Manufacturing License Application Form. This is a Utah form and can be use in Department Of Alcoholic Beverage Control Statewide.
Tags: Manufacturing License Application, Utah Statewide, Department Of Alcoholic Beverage Control
UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL 1625 South 900 West • PO Box 30408 • Salt Lake City, UT 84130-0408 • (801) 977-6800 • FAX (801) 977-6888 www.abc.utah.gov “MANUFACTURING LICENSE” APPLICATION CHECKLIST Winery License [ ] Distillery License [ ] Brewery License [ ] The items below should be completed and submitted by the 10th of the month or earlier, so that your application can be processed in a timely manner. All licensing requirements must be fully satisfied in order to complete your application. You will be notified of the next monthly Utah Alcoholic Beverage Control Commission meeting when your application will be considered for issuance of a license. 1.____Completed application (form enclosed). 2.____Ownership entity organizational papers for business: a) if a corporation, submit a copy of articles of incorporation; b) if a partnership, submit a copy of written agreement; c) if a limited liability company, submit a copy of the articles of organization. 3.____Criminal history background check information (see application). 4.____Written consent from city/town council or county commission, whichever is applicable (form enclosed). 5.____Copy of current local business license. 6.____Copy of Alcohol and Tobacco Tax and Trade Bureau permit. 7.____$10,000 manufacturing cash or corporate surety bond (form enclosed). 8.____Certificate of public liability insurance. 9.____Scaled floor plan (8 1/2”x11”) of premises highlighting the area where alcoholic products will be produced, stored, etc. 10.___$250 application fee (non refundable). 11.___$3,250 initial licensing fee (make checks payable to UDABC). Enclosed are copies of the Utah laws and commission rules pertaining to manufacturing licensees. If you have any questions concerning these forms or the application process, please contact our DABC Licensing and Compliance Division at (801) 977-6800. 6.04.08 American LegalNet, Inc. www.FormsWorkflow.com UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL APPLICATION FOR MANUFACTURING LICENSE Winery License [ ] Distillery License [ ] Brewery License [ ] 1. Business Name:___________________________________________________________ 2. Applicant/owner of business:________________________________________________ 3. Location: _______________________________________________________________ Street 4. City State Zip Mailing address:__________________________________________________________ Street P O Box City State Zip 5. Business phone: _______________Office phone: ___________ Fax: ________________ 6. Contact person: _________________________________ 7. Owner of real property and building:__________________________________________ 8. List any other alcoholic beverage licenses held by applicant/principles: _______________________________________________________________________ 9. Ownership: Check appropriate box and provide the requested information in the space below (add additional sheets if necessary).  Applicant is an individual: List below information for: (a) Individual (b) Managers  Applicant is a partnership: List below information for: (a) All Partners (b) Managers  Applicant is a corporation: List below information for: (a) Any Stockholder owning at least 20% of the corporation (b) All Corporate officers (c) Managers  Applicant is a limited liability company (LLC): List below information for: (a) Any members owning at least 20% of the company (b) Managers TITLE____________NAME_______________________HOME ADDRESS______________________ HOME PHONE#____________DR LIC#_____________SS#___________DOB______%OWNED____ Are you a United States Citizen? ________ If no, must attach a copy of residency status. TITLE____________NAME_______________________HOME ADDRESS______________________ HOME PHONE#____________DR LIC#_____________SS#___________DOB______%OWNED____ Are you a United States Citizen? ________ If no, must attach a copy of residency status. 6.04.08 American LegalNet, Inc. www.FormsWorkflow.com 10. Criminal History. The law prohibits any person who has been convicted of a felony under any federal or state law or any violation of any federal or state law or local ordinance concerning the sale, manufacture, distribution, warehousing, adulteration, or transportation of alcoholic beverages from being in the alcoholic beverage business. The law also prohibits any person who has been convicted of any crime involving moral turpitude or, on two or more occasions within the last five years, has been convicted of driving under the influence of alcohol, or any drug, or the combination of alcohol and any drug from being in the alcohol business. This proscription also applies to any officers, partners, managers, managing agents, directors, stockholders who hold at least 20% of the total issued and outstanding stock of an applicant corporation, members who own at least 20% of an applicant limited liability