1350 STATE OF SOUTH CAROLINA DEPARTMENT OF REVENUE ABL-566 (Rev. 10/20/08) 4279 COMPUTER REQUEST FORM Mail to: SC Department of Revenue, ABL Section, Columbia, SC 29214-0907 For Office Use Only DLN File Number PCVD Paid 14 3990 Choose only one selection (1, 2 or 3) Prices effective 8-1-1999. (1) ( ) $100.00 Flat fee for diskette with all license types, all counties. (Diskette = All diskettes will be 3.5inch 1.44HD in ASCII Format) Printed List (8 1/2 x 11 cut sheet paper) Maximum of three (3) License Types can be selected per request. PBW TBW PBG TBG PSB TSB = = = = = = On Premise Beer/Wine Temporary 120-Day On Premise Beer/Wine Off Premise Beer/Wine Temporary 120-Day Off Premise Beer/Wine Business (Restaurant & Hotel) Minibottle Temporary 120-Day Business (Restaurant & Hotel) Minibottle Business (Restaurant & Hotel) Liquor by the Drink Temporary 120-Day Business (Restaurant & Hotel) Liquor by the Drink Non-Profit (Private Club) Minibottle Temporary 120-Day Non-Profit (Private Club) Minibottle Non-Profit (Private Club) Liquor by the Drink Temporary 120-Day Non-Profit (Private Club) Liquor by the Drink Food Service Establishment Wholesale Beer/Wine Distributor Brewery/Winery Liquor Producer { } $ 40.00 P7B = 7 Day Week Off Premises Beer/Wine { } $ 35.00 T7B = Temporary 120-Day 7 Day Week Off Premises Beer/Wine { } $ 35.00 PBB = Brewpub Beer/Wine { } $ 35.00 TBB = Temporary 120-Day Brewpub Beer/Wine { } $ 60.00 PRL = Retail Liquor Store { } $ 35.00 TRL = Temporary 120-Day Retail Liquor Store { } $ 35.00 PWL = In-State Liquor Wholesaler { } $ 40.00 PBP = Beer/Wine Producer or Importer { } $ 35.00 PLR = Liquor Producer Representative { } $ 35.00 LOP = Local Option Permit { } $ 35.00 TBP = Special Event (1 Day) Beer/Wine { } $ 35.00 TLP = Special Event (1 Day) Liquor by the Drink { } $ 35.00 PWS = Out of State Wine Shipper { } $ 35.00 PRB = Sunday/Sabbath Beer/Wine { } $ 35.00 TRB = Temporary 120-Day Sunday/Sabbath Beer/ Wine { } $ 35.00 PML = In-State Liquor Manufacturer { } $ 35.00 PFM = In-State Food Manufacturer { } $ 35.00 PBL = In-State Special Bakery License (2) ( ) { { { { { { } } } } } } $180.00 $ 35.00 $115.00 $ 35.00 $ 80.00 $ 35.00 { } $ 80.00 PLB = { } $ 35.00 TLB = { } $ 50.00 PSC = { } $ 35.00 TSC = { } $ 50.00 PLC = { } $ 35.00 TLC = { { { { } } } } $ $ $ $ 40.00 35.00 35.00 35.00 PAL PWB PWY PLP = = = = Can get all counties Or Circle each selected county on the next page (Maximum of 5) Total to remit (Use amounts from above) = + + + $25.00* = * postage and handling (3) ( ( ) ) Diskette $100.00 all counties or Diskette $35.00 for each county (circle a maximum of 5 counties per request on the next page) Number of counties selected x $35.00 = Total $ License types: (maximum of 3 or leave blank for all licenses) If selected date desired accounts should be open after . (MMDDCCYY) 42791012 American LegalNet, Inc. www.FormsWorkFlow.com 01 02 03 04 05 06 07 08 09 10 11 12 - Abbeville Aiken Allendale Anderson Bamberg Barnwell Beaufort Berkeley Calhoun Charleston Cherokee Chester 13 14 15 16 17 18 19 20 21 22 23 24 - Chesterfield Clarendon Colleton Darlington Dillon Dorchester Edgefield Fairfield Florence Georgetown Greenville Greenwood 25 26 27 28 29 30 31 32 33 34 35 36 - Hampton Horry Jasper Kershaw Lancaster Laurens Lee Lexington McCormick Marion Marlboro Newberry 37 38 39 40 41 42 43 44 45 46 99 - Oconee Orangeburg Pickens Richland Saluda Spartanburg Sumter Union Williamsburg York Out of State NOTE: Cannot process without Proper Fees being enclosed. Total amount enclosed Requestor Name Mailing Address Comment City $ Telephone No. St. Zip 42792010 American LegalNet, Inc. www.FormsWorkFlow.com