1350 STATE OF SOUTH CAROLINA DEPARTMENT OF REVENUE ABL 902C (Rev. 12/21/09) 4385 ABL 902 Checklist: For your application to be processed you must fulfill ALL of the following requirements: ABL 902 Checklist: 1. Completed application, signed, dated and notarized. 2. Submit nonrefundable filing fees. 3. Submit an Affidavit of Publication from the newspaper running your ad. The affidavit must include a copy of your ad. If you have just started your ad in the newspaper and have not received the ad and affidavit, you MUST include the receipt from the newspaper with your application. Forward the ad and affidavit from the newspaper as soon as the newspaper provides it to you. Your license/permit cannot be issued until this is received. (NOTE: Not required for beer/wine wholesalers) 4. Complete the Consent and Waiver form of the application. 5. Attach a copy of the Articles of Incorporation, if applying as a corporation. 6. Attach a copy of Articles of Organization, and Operating Agreement (if applicable), when applying as a Limited Liability Corp. (LLC). 7. Attach partnership agreement, if applying as a partnership or Limited Liability Partnership (LLP). 8. All principals must attach a criminal records check (CRC), not more than 90 days old. If the principal has lived in SC for more than 2 years, obtain the CRC from SLED at www.sled.state.sc.us or SLED Headquarters, Criminal Records Department, 4400 Broad River Rd., P.O. Box 21398, Columbia, SC 29221. If the principal has lived in SC less than 2 years, obtain a CRC from previous state of residency AND a CRC from SLED. If principal is not a SC resident, obtain a CRC from current state of residency. 9. If you own the property upon which the business will be located, you must submit a copy of the deed or tax bill; if not, submit a copy of your lease or use agreement. 10. Attach Certificate of Authority to do Business in SC from the SC Secretary of State's office, if applying as a foreign corporation. 11. EFFECTIVE JULY 1, 2008: Attach completed appropriate residency status verification affidavit. Use Verification of Lawful Presence in the United States (ABL-577) for owners of sole proprietorships. Use Verification of Lawful Background for Applicant's Principal (ABL-920) for each principal, if applicant is other than a sole proprietor. Each principal, officer, owner, member, and/or partner MUST sign the appropriate form. If applicable, include his/her non-citizen alien registration number and attach a copy of all appropriate immigration documents. American LegalNet, Inc. www.FormsWorkFlow.com 1350 STATE OF SOUTH CAROLINA DEPARTMENT OF REVENUE APPLICATION FOR IN-STATE BREWERY, WINERY, LIQUOR MANUFACTURER, BEER/WINE AND/OR LIQUOR WHOLESALER File Number: ABL-902 (Rev. 9/29/10) 4309 Mail to: SC Department of Revenue, ABL Section, Columbia, SC 29214-0907 Telephone: (803) 898-5864 DOR Website: www.sctax.org License Type Instate brewery or winery Seven Day winery Domestic winery Wholesale beer and/or wine Liquor manufacturer Wholesale liquor Liquor micro-distillery Nonrefundable Filing Fee $ 300.00 $ 300.00 $ 300.00 $ 300.00 $ 200.00 $ 200.00 $ 200.00 License Fee $ 400.00 biennially $ 1,500.00 biennially $ 400.00 biennially $ 2,200.00 biennially $ 50,200.00 biennially $ 20,200.00 biennially $ 5,200.00 biennially PLEASE PRINT OR TYPE ALL INFORMATION 1. OWNER, PARTNERSHIP, OR CORPORATE CHARTER NAME 6. TRADE NAME (DOING BUSINESS AS) 2. PHYSICAL LOCATION OF BUSINESS REQUIRED (NO P.O. BOX) 7. BUSINESS PHONE NUMBER STREET 8. FEDERAL IDENTIFICATION NUMBER AND/OR SOCIAL SECURITY NO. DAYTIME PHONE NUMBER CITY COUNTY (REQUIRED) STATE ZIP 3. MAILING ADDRESS (FOR ALL CORRESPONDENCE) "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." IN CARE OF STREET 9. NATURE OF BUSINESS CITY 4. TYPE OF OWNERSHIP COUNTY STATE ZIP 10. LOCATION OF RECORDS (NO P.O. BOX) SOLE PROPRIETOR (one owner) LLC/LLP FOREIGN CORPORATION STATE INC. NON-PROFIT ORGANIZATION OTHER (EXPLAIN) PARTNERSHIP (two or more owners) 11. RETAIL SALES TAX LICENSE # (if required) SC CORPORATION DATE INC. DATE OF INC. If the corporation is publicly traded, you must designate an officer or other person to hold the license. This person must be of good moral character, over the age 21, and a SC resident. This person should be included on the Consent and Waiver along with other principals of the corporation. Name of designated officer or other employee: 5. DO YOU HAVE ANY OWNERSHIP INTEREST ON ANY OTHER DISTRIBUTION TIER? IF SO, PLEASE SPECIFY: COMPLETE REVERSE SIDE OF THIS FORM 43091024 American LegalNet, Inc. www.FormsWorkFlow.com DESIGNATED AGENT A. You must designate a person to receive all notices from the Department of Revenue concerning your permit/license. These notices will be sent to the person at the mailing address shown in question 3. It is your responsibility to keep the department advised of any change regarding this person or your mailing address as the law will presume you received all notices sent to the address you have given us. Name of Designated Agent: CONTACT PERSON B. The S.C. State Law Enforcement Division will conduct an investigation on this application, and will need to meet with the contact person at the location for which you are seeking a permit or license, to discuss the business and ownership of the business. Give the name and telephone numbers (daytime and evening) of the contact person who can meet with the SLED agent for this purpose. Name of Contact Person Telephone Number Telephone Number (daytime) (evening) If the agent is unable to contact the Contact Person or if the Contact Person cannot discuss the ownership of the business, your application will be delayed. Processing of this application may take six to eight weeks, or more. If the application is denied by the Department or protested by a member of the public or law enforcement, it could take up to six months or more for a hearing to be held and a decision made on the application by the Administrative Law Court. If applying for an off-premises beer and wine permit, wholesale