Massachusetts > Statewide > Alcoholic Beverages Commission
Application For A License To Sell Alcoholic Beverages On A Ship - Massachusetts
| Application For A License To Sell Alcoholic Beverages On A Ship Form. This is a Massachusetts form and can be used in Alcoholic Beverages Commission Statewide . |
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The Commonwealth of Massachusetts Alcoholic Beverages Control Commission 239 Causeway Street Boston, MA 02114 www.mass.gov/abcc APPLICATION FOR A LICENSE TO SELL ALCOHOLIC BEVERAGES ON A SHIP MONETARY TRANSMITTAL FORM [APPLICATION MUST BE COMPLETED ONLINE] ECRT CODE: SHIP CHECK PAYABLE TO ABCC OR COMMONWEALTH OF MA: (CHECK MUST DENOTE THE