Application For Producer Of Alcoholic Liquor Certificate Of Registration
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Application For Producer Of Alcoholic Liquor Certificate Of Registration Form. This is a South Carolina form and can be use in Department Of Revenue Statewide.
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Tags: Application For Producer Of Alcoholic Liquor Certificate Of Registration, ABL-107, South Carolina Statewide, Department Of Revenue
STATE OF SOUTH CAROLINA
DEPARTMENT OF REVENUE
APPLICATION FOR PRODUCER OF ALCOHOLIC
LIQUOR CERTIFICATE OF REGISTRATION
ABL-107
(Rev. 7/29/03)
4264
For Office Use Only
Mail to: SCDOR, ABL Section, Columbia, SC 29214-0908
Telephone: (803) 898-5864
DOR Website: www.sctax.org
File Number
License Period Ending
DLN
PLEASE PRINT OR TYPE ALL INFORMATION
DLN
Fee: $400 Biennially
14-3961-0009
SLED
34-3973-9000
1. Owner, Partnership, or Corporate Charter Name
2. Physical Location of Business Required (No P.O. Box)
STREET
CITY
COUNTY (REQUIRED)
STATE
ZIP
STATE
ZIP
3. Mailing Address (For all Correspondence)
STREET
CITY
COUNTY
4. Type of Ownership
Sole Proprietor (one owner)
SC Corporation Date Inc.
Non-Profit Organization
Partnership (two or more owners)
LLC/LLP
Foreign Corporation (Attach copy of Articles of Certificate of Authority)
Other (Explain)
5. Trade Name (Doing Business As)
6. Business Phone Number
Daytime Phone Number
7. Federal Identification Number and/or Social Security Number
8. Location of Records (No P.O. Box)
9. Is this Location within SC Municipal Limits?
10.
Yes
No
If Yes which city
Name(s) of business owner, general partners,prinicipals, or officers:
Social Security Number
Name/Title/General Partners
Home Address
Date of Birth
Back of Form must be completed.
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I,
(Name of individual applying)
Title
of the firm of
herby certify that the information contained in this application and the attached ABL-107A and ABL-107B is true and
correct to the best of my knowledge and belief. The Department of Revenue shall have the right within the Statutory
limitations to audit and examine the books and records, papers and memoranda of this form with respect to the
administration and enforcement of laws administered by the SC Department of Revenue and the South Carolina Law
Enforcement Division.
Signature of individual applying
Social Security Privacy Act Disclosure
It is mandatory that you provide your social security number on this form. 42 U.S.C 405(c)(2)(C)(i) permits a state to use
an individual's social security number as means of identification in administration. SC Regulation 117-1 mandates that
any person required to make a return to the SC Department of Revenue shall provide identifying numbers, as prescribed,
for securing proper identification. Your social security number is used for identification purposes.
42642017
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