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NORTH CAROLINA ALCOHOLIC BEVERAGE CONTROL COMMISSION 4307 MAIL SERVICE CENTER RALEIGH NC 27699-4307 (919) 779-0700 FAX: (919) 662-3583 PROOF OF ALCOHOL SELLER/SERVER TRAINING IMPORTANT: The Applicant will complete SECTION A, below. SECTION B, below is to be completed by the training provider. NOTE: If you provide other proof of training (i.e., certificate of training, transcript or other documentation), attach it to this form. Failure to provide Proof of Alcohol Seller/Server training will prevent you from obtaining a TEMPORARY ABC permit. SECTION A - APPLICANT TO COMPLETE Name of Applicant _______________________________________________________ Trade Name of Business __________________________________________________ Address of Business ______________________________________________________ City _______________________ County _____________________State___________ Phone Number (____)____________________________________________________ SECTION B TRAINING PROVIDER TO COMPLETE I certify that the above named applicant has completed an Alcohol Seller/Server training class. Basic information covered in the class included: acceptable forms of identification in North Carolina, preventing underage sales, signs of intoxicated patrons, preventing sales to intoxicated patrons, dram shop liability and hours of sale. Name of Instructor (print)____________________________________________________ Company/Agency of Course Provider __________________________________________ Address of Business _________________________________________________________ City _________________________ County _______________________State__________ Phone Number (____)________________________________________________________ Signature __________________________________ Date of Training: ________________ American LegalNet, Inc. www.FormsWorkFlow.com