIDUAL REPRESENTING GROUP OR ORGANIZATION: ________________________________________________________________________ BUSINESS PHONE NUMBER: SIGNATURE OF INDIVIDUAL REPRESENTING GROUP OR ORGANIZATION PLACE WHERE TASTING WILL BE CONDUCTED ROOM #, IF APPLICABLE: FACILITY NAME: STATE: CITY: FACILITY ADDRESS: OHIO ZIP CODE: DATE, TIME, AND SPECIFICS OF TASTING DATE OF TASTING: HOURS OF TASTING: NUMBER INVITED TO ATTEND: SPIRITUOUS LIQUOR PRODUCTS, BY INDIVIDUAL BRAND NAMES, TO BE TASTED: FOR DIVISION USE ONLY: TASTING IS: APPROVED REJECTED DIVISION OF LIQUOR CONTROL OFFICIAL DATE COMMENTS: DLC 1541 (Rev 05-10) An Equal Opportunity Employer and Service Provider TTY Users Dial ORS 1-800-750-0750 American LegalNet, Inc. www.FormsWorkFlow.com