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Record Of Delivery LIC0120 - Arizona

Record Of Delivery Form. This is a Arizona form and can be used in Liquor Licenses And Control Statewide .
 Fillable pdf Last Modified 9/7/2015
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Arizona Department of Liquor Licenses and Control 800 W. Washington, 5th Floor Phoenix AZ 85007-2934 www.azliquor.gov (602) 542-5141 Record of Delivery Pursuant to A.R.S. § 4-203(J), a retail licensee permitted to deliver spirituous liquor shall make a record of delivery as required by A.A.C. R19-1-504, at the time of delivery off the licensed premises on a form approved by the department. A licensee may provide additional information regarding the delivery at his discretion. 1. Business Name: (Exactly as it appears on the license) 2. Business Address: Street City County Zip Code 3. License Number: 4. Date of Delivery: 5. Address of Delivery: Street City County Zip Code Time of Delivery: AM / PM (circle one) 6. Type and Brand of Spirituous Liquor(s) Delivered: 7. The following information pertains to the person MAKING the delivery. Name: (Please print) Signature: 8. The following information pertains to the person ACCEPTING the delivery. THE LICENSEE SHALL REQUIRE THAT PROOF OF AGE BE SHOWN. Name: (Please print) Date of Birth: ID Number: (Serial Number) Identification Type: Signature: The Record of Delivery shall be retained by the Licensee for at least two (2) years as required by A.R.S. § 4-210(A)(7). A LICENSEE THROUGH ANY EMPLOYEE MAKING DELIVERY SHALL BE LIABLE FOR ALL VIOLATIONS OF TITLE 4. 7/27/2015 Page 1 of 3 Individuals requiring ADA accommodations please call (602)542-9027 American LegalNet, Inc. www.FormsWorkFlow.com R19-1-504 Retail delivery of spirituous liquor A. Definitions. 1. 2. 3. 4. 5. "Delivery" means the delivery of spirituous liquor pursuant to A.R.S. Section 4-203(J) and this rule. "Identification" means an unexpired driver's license, an identification license issued pursuant to A.R.S. § 28-3165, an armed services identification card, or a valid unexpired passport showing a date of birth, with a photograph of the person named, on the identification. "Licensee" means a retail licensee permitted to deliver spirituous liquor pursuant to A.R.S. § 4-101.21 or an employee of such licensee. "Time of delivery" means when the person to whom delivery is made obtains physical possession of the spirituous liquor. "Title 4" means Title 4 of the Arizona Revised Statutes and all rules under said Title. B. A licensee shall make a record of delivery at the time of delivery on a form approved by the Department. The record of delivery shall be retained by the licensee for at least two (2) years. C. The form shall include: 1. 2. 3. 4. 5. 6. 7. The licensee's business name, address and liquor license number. The date and time of delivery. The address where delivered. The type and brand name of spirituous liquor delivered. The printed name and signature of the person making delivery. The printed name and signature of the person accepting delivery. The type and serial number of the identification, and date of birth for the person accepting delivery. D. A licensee making delivery shall be liable for any violation of Title 4 in connection with such delivery with special emphasis on the following: 1. 2. 3. 4. 5. Delivery shall only be made by a person at least 21 years old. Delivery shall only be made during g the hours of lawful service of spirituous liquor. Delivery shall not be made to an intoxicated or disorderly person. Delivery shall only be made after identification has been shown by the person accepting delivery, the identification shows the person is of legal drinking age, and the information required to be recorded by this rule has been recorded. Delivery shall not be made to the licensed premises of a retailer. E. A licensee making delivery shall refuse to complete a delivery at any time prior to the time of delivery, if the licensee believes such delivery would constitute a violation of Title 4. 7/27/2015 Page 2 of 3 Individuals requiring ADA accommodations please call (602)542-9027 American LegalNet, Inc. www.FormsWorkFlow.com R19-1-504. Record of Delivery of Spirituous Liquor A. A retail licensee having off-sale privileges or licensed domestic farm winery that delivers spirituous liquor, as authorized by A.R.S. § 4-203(J) or 4-205.04(C)(9) and R19-1-315, shall complete a record of each delivery at the time of delivery. The licensee shall ensure that the record provides the following information: 1. Name of licensee making the delivery; 2. Address of licensee making the delivery; 3. License number; 4. Date and time of delivery; 5. Address at which delivery is made; 6. Type and brand of spirituous liquor delivered; and 7. Printed name and signature of the individual making the delivery. B. In addition to the information required under subsection (A), a retail licensee having off-sale privileges that delivers spirituous liquor, as authorized by A.R.S. § 4-203(J), shall obtain the following information about the individual accepting delivery of the spirituous liquor: 1. Name, 2. Date of birth, 3. Type of and number on the identification used to verify the individual's date of birth, and 4. The signature of the individual accepting delivery. The retail licensee making delivery may use an electronic signature system to comply with this subsection. C. A licensed domestic farm winery that delivers spirituous liquor, as authorized by A.R.S. § 4 205.04(C)(9), may rely on an electronic signature system operated by the United Parcel Service or Federal Express to comply with the requirements in subsection (A). D. A licensed retailer that delivers spirituous liquor under A.R.S. § 4-203.04(H) or a direct shipment licensee that ships wine under A.R.S. § 4-203.04(J) may rely on an electronic signature system operated by the United Parcel Service or Federal Express. E. This Section is authorized by A.R.S. §§ 4-112(B)(1)(d), 4-203(J) and (M), 4-203.04(H) and (J), 4-205.04(C)(9) and (D). 7/27/2015 Page 3 of 3 Individuals requiring ADA accommodations please call (602)542-9027 American LegalNet, Inc. www.FormsWorkFlow.com
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