OREGON LIQUOR CONTROL COMMISSION WINE SELF-DISTRIBUTION PERMIT APPLICATION AND AGREEMENT Permit Fee: $100.00 Permit Term: 1 year (expires 12/31 each year) Eligibility requirements: 1. 2. You must have a license in your state that allows the manufacture of wine or cider. You must hold an Oregon Certificate of Approval Your permit will not be issued until we receive the following: o Copy of your home state license (enclose with application) o $100 fee (enclose check made payable to OLCC. If application is submitted between Oct 1st and Dec 31st please send a total of $200 to cover renewal fee) o Copy of OLCC Certificate of Approval (enclose with application) o $1000 minimum bond or waiver (bond or waiver form will be faxed to you when we receive your application and permit fee. Please read attached memo for further details). Applicant Name: _____________________________________________ Trade Name: _____________________________________________ Business Address: _____________________________________________ City/State/Zip Code: _____________________________________________ Mailing Address: _____________________________________________ City/State/Zip Code: _____________________________________________ BOND WAIVER: Check this box if you produce less than 100,000 gallons per year. The applicant or authorized corporate officer or member of a partnership or limited liability company must sign this application. Signature: _________________________ Date: ________________ (I acknowledge by my signature that I have read the Information Memo and agree to abide by the guidelines of this permit) Phone: _____________________________ Fax: _________________ RETURN to: Oregon Liquor Control Commission PO Box 22297, Milwaukie, OR 97269-2297 Phone: (503) 872-5123 Fax: (503) 872-5018 www.oregon.gov/OLCC 01/10 American LegalNet, Inc. www.FormsWorkFlow.com WINE SELF DISTRIBUTION PERMIT INFORMATION MEMO OREGON LIQUOR CONTROL COMMISSION WHOLESALE & MANUFACTURER INFORMATION PROGRAM PRIVILEGES: QUALIFICATIONS: A Wine Self Distribution Permit holder may sell at wholesale and transport wine or cider that the manufacturer (permit holder) produces directly to the Oregon Liquor Control Commission or to Oregon retailers whose license is endorsed by the Commission to receive such shipments. A person who holds a license issued by another state, within the United States, that authorizes the manufacture of wine or cider and who also holds an Oregon Certificate of Approval is eligible for the Wine Self Distribution Permit. Applicants need to obtain a minimum bond of $1000 or a bond waiver. The commission shall waive the bond required under ORS 471.155 (1) if: (a) (b) The licensee or permit holder was not liable for a privilege tax under this chapter in the immediately preceding calendar year and does not expect to be liable for a privilege tax under this chapter in the current calendar year; or The licensee or permit holder of a business established during the current calendar year does not expect to be liable for a privilege tax under this chapter in the current calendar year. 473.050 (5) No privilege tax shall be levied, collected or imposed upon the first 40,000 gallons, or 151,000 liters, of wine sold annually in Oregon from a U.S. manufacturer of wines producing less than 100,000 gallons, or 379,000 liters, annually. If you have additional questions about the bond or waiver contact Debbie Amsberry by emailing Debbie.amsberry@state.or.us . SHIPPING REQUIREMENTS: RECORD KEEPING, TAXES AND REPORTING REQUIREMENTS: QUESTIONS: Wine or cider may be shipped or transported only by the employees of the Wine Self Distribution Permit holder or by a “for hire” carrier that has a Commission approved delivery plan. Shipments may only be made to retail licensees that are endorsed by the Commission to receive such shipments. If the permit holder uses a “for hire” carrier, the permit holder must take reasonable steps to ensure that the carrier delivers only to such endorsed businesses. Wine Self Distributor Statements must be filed by the 20th of the month for the previous month’s activity with the Privilege Tax Department. The Privilege Tax department will mail all forms within 30 days of issuance of the Permit. Any questions regarding reporting requirements need to be directed to Miranda Malone at 503-872-5166. Call Lanette Clayton, License Process at (503) 872.5123 or email at lanette.clayton@state.or.us 01/10 American LegalNet, Inc. www.FormsWorkFlow.com Bond Waiver Certification The 2007 Legislature authorized OLCC to waive the required surety bond for Winery Licensees that meet specific criteria. The 2009 Legislature added Growers Sales Privilege and Warehouse licensees and Direct Shippers and Wine Self Distribution permit holders that meet specific criteria to the bond waiver certification. If you qualify for a waiver, complete the certification at the bottom of this form and submit it in lieu of a surety bond with your renewal. This waiver will need to be received prior to your license being renewed. 473.065 (4) Unless the commission determines that a grower sales privilege or warehouse licensee or direct shipper or wine self-distribution permit holder presents an unusual risk for nonpayment of any license fees, privilege taxes, agricultural products taxes or other tax, penalty or interest imposed under this chapter or ORS chapter 471, the commission shall waive the bond required under ORS 471.155 (1) for the winery licensee or permit holder if: (a) The licensee or permit holder was not liable for a privilege tax under this chapter in the immediately preceding calendar year and does not expect to be liable for a privilege tax under this chapter in the current calendar year; or (b) The licensee or permit holder of a business established during the current calendar year does not expect to be liable for a privilege tax under this chapter in the current calendar year. 473.050 (5) No privilege tax shall be levied, collected or imposed upon the first 40,000 gallons, or 151,000 liters, of wine sold annually in Oregon from a United States manufacturer of wines producing less than 100,000 gallons, or 379,000 liters, annually. Unusual Risks: 1. Non reporting: licensee has not filed their privilege tax statements or their Oregon Wine Board statement by the required due date. 2. Licensee checks returned to OLCC for non sufficient funds. 3. Any activity that is non compliant with Commission statutes or rules. I certify, as an Oregon licensee, that I owed no privilege tax in the prior calendar year and will not owe any tax in the current calendar year. I request a waiver for the bond required under ORS 471.155. I certify that I am the duly appointed and authorized (Official position) __________________ of the (Licensee) and that the foregoing statement is true and complete for the license period, _____________________________________________________ LICENSEE NAME: _________________________________________________________________ TRADE NAME: ____________________________________________________________________ LICENSE TYPE: ____________________________________________________________________ PREMISES ADDRESS: _________________________________________________________ _____ PHONE #:__________________________ SIGNATURE:___________________________________ EMAIL ADDRESS: __________________________________________________________________ 1/10 American LegalNet, Inc. www.FormsWorkFlow.com