FORM C-51 (10/2002) APPLICATION FOR DESTRUCTION OF ALCOHOLIC BEVERAGES Date: Trade name: _______ CLP Number: ____________________________ Address: ____ Telephone Number: ___ City: ________________________ Fax Number: ______________________________ This is a request to destroy alcoholic beverages. The alcoholic beverages to be destroyed are shown on one of the follow ing exhibits: • Exhibit A – Beer • Exhibit B – Ale or Malt Liquor • Exhibit C – Distilled Spirits and/or Wine (Check one item only) The destruction is scheduled to take place on _______________________________ at _______ a.m./p.m. The destruction w ill take place at the follow ing location: Location Name: _____________________________________________________________________________ Street Address: _____________________________________________________________________________ City: ______ State __________________________________ Method of Destruction: _______________________________________________________________________ Reason for Destruction: _______________________________________________________________________ __________________________________________________________________________________________ The information contained in this application for destruction is true and correct to the best of my ability. _________________________________________________ Signature _________________________________________________ Print or Type Name Title APPROVED: __________________________________________________________________________________________ TABC Representative Date INST RUCTIONS – SEE REV ERSE SIDE - 1American LegalNet, Inc. www.FormsWorkflow.com FORM C-51 (10/2002) DESTRUCTION OF ALCOHOLIC BEV ERAGES INSTRUCTIONS 1. Prepare a separate form for distilled spirits and w ine, beer, or ale and malt liquor. 2. A copy of this form must be sent to your nearest Texas Alcoholic Beverage Commission offic e by mail or facsimile. Written approval for the destruction must be received from that office at least three w orking days prior to the destruction. 3. A copy of this form w ith the w ritten approval w ill become a part of the affidavit prepared by a representative of your company w ho w itnessed the destruction. This affidavit and attachment w ill be sent to the T.A.B.C. headquarters office in Austin w ith the monthly tax report on w hich the destruction exemption is entered. 4. A copy of the form and affidavit prepared by your employee should be retained in your files. If the merchandise w as destroyed off your licensed premises, a receipt signed and dated by a representative of the landfill or other location w here the merchandise w as destroyed is also attached to your file copy and retained in your files. Exhibit A – Beer to be Destroyed (Separate forms must be prepared for beer or ale and m alt liquor.) 5. “Brand” refers to the name reflected on the product label. 6. “Packages to be Destroyed” refers to the number of containers per package and the size of the container (i.e. ½ bbl., 24/16 oz., 24/12 oz., etc.). List the number of cases under the proper size on the exhibit. If less than a case is destroyed, show the bottles destroyed as a fraction of the original case size (e.g. 6 tw elve ounce bottles destroyed w hich were out of a 24/12 oz. case will be show n as 6/24 under the 24/12 oz. column.) 7. “Miscellaneous Sizes” show any package sizes destroyed that are not preprinted (i.e. 12/12 oz., 48/7 oz., etc.). 8. “Total” show totals for any package sizes that have entries. 9. Additional exhibits may be used if destruction size requires it. Any additional pages used should be numbered 1 of 3, 2 of 3, etc. and a grand total of all pages must be show n. Exhibit B – Ale or Malt Liquor to be Destroyed (Separate forms must be prepared for beer or ale and m alt liquor.) 10. “ Brand” refers to name reflected on the product label. 11. “Packages to be Destroyed” refers to the number of containers per package and the size of the container (i.e. ½ bbls., 24/16 oz., 24/12 oz., etc.). List the number of cases under the proper size on the exhibit. If less than a case is destroyed, show the bottles destroyed as a fraction of the original case size (e.g. 6 tw elve ounce bottles destroyed w hich were out of a 24/12 oz. case will be show n as 6/24 under the 24/12 oz. column.) 12. “Miscellaneous Sizes” show any package sizes destroyed that are not preprinted (i.e. 12/12 oz., 48/7 oz., etc.). - 2American LegalNet, Inc. www.FormsWorkflow.com FORM C-51 (10/2002) DESTRUCTION OF ALCOHOLIC BEV ERAGES INSTRUCTIONS 13. “Total” show totals for any package sizes that have entries. 14. Additional exhibits may be used if destruction size requires it. Any additional pages used should be numbered 1 of 3, 2 of 3, etc. and a grand total of all pages must be show n. Exhibit C – Distilled Spirits and/or Wine to be Destroyed 15. “Class of Beverage” should indicate distilled spirits, low wine, high w ine, sparkling w ine, or distilled spirit miniature. 16. “Cases or Bottles” should indicate the number of cases to be destroyed. If items to be destroyed are less than one case indicate the number of bottles to be destroyed. 17. “Bottle Size” indicates the size container in w hich the distilled spirits or w ine is packaged (750 ml., liter, 1.75 ltr., etc.). 18. “Bottles per Case” indicates the number of bottles in each case to be destroyed. If the items show n in the column titled “Cases or Bottles” are bottles, leave this column blank for that item. 19. “Wine Gallons Per Unit” represents the w ine gallons per case if cases are used in the column titled ” Cases or Bottles” or the w ine gallons per bottle if bottles w ere use. This column is left blank if “Class of Beverage” reflects distilled spirits miniatures. 20. The four columns show n under “Wine Gallons” should reflect the product of the amounts entered “ Cases or Bottles” times “Wine Gallons Per Unit”. The product should be entered in the column corresponding with the entry in the column titled “Class of Beverage”. 21. “Distilled Spirits Miniatures” should reflect the total number of bottles of distilled spirits miniatures to be destroyed. This total w ill be the product of the entry in the column titled “Cases or Bottles” multiplied by the amount entered under the column titled “Bottles Per Case”. - 3American LegalNet, Inc. www.FormsWorkflow.com EXHIBIT A – BEER T O BE DESTROYED Brand Packages to be Destroyed 1/2 bbl 12/32 oz 24/16 oz Miscellaneous Sizes 24/12 oz TOTAL - 4American LegalNet, Inc. www.FormsWorkflow.com EXHIBIT B – AL E AND MALT LIQUOR TO BE DEST ROYED Brand ½ bbl Packages to be Destroyed 12/40 oz 24/32 oz 24/16 oz Miscellaneous Sizes 24/12 oz TOTAL - 5American LegalNet, Inc. www.FormsWorkflow.com EXHIBIT C – WINE AND DISTILLED SPIRITS TO BE DEST ROYED Class of Bev erage Cases or Bottles Wine Gallons Bottle Size Bottles Per Case Wine Gallons Per Unit Distilled Spirits Low Wine High Wine Sparkling Wine Distilled Spirits Miniature s TOTAL - 6American LegalNet, Inc. www.FormsWorkflow.com