APPLICATION FOR AIRLINE BEVERAGE PERMIT, CARRIER’S PERMIT, INDUSTRIAL PERMIT, LOCAL INDUSTRIAL ALCOHOL MANUFACTURER’S PERMIT, MARKET RESEARCH PACKAGER’S PERMIT, PASSENGER TRAIN BEVERAGE PERMIT TABC USE ONLY TYPE OR PRINT IN INK FORM L-102 (2/2009) ISSUE DATE FEE SURCHARGE LATE FEE (RENEWAL ONLY) 1A. APPLICATION FILED FOR: Registry No. AB AIRLINE BEVERAGE PERMIT (ONLY FOR CORPORATIONS) C CARRIER’S PERMIT I INDUSTRIAL PERMIT LI LOCAL INDUSTRIAL ALCOHOLIC MANUFACTURER’S PERMIT MR MARKET RESEARCH PACKAGER’S PERMIT PT PASSENGER TRAIN BEVERAGE PERMIT (ONLY FOR CORPORATIONS) AB, C, I, LI, MR, PT B. APPLICATION FILED FOR: Original Renewal Change Change: C. If renewal or change, enter license/permit no(s).: 2. APPLICATION IS FILED BY: Individual Partnership Corporation Limited Partnership Limited Liability Company Limited Liability Partnership Other: 3. Trade Name of Business 4. Address or Location City County State Zip Code (9 digits) - 5. Mailing Address City/Foreign Country State Zip Code (9 digits) - 6. Area Code + Business Telephone Number ) ( Area Code + Alternate Telephone Number ( ) - E-mail Address (optional) TABC USE ONLY FOR INDIVIDUAL FOR INDIVIDUAL Issuing State and Driver’s License Number 7. Social Security Number - - Date of Birth (mm/dd/yyyy) / / Full Legal Name (Last, First, Middle) Residential Address City State Zip Code (9 digits) - PROCESSOR REVIEW DATE / / WRITTEN PROCESS DATE END PROCESS DATE / / / / PROCESSOR I.D. Page 1 of 4 American LegalNet, Inc. www.FormsWorkflow.com P A R T N E R S H I P S /C O R P O R A T I O N S TRADE NAME: FORM L-102-PC (12/2007) 1A. Indicate type of ownership and complete the information below: Corporation Limited Liability Company Partnership Limited Partnership Limited Liability Partnership B. Federal Employer’s I.D. No.: C. Entity Name: D. Charter No.: 2. / / State: COMPLETE THE FOLLOWING PER INSTRUCTIONS: Social Security Number - FOR ALL OFFICER(S), PARTNER(S), DIRECTOR(S) AND MANAGER(S) Date Approved: Issuing State/ Driver’s License Number Full Legal Name of Partner (Last, First, Middle) Officer Partner Residential Address Social Security Number - City Issuing State/ Driver’s License Number Full Legal Name of Partner (Last, First, Middle) Officer Partner Residential Address Social Security Number - Issuing State/ Driver’s License Number Officer Partner Residential Address Issuing State/ Driver’s License Number Officer Partner Residential Address Issuing State/ Driver’s License Number Officer Partner Residential Address Director/Manager City Issuing State/ Driver’s License Number Full Legal Name of Partner (Last, First, Middle) Residential Address Director/Manager City Full Legal Name of Partner (Last, First, Middle) Social Security Number - Director/Manager City Full Legal Name of Partner (Last, First, Middle) Social Security Number - Director/Manager City Full Legal Name of Partner (Last, First, Middle) Social Security Number - Director/Manager Officer Partner Director/Manager City Date of Birth (mm/dd/yyyy) / / Title State ZIP Code (9 Digits) - Date of Birth (mm/dd/yyyy) / / Title State ZIP Code (9 Digits) - Date of Birth (mm/dd/yyyy) / / Title State ZIP Code (9 Digits) - Date of Birth (mm/dd/yyyy) / / Title State ZIP Code (9 Digits) - Date of Birth (mm/dd/yyyy) / / Title State ZIP Code (9 Digits) - Date of Birth (mm/dd/yyyy) / / Title State ZIP Code (9 Digits) - (IF YOU NEED ADDITIONAL SPACE FOR MORE NAMES, USE ADDITIONAL COPIES OF THIS PAGE.) Page 2 of 4 American LegalNet, Inc. www.FormsWorkflow.com APPLICATION FOR AIRLINE BEVERAGE PERMIT, CARRIER’S PERMIT, INDUSTRIAL PERMIT, LOCAL INDUSTRIAL ALCOHOL MANUFACTURER’S PERMIT, MARKET RESEARCH PACKAGER’S PERMIT, PASSENGER TRAIN BEVERAGE PERMIT CONTINUED AIRLINE BEVERAGE PERMIT TRADE NAME: FORM L-102 (2/2009) FOR AIRLINE BEVERAGE PERMIT 8A. Do you operate a commercial passenger airplane in compliance with a valid license, permit or certificate issued under the authority of the United States or the State of Texas? B. Give address of location in Texas where records will be kept and available for inspection: 8A. YES NO CARRIER’S PERMIT FOR CARRIER’S PERMIT water carrier airline