STATE OF SOUTH CAROLINA DEPARTMENT OF REVENUE 1350 ABL-565 (Rev. 10/20/09) 4278 ABL RENEWAL FORM Renew and pay online. Go to www.scbos.sc.gov Mail to: SCDOR, ABL Section, Columbia, SC 29214-0907 **Renewal Fee Renewal Due Date: For Office Use Only File Number License Period Ending License Type 1. Mailing Name and Address Any change of address should be noted to the right of the old address. DLN DLN 2. A. Owner/Corporate Name Federal ID # (If Liquor Producer Rep., indicate the company you represent) B. Licensee Social Security # (If Sole Proprietor) C. Retail Sales Tax License # (REQUIRED) 3. Trade Name (If Applicable) 4. Business Address Ownership Type County 5. If there is a change in your location's address, check why: ( business ( ) Other - Explain: ) U.S. Postal Service changed address ( ) Moved location of 6. YOU MUST COMPLETE THE CONSENT AND WAIVER SECTION ON THE BACK OF THIS FORM, AND THE ATTACHED ABL-577, IF SOLE PROP.; IF OTHER THAN SOLE PROP., COMPLETE ATTACHED ABL-920 FOR ALL PRINCIPALS. 7. Have you, any partner, any principal, or any employee with day-to-day management responsibilities ever been convicted of a crime? Yes No If "yes", give details: 8. Review and sign this application. Return it with the appropriate renewal fee. If this application with the appropriate fee is not received by the S.C. Department of Revenue prior to the expiration date shown above, you must pay a filing fee along with the license fee. If your renewal is late, you may be required to file an application for a new license, publish a newspaper notice of your application, and wait on a SLED investigation. You must cease all sales of beer, wine, or liquor upon the expiration of your license, and may not resume sales until you receive your new license. Therefore, file your renewal application promptly. *Note: For faster processing renew online. (See information sheet attached for instructions for online renewing www.SCBOS.SC.GOV). By signing this application, I certify that all the information listed above is correct. (Signature of applicant) Date Telephone number from 8 am to 5 pm **61-6-120B: An applicant for license renewal or for a new license at an existing location shall pay a five dollar certification fee to determine if the exemptions provided for in subsection (A) apply. Subsection A refers to the distance requirements for retail liquor stores, business liquor by the drink and nonprofit private club liquor by the drink licenses. ____ 42781021 American LegalNet, Inc. www.FormsWorkFlow.com CONSENT AND WAIVER ABL-946 Rev. 11/19/09 File Number: Name of Corporation, Partnership, LLC, etc. FEI S.C. Code Ann. Section 61-2-160 prohibits the issuance of any permit or license under Title 61 unless the Department determines that the applicant does not owe the State any delinquent taxes, penalties or interest. The signature(s) below authorizes the S.C. Department of Revenue, pursuant to the provisions of S.C. Code Ann. Section 12-54-240 and 30-2-10, et seq., to release to any party, person or entity, law enforcement request(s) for purposes of processing this application or responding to questions related thereto, including but not limited to an information related to problems with the application, reasons for denial, delinquent taxes, outstanding liabilities, failure to file returns, penalties and interest. The signature below also authorizes S.C. Law Enforcement Division (SLED) to check, examine and release to the Department of Revenue the criminal history record of the person(s) having signed below. If an application is made for a license or permit by a person other than an individual, all principals are deemed to be the applicant. S.C. Code Ann. Section 61-2-100(C). All principals of the applicant are therefore required to be disclosed to the Department of Revenue. SOCIAL SECURITY DISCLOSURE “In compliance with the Federal Privacy Act of 1974, the disclosure of an individual’s social security number on this form is mandatory*. SC regulation 117-201 provides that any person required to make a return, statement or document to the Department must include identifying numbers on such return, statement or document if the Department requests such information. Social security numbers are primarily used for the purposes of identifying taxpayers and monitoring tax compliance and/or fraud.” 