Minnesota > Statewide > Alcohol And Gambling Enforcement Division
Application For Malt Beverage Importers License - Minnesota
| Application For Malt Beverage 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 MALT BEVERAGE IMPORTER'S LICENSE $1600 plus $150 Office of Enterprise Technology surcharge-Total due $1750 License Expiration Date Licensee's Name Federal Tax ID Number of the City of Telephone Number , Fax Number License Number DBA Trade Name , Street Address , State of , Zip Code , hereby apply for license to ship into and sell day of Date Approved 340A, and Regulations of the Liquor Control Director for a period of one year from and after the 20 We are duly licensed by the State of in which our principal place of business as a brewer-wholesaler is located. We hold valid and currently effective Federal Basic Qualifying Documents as provided by the Federal Beer Regulations. We agree to comply with the Minnesota Excise Tax and Liquor Control Laws and Regulations issued. On the reverse side of this application we list the names and addresses of Minnesota Wholesale Distributors to whom we presently sell our products. Does your company have any interest in any retail alcoholic beverage licenses? If you answered yes please provide the names and addresses I certify that I have read the above questions and that the answers are true and correct to the best of my knowledge. Yes No Print Full Name of Applicant and Title Signature of Applicant DOB Date ALL LABELS MUST BE APPROVED BY THE ALCOHOL AND GAMBLING ENFORCEMENT BEFORE AN ALCOHOLIC BEVERAGE MAY BE IMPORTED INTO MINNESOTA MAKE CHECK PAYABLE TO: DIRECTOR ALCOHOL AND GAMBLING ENFORCEMENT American LegalNet, Inc. www.FormsWorkFlow.com NAMES AND ADDRESSES OF THE APPLICANT'S MINNESOTA WHOLESALERS Name Name Name Name Name Name Name Name Name Name Name Name Name Name Name Name Name Name Name Name Address Address Address Address Address Address Address Address Address Address Address Address Address Address Address Address Address Address Address Address City City City City City City City City City City City City City City City City City City City City American LegalNet, Inc. www.FormsWorkFlow.com
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