carrier railway carrier 9A. Specify your classification: B. If a common carrier or motor carrier, indicate under which authority do you operate. (1) Under (Chapter 643, Transportation Code) -OR(2) Under a certificate issued by the Surface Transportation Board. motor carrier C. Give address of location in Texas where records will be kept or indicate, “records will be available for inspection upon request.” \INDUSTRIAL PERMIT FOR INDUSTRIAL PERMIT 10. State fully the nature of business in which applicant is engaged and also state for what purpose alcohol or wine is to be used: LOCAL INDUSTRIAL ALCOHOL MANUFACTURER’S PERMIT FOR LOCAL INDUSTRIAL ALCOHOL MANUFACTURER’S PERMIT NOTE: Plant plans and specifications must be submitted as part of your application. 11A. Do you at this time request permission to store alcohol at a storage facility that is under your control located off the licensed premises? If answer is “YES,” give address of location. B. Have you provided the following: 1. General layout and location of the entire production operation? 2. Specific design of distilling equipment? 3. Detailed plans and specifications of the final production phase? 4. Plans for security precautions to prevent unauthorized beverage use of the production facility? NOTE: Supplemental information will be required if the material submitted is inadequate. Your operation will be subject to continuing review and evaluation. Further modification of equipment or procedure may be required at any time. Any changes or modifications of plant and specifications must be submitted to and approved by this office. C. Describe method or procedure or indicate additive used to render the alcohol unfit for human consumption. 11A. YES NO B1. YES NO 2. YES NO 3. YES NO 4. YES NO Page 3 of 4 American LegalNet, Inc. www.FormsWorkflow.com APPLICATION FOR AIRLINE BEVERAGE PERMIT, CARRIER’S PERMIT, INDUSTRIAL PERMIT, LOCAL INDUSTRIAL ALCOHOL MANUFACTURER’S PERMIT, MARKET RESEARCH PACKAGER’S PERMIT, PASSENGER TRAIN BEVERAGE PERMIT CONTINUED TRADE NAME: FORM L-102 (2/2009) D1. Do you plan to transport alcohol produced under this permit? D1. YES NO PASSENGER TRAIN BEVERAGE PERMIT MARKET RESEARCH PACKAGER’S PERMIT LOCAL INDUSTRIAL ALCOHOL MANUFACTURER’S PERMIT If “YES,” give method used to transport. -ORGive the following information concerning the vehicles to be used with this permit. D2. (If additional space is needed, attach a page) MAKE MODEL YEAR LICENSE NUMBER FOR MARKET RESEARCH PACKAGER’S PERMIT 12A. Indicate name of permittee from whom your product is received. B. Will the product be received from inside or outside the state? 12B. Inside State Outside State 13A. YES NO B. YES NO FOR PASSENGER TRAIN BEVERAGE PERMIT 13A. Is the applicant corporation organized under Title 112, Revised Statutes or Rail Passenger Service Act of 1970 as amended (45 U.S.C.A. Section 501 et seq.)? B. Does the applicant operate a commercial passenger train service? WARNING: Section 101.69 of the Texas Alcoholic Beverage Code is as follows: “…a person who makes a false statement or false representation in an application for a permit or license or in a statement, report, or other instrument to be filed with the Commission and required to be sworn commits an ACKNOWLEDGMENT offense punishable by imprisonment in the penitentiary for not less than 2 nor more than 10 years.” ACKNOWLEDGMENT If Applicant is: Who Must Sign: Individual Individual Owner Partnership Partner Corporation Officer Limited Partnership General Partner Limited Liability Partnership General Partner Limited Liability Company Office or Manager PRINT NAME: NAME MUST APPEAR AS NAME SHOWN IN QUESTION 7 ON L-102 OR 2 ON L-106-PC SIGN HERE: SIGNATURE MUST APPEAR AS NAME SHOWN IN QUESTION 7 ON L-102 OR 2 ON L-106-PC Before me, the undersigned authority, on this , 20 day of the person whose name is signed to the foregoing application personally appeared and, duly sworn by me, states under oath that he or she read the said application and that all the facts therein set forth are true and correct. SIGN HERE: SEAL NOTARY PUBLIC Page 4 of 4 American LegalNet, Inc. www.FormsWorkflow.com