company and to any person employed to act in a supervisory or managerial capacity. Please list all criminal offenses other than minor traffic offenses of which you or any of the above persons have ever been convicted: (also include any pending criminal charges). NAME CRIMINAL OFFENSE DATE OF CONVICTION _______________________________________________________________________ ______________________________________________________________________________ In addition, a criminal history background check must be furnished on each person listed above and in subparagraph 5. This may be done as follows: a. Utah residents: If any person listed has been a resident of Utah for at least two years, he/she shall submit a fingerprint card to the DABC and consent to a fingerprint criminal background check by the Utah Bureau of Criminal Identification. b. Non Residents: Out of state residents or persons who have resided in Utah for less than two years shall submit a fingerprint card to the DABC and consent to a fingerprint criminal background check by the Federal Bureau of Investigation (F.B.I). An informed consent and release of liability form is included with this application. Fingerprint cards are available at law enforcement agencies. You may download the fingerprint card at this web address: http://www.fbi.gov/hq/cjisd/pdf/fpcardb.pdf Submit the form(s) to the DABC with a processing fee of: • $15.00 per card for BCI background checks, or • $34.25 per card for FBI background checks. In the case of an undue delay in the processing of an F.B.I. criminal background check, here are the rules and procedures for obtaining a third-party national background check: An application that requires F.B.I. criminal history background report(s) may be included on a commission meeting agenda, and may be considered by the commission for issuance of a license, permit, or package agency if: 1). the applicant has completed all requirements to apply for the license, permit, or package agency other than the department receiving the F.B.I. criminal history background report(s); 2). the applicant attests in writing that he or she is not aware of any criminal conviction of any person identified in the application that would disqualify the applicant from applying for and holding the license, permit, or package agency; 3). the applicant has submitted to the DABC the necessary fingerprint card(s) required for the application and consented to the fingerprint criminal background check(s) by the F.B.I. 4). the applicant at the time of application supplies the department with a current criminal history background report conducted by a third-party background check reporting service on any person for which an F.B.I. background check is required; and 6.04.08 American LegalNet, Inc. www.FormsWorkflow.com 5). the applicant stipulates in writing that if an F.B.I. report shows a criminal conviction that would disqualify the applicant from holding the license, permit, or package agency, the applicant shall immediately surrender the license, permit, or package agency to the department. A suggested attestation/stipulation letter that satisfies the above requirements is enclosed. A third-party national criminal background check can be obtained by; • searching the yellow pages under Background Screening • searching the internet under Background Screening or Background Checks Because the DABC is State Agency, we cannot recommend any one background screening service over another. It is your responsibility however, to obtain the most complete, nationwide, criminal history available for the application process. 11. Applicant agrees to immediately notify the department of any change in ownership, management, and if a corporation, any change in the officers/directors, and understands that failure to do so may result in immediate suspension of license. 12. Have you as an applicant, or proprietor, partner, managing agent, director, officer, stockholder owning at least 20% corporation stock, or if a limited liability company, any member owning at least 20% of the company, had a state alcoholic beverage license, permit, or agency revoked within the last three years?_________ If so, please explain.____________________________ ___________________________________________________________________________ 13. Please supply all applicable numbers: Utah State Sales Tax # _______________________________ Utah State Payroll Withholding # ______________________ Utah State Dept Workforce Services # __________________ Federal IRS Taxpayer ID # ___________________________ * Federal ATTTB (formerly BATF) Identification # ________________________ Type of Federal ATTTB (Formerly BATF) Permit ________________________ * ATTTB: Alcohol and Tobacco Tax and Trade Bureau. 