Minnesota > Statewide > Alcohol And Gambling Enforcement Division
Application For Wine And Or Distilled Spirits Importers License - Minnesota
| Application For Wine And Or Distilled Spirits Importers License Form. This is a Minnesota form and can be used in Alcohol And Gambling Enforcement Division Statewide . |
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Minnesota Department of Public Safety ALCOHOL AND GAMBLING ENFORCEMENT DIVISION 444 Cedar Street, Suite 222, St. Paul, MN 55101 (651) 201-7500 TDD (651) 282-6555 FAX (651) 297-5259 Print Form APPLICATION FOR WINE AND/OR DISTILLED SPIRITS IMPORTER'S LICENSE $420 plus $42 Office of Enterprise Technology surcharge-Total due $462 License Expiration Date: Minnesota Tax ID Number Licensee's Name DBA or Trade Name Main Address of Carrier City YOU ARE APPLYING TO IMPORT (CHECK ONE) LIST OTHER STATES WHERE LICENSED DO YOU HAVE AN INTEREST IN ANY RETAIL LICENSE? Yes No If yes please provide name and address. WINE State DISTILLED SPIRITS BOTH License Number: Date Approved: Federal Tax ID Number License Period From To Business Phone Fax Number Zip Code We hold valid and currently effective Federal Basic Qualifying Documents as provided by Alcohol Administration Act of August 29, 1935 (Title 27 U.S. Code, Section 203). We agree to comply with the Minnesota Excise Tax and alcoholic beverage laws and regulations. Names of the licensee's Minnesota Wholsalers. Print Full Name of Applicant and Title Signature of Applicant DOB Date All labels must be approved by Alcohol and Gambling Enforcement before an alcoholic beverage may be imported into Minnesota. MAKE CHECK PAYABLE TO: DIRECTOR ALCOHOL AND GAMBLING ENFORCEMENT AMOUNT RECEIVED A $30.00 service charge will be added to all dishonored checks. You may also be subjected to a civil penalty of $100 or 100% of the value of the check, whichever is greater, plus interest and attorney fees. American LegalNet, Inc. www.FormsWorkFlow.com
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