Form C-41 (01/2006) TEXAS ALCOHOLIC BEVERAGE COMMISSION REQUEST FOR APPROVAL OF MACHINE BOOKKEEPING SYSTEM TradeName: CLP Number: Street Address: City: Zip: Mail Address: City: Zip: Approval is requested for the use of a machine bookkeeping system. A detailed explanation of the system is attached. The person listed below as Applicant may be contacted to review the proposed system or answer any questions concerning the system. Name: Phone No.: Street Address: City: Zip: Mail Address: City: Zip: List below all permits or licenses currently approved to utilize this system or who have filed a request for approval to utilize this system: TradeName City Permit No.: Attach a supplemental list if additional space is needed Applicant Signature and Title This authorization is granted under the conditions of Section 5.51 of the Texas Alcoholic Beverage Code. If this statute or the listed conditions, instructions, or other requirements of this Commission are not complied with, this authorization may be revoked. Approved: Administrator By: Date Title: TEXAS ALCOHOLIC BEVERAGE COMMISSION SEE REVERSE SIDE FOR STATUTE, CONDITIONS AND INSTRUCTIONS American LegalNet, Inc. www.FormsWorkflow.com INFORMATION AND INSTRUCTIONS FORM C-41 The holder of any T.A.B.C. permit or license, which is required to maintain bookkeeping records for the Commission, may request to maintain those records on a business machine. STATUTE REFERENCES The Texas Alcoholic Beverage Code states: "Sec. 5.51. BOOKKEEPING RECORDS. A permittee who holds a permit issued under Chapters 28 through 33 of this code may elect to keep all records required under this code on a machine bookkeeping system. A permittee who desires to use such a system must submit a written application for commission approval of the system before implementing the system..." Texas Alcoholic Beverage Commission Rule 41.52(c)(1)(D) states: "...a club using a business machine to maintain its membership records shall not be required to keep a well bound book if such machine provides such information as shall be required by the administrator, and is approved in writing by the administrator;" CONDITIONS Request for approval of a machine bookkeeping system must be made by the permittee, licensee, or an officer on a completed Form C-41 and forwarded for evaluation to the local district compliance office of the permittee or licensee making the request. A separate Form C-41 must be filed for each permit or license requesting approval of a system. The Form C-41 must be accompanied by a detailed explanation of the system for which approval is requested. Any systems approved will have to include, but not be limited to, the following characteristics: 1. The system must provide an auditable transaction trail. 2. The system must provide all records and information required by the Texas Alcoholic Beverage Commission Code and Rules. INSTRUCTIONS: 1. Submit the original and three copies of this form to your local district TABC Compliance office for evaluation. 2. If approved, the original form will be returned to the permit or license mailing address and the form should be kept on the licensed premises for inspection. . American LegalNet, Inc. www.FormsWorkflow.com