14. List types and brands of alcoholic beverages to be produced:_____________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ _____________________________________________________________________________ 6.04.08 American LegalNet, Inc. www.FormsWorkflow.com 15. By signing below, the applicant attests that: a) the proprietor/applicant is at least 21 years of age. b) consent is granted to representatives of the Alcoholic Beverage Control Department, Commission, State Bureau of Investigation (Bureau of Alcoholic Beverage Law Enforcement), and other law enforcement agencies to be admitted immediately and permitted without hindrance or delay to inspect the entire premises and all records of the licensee. c) he/she has read and will abide by the provisions of Title 32A, Utah Code, and all rules of the commission and directives of the Department of Alcoholic Beverage Control; and understands that failure to adhere thereto or to no longer possess the qualifications of a licensee may result in suspension or revocation of the liquor license and forfeiture of compliance bond. d) the applicant does not and will not discriminate against persons on the basis of race, color, sex, religion, ancestry, or national origin. 16. The undersigned hereby makes application to the Utah Alcoholic Beverage Control Commission for a manufacturing license and certifies that the information contained herein and attached hereto is true and correct. Date: ___________________________ STATE OF ________________________ ________________________________ Applicant/owner of business COUNTY OF_______________________ Subscribed & sworn to before me this _______ day of ________________________________ Authorized signature ____________________, ________. ________________________________ Name/title _______________________________ Notary Public SEAL: 6.04.08 American LegalNet, Inc. www.FormsWorkflow.com UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL (Manufacturing) LOCAL CONSENT Date:_____________________ Utah Department of Alcoholic Beverage Control Licensing & Compliance Section 1625 So 900 West PO Box 30408 Salt Lake City, Utah 84130-0408 __________________________________________________(City)(Town)(County) hereby grants its consent to the issuance of a manufacturing license to _______________________ ________________________________, Brewery/Distillery/Winery located at ___________ _______________________________________, pursuant to the provisions of Section 32A-8, Utah Code, for the purpose of importation, production, sale, and/or other lawful use of alcohol beverage products as authorized by the Utah Department of Alcoholic Beverage Control. ______________________________ Authorized Signature ______________________________ Name/Title 6.04.08 American LegalNet, Inc. www.FormsWorkflow.com INFORMED CONSENT AND RELEASE OF LIABILITY PURPOSE: To determine, in accordance with Utah Code 32A-1-702 and 32A-1-703, if an applicant with the Department of Alcoholic Beverage Control has been: convicted of a felony under federal or state law; convicted of a violation of a federal law, state law, or local ordinance concerning the sale, manufacture, distribution, warehousing, or transportation of an alcoholic beverage; convicted of a crime involving moral turpitude; convicted on two or more occasions within the previous five years, driving under the influence of alcohol, a drug, or the combined influence of alcohol and a drug. RELEASE I hereby authorize the Department of Alcoholic Beverage Control (DABC) to investigate my criminal history records to ascertain any and all information which may be pertinent to my qualifications as an applicant with the DABC. The release of any and all information is authorized whether it is of record or not, and I do hereby release all persons, firms, agencies, companies, groups or installations, whomsoever, from any damages of or resulting from, furnishing such information to the DABC. I further agree that a copy of this release will remain in my application file. ______________________________________________________________________ Name (please print; last, first, middle initial) _______________________________ Formerly used last names (please print) _________________________________ Applicant/ doing business as _______________________________ Signature _________________________________ Date 6.04.08 American LegalNet, Inc. www.FormsWorkflow.com (suggested attestation/stipulation letter to the DABC for a third-party national criminal background check) Date: ________________________ To whom it may concern: I, _____________________________, attest: 1. That I have submitted to the DABC the necessary fingerprint card(s) required for the application and consented to the fingerprint criminal background check(s) by the F.B.I. 2. That I am not aware of any criminal conviction that would disqualify me from applying for and holding a Utah Department of Alcoholic Beverage Control license or permit. I stipulate that if an F.B.I. report shows a criminal conviction that would disqualify me from holding the license, permit, or package agency, I shall immediately surrender the license, permit, or package agency to the department. I am enclosing a national criminal history background report from a third party background check reporting service. _____________________________________ Signature _____________________________________ Name/Title 6.04.08 American LegalNet, Inc. www.FormsWorkflow.com