1 - 12 is a list of principal types. Each principal type must complete and sign a box below. If a required principal does not sign, this application will be denied. Principal Types: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. The owner (if sole proprietorship); All officers of the business or entity which owns the business; All partners (limited partners that cannot exercise management control need not sign); All persons who own twenty-five percent (25%) or more of the value of the business entity; All persons who own twenty-five percent (25%) or more of the combined voting power of the business or entity; Members and Managers of a limited liability company which is managed by managers; Members of a limited liability company which is not managed by managers; Any fiduciary who manages, controls title, or is otherwise in control of the business; All employees who will have day-to-day operational management responsibility for the business or entity; and, If a publicly traded corporation, the designated license holder (designated agent) (must be over 21 and a resident of S.C.). All other principals must be listed also. If not a publicly traded corporation, list all stockholders. If a nonprofit organization, list all officers and directors of the organization. Name Home Address City State Zip Yr/Mo/Date of SC Residency Sex Social Security No. Federal Employer Identification No. Principal/Type: (use above #1-12) % of ownership Race Date of Birth Signature Have you as an individual, or as an organization in which you were a principal, had revoked or suspended in this state or any other state any license to sell beer, wine, or alcoholic liquors? Yes No If yes, attach explanation. Have you been convicted of a crime in South Carolina or any other state? Yes No If yes, attach explanation. Additional Space on Back. 44221018 American LegalNet, Inc. www.FormsWorkFlow.com File Number: Name Home Address City State Yr/Mo/Date of SC Residency Sex Social Security No. Principal/Type: (use above #1-12) Zip Race Date of Birth Federal Employer Identification No. % of ownership Signature Have you as an individual, or as an organization in which you were a principal, had revoked or suspended in this state or any other state any license to sell beer, wine, or alcoholic liquors? Yes No If yes, attach explanation. Have you been convicted of a crime in South Carolina or any other state? Yes No If yes, attach explanation. Name Home Address City State Yr/Mo/Date of SC Residency Sex Social Security No. Principal/Type: (use above #1-12) Zip Race Date of Birth Federal Employer Identification No. % of ownership Signature Have you as an individual, or as an organization in which you were a principal, had revoked or suspended in this state or any other state any license to sell beer, wine, or alcoholic liquors? Yes No If yes, attach explanation. Have you been convicted of a crime in South Carolina or any other state? Yes No If yes, attach explanation. Name Home Address City State Yr/Mo/Date of SC Residency Sex Social Security No. Principal/Type: (use above #1-12) Zip Race Date of Birth Federal Employer Identification No. % of ownership Signature Have you as an individual, or as an organization in which you were a principal, had revoked or suspended in this state or any other state any license to sell beer, wine, or alcoholic liquors? Yes No If yes, attach explanation. Have you been convicted of a crime in South Carolina or any other state? Yes No If yes, attach explanation. Name Home Address City State Yr/Mo/Date of SC Residency Social Security No. Principal/Type: (use above #1-12) Zip Sex Race Date of Birth Federal Employer Identification No. % of ownership Signature Have you as an individual, or as an organization in which you were a principal, had revoked or suspended in this state or any other state any license to sell beer, wine, or alcoholic liquors? Yes No If yes, attach explanation. Have you been convicted of a crime in South Carolina or any other state? Yes No If yes, attach explanation. 44222016 American LegalNet, Inc. www.FormsWorkFlow.com STATE OF SOUTH CAROLINA DEPARTMENT OF REVENUE REGULATORY DIVISION Alcohol Beverage Licensing Section Dear License and/or Permit Holder: The Department of Revenue, Regulatory Division, Alcohol Beverage Licensing Section (hereinafter “ABL”) is enclosing a renewal for an ABL license and/or permit. On June 4, 2008, the Governor signed into law Bill Number H4400, collectively known as the S.C. Illegal Immigration Reform Act. Specifically, this new law has been codified for “state or local benefits”. It is necessary for all principals to have submitted one of the two following forms to the ABL section: Form ABL-577 - “Verification of Lawful Presence in the United States” Form ABL-920 - “Verification of Lawful Background for Applicant’s Principal” If all principals have submitted one of the appropriate forms it is not necessary to resubmit another copy UNLESS a principal's immigration status or citizenship has changed or expired. Please see reverse side for a copy of a document titled “Frequently Asked Questions: S.C. Illegal Immigration Act” which may answer some of your questions. Should you have any additional questions, please contact the Regulatory Immigration Officer at (803) 898-5865. Thank you in advance for your anticipated cooperation. Sincerely, Michelle Mishoe South Carolina Department of Revenue Regulatory Immigration Officer ____ 43991017 ABL-928 (Rev. 12/22/10) American LegalNet, Inc. www.FormsWorkFlow.com South Carolina Illegal Immigration Reform Act Frequently Asked Questions Q. To what licenses or permits does this apply? A. The SC Illegal Immigration Reform Act form is required for all Alcohol licenses or permits. Q. How does it affect my application? A. All new applicants that apply as a sole proprietor for an Alcohol Beverage License, of any type or duration, must complete the Verification of Lawful Presence in the United States. All principals of a corporation must complete the Verification of Lawful Background for Applicant's Principal. Q. What documentation will I need? A. A front and back copy of all immigration documents must be attached. Applications for citizenship or residency are NOT accepted. Q. What if I don't complete the form? A. Your Alcohol license or permit will be denied. Q. What forms do I need? A. If you are a corporate entity (corporation, LLC, LLP or a partnership), the entity is required to complete form ABL-920, Verification of Lawful Background For Applicant's Principal. All principals of any corporate entity must complete the ABL 920 form in its entirety. Be sure it is notarized. If you are a sole proprietorship, complete form ABL-577, Verification of Lawful Presence In the United States. Be sure to have this form completed in its entirety and that the form is notarized. Q. Where can I get these forms? A. Forms can be obtained from our website: WWW.SCTAX.ORG or at the Taxpayer Service Center(s) or Fax on Demand. The South Carolina Department of Revenue maintains a Fax-on-Demand automated form and document retrieval system by which you may call in using either a fax phone or a regular touch tone phone to order single copy of the form. Fax On Demand Telephone Number: (803)898-5320 (in Columbia, South Carolina) ABL-920 Verification of Lawful Background For Applicant's Principal - Order Number: 5519 ABL-577 Verification of Lawful Presence In the United States - Order Number: 5520 Q. Do I submit a new ABL-920 or ABL-577 each time I renew my license/permit? A. No, if all principals have previously submitted an ABL-920 or ABL-577 unless the immigration status or citizenship has changed or expired. Q. What is an A-number? A. An "A-number" is an Alien Registration Number. Go to our website WWW.SCTAX.ORG American LegalNet, Inc. www.FormsWorkFlow.com State of South Carolina Department of Revenue 301 Gervais Street, P.O. Box 125, Columbia, South Carolina, 29214 You are now able to renew your Alcohol Beverage license permits online by accessing SCBOS - the South Carolina Business One Stop Web site. If you renew online, you will not need to mail in form ABL-565. Instructions for using SCBOS: 1. Go to http://www.scbos.sc.gov 2. New Users to SCBOS Create an account and password.* After the welcome screen, select Renewals and enter the file number printed on the top right corner of the renewal form Existing Users on SCBOS Login using your name and password After the welcome screen, select Renewals and enter the file number printed on the top right corner of the renewal form 3. Confirm the information; submit to shopping cart; checkout and pay. Visa®, Master Card® and Electronic Funds Withdrawal may be used to pay. There are no additional fees to pay online. 4. Print Receipt. 5. Print temporary ten-day license letter by Selecting the Renewal Activity link underneath the Logout button on the left side of the page Selecting the View icon corresponding to the license that is renewed Selecting Print and the temporary license will be printed If you have any questions concerning renewals, please call (803) 898-5864. If you have any questions concerning online renewals, please call SCBOS HELP at (803) 898-5690. South Carolina Business One Stop With SCBOS, you can: Register your business Obtain licenses, permits and registrations File and pay business taxes Communicate with multiple state agencies Link to helpful business resources Renew your Alcohol Beverage License * If you already have an account on Department of Revenue's web site for E-pay, E-sales, E-withholding or DORBOS, you may use the same User Name and Password to log onto SCBOS as a registered user. If you renew online you will not need to mail in form ABL-565. 44211019 ABL-945L (Rev. 10/15/09) American LegalNet, Inc. www.FormsWorkFlow.com