** Renew Online at https://online.tabc.texas.gov ** APPLICATION FOR TWO-YEAR RENEWAL OF NONRESIDENT SELLER'S PERMIT (S) AND NONRESIDENT BREWER'S PERMIT (U) FORM S (08/2015) LICENSE/PERMIT NUMBER: CAREFULLY READ ALL INSTRUCTIONS 1. Mailing Address: EXPIRES: 2. Trade Name: 3. Location Address: 4. Mailing Address: LICENSE/PERMIT NUMBER ISSUE DATE TWO-YEAR FEE TWO-YEAR SURCHARGE LATE FEE TOTAL FEES DUE - - BOND INFORMATION REGISTRY NO. 5. Applicant Name: This does not represent the entire business entity structure on file with the Texas Alcoholic Beverage Commission. The license/permit holder is responsible for notifying TABC of any organizational changes at any level of your business structure. Failure to do so may result in the cancellation of your license/permit. QUALIFICATIONS 6. Is this application being made by you for the benefit of someone else? If "YES," indicate below or attach explanation. 6. YES NO 7. Has the applicant, applicant's spouse, partner, officer, director or stockholders, of the licensed entity become disqualified by law or by facts and conditions from holding a license or permit under the Texas Alcoholic Beverage Code? If "YES," indicate below or attach explanation. 7. YES NO 8. Have there been changes since your original application that have not been reported on this or previous applications? If "YES," indicate below or attach explanation. 8. YES NO Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Form S (08/2015) LICENSE/PERMIT NUMBER: FORM S 9. The name of the appointed agent, resident of the State of Texas, certified by applicant to Texas Secretary of State, as the person upon who service of any legal instrument may be had is correct, or if your approved agent has changed, indicate correct information and file Form L-20.2 with the Secretary of State to certify appointed agent. Your application cannot be approved until this certification is received. FOR NONRESIDENT BREWER'S PERMIT (U) APPLICANT ONLY (ANSWER QUESTIONS 10 THROUGH 13) 10. Do you, the applicant, own a fee interest (ownership) in a brewing facility? If "NO," please submit a Fee Interest Bond which must be on file and approved to issue your renewal. Fee Interest Bond form and instructions can be downloaded from http://www.tabc.state.tx.us/forms/ 11. Do you, the applicant, hold a Brewer's Notice issued by the Alcohol and Tobacco Tax and Trade Bureau of the United States Department of the Treasury? If "YES," please provide TTB Brewers Notice Number and attach copy. CONTRACT BREWING AGREEMENT 12. Do you, the applicant, hold a Nonresident Brewer's Permit (U) and contract with another brewery to produce your product? If "YES," provide the TABC license/permit number of that brewery. Is your product brewed at their location? YES NO ALTERNATING BREWER PROPRIETORSHIP 13. Do you, the applicant, hold a Nonresident Brewer's Permit (U) and utilize an alternating proprietorship agreement to produce your product? If "YES," provide TABC license/permit number of that brewery. Is your product brewed at their location? YES NO APPLICANT CONTACT INFORMATION Business Phone # Alternate Phone # Cell Phone # (optional) E-mail (optional) 10. YES NO . If this is not 11. YES NO 12. YES NO 13. YES NO WARNING: Sec. 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 offense punishable by imprisonment in the Texas Department of Criminal Justice for not less than 2 nor more than 10 years." If Applicant is: Who Must Sign: Individual Owner Partner Officer General Partner General Partner Officer or Manager PRINT NAME HERE APPLICANT: PRINT NAME SIGN HERE APPLICANT: SIGN NAME AS SHOWN ABOVE ACKNOWLEDGMENT IMPORTANT Individual Partnership Corporation Limited Partnership Limited Liability Partnership Limited Liability Company Before me, the undersigned authority, on this application and that all the facts therein set forth are true and correct. day of , 20 the person whose name is signed to the foregoing application personally appeared and, duly sworn by me, states under oath that he or she has read the said SIGN HERE NOTARY PUBLIC SEAL American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 Form S (08/2015) ALL RENEWAL INSTRUCTIONS RENEW online at https://online.tabc.texas.gov and login to your existing account or click the "Registration" link. Payments can be made by credit card or electronic transfer (ACH). Do not submit application by mail if you renew online. RENEW by mail: Verify information shown in 1 through 5 for accuracy. Tradename and mailing address changes can be made directly on this form by marking through the incorrect information and entering the current information. Any other changes will require additional forms. Contact your local TABC office or the Licensing Division at 512-206-3360. Sign this application before a notary public. Retain a copy of this renewal for your records. STATE FEES AND SURCHARGES are printed on the front page. Please add your fees and surcharges together for the total amount due. PAYMENTS: Must be paid with a cashier's check, money order or company check payable to the Comptroller of Public Accounts. Personal checks will not be accepted. The postmark date will serve as proof of timely filing. MAIL your renewal, bond if required, and total amount due to: TABC PO Box 13127 Austin TX 78711-3127 NOTE: Bonds may only be required for retail and manufacturer licenses/permits. LATE FILINGS: If you do not file this application before your expiration date, your license/permit will expire and you must cease operations. Your renewal may be filed within 30 calendar days after your expiration date. A $100 late fee will be required for each license/permit, in addition to all fees and surcharges. OTHER FEES: Please note additional fees may be due to your city/county. It is your responsibility to contact these authorities to determine what amounts, if any, may be due and pay those fees. Failure to pay fees due to the city/county may result in administrative action against your license/permit by the commission. For forms and additional information visit us at: www.tabc.texas.gov American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 Form S (08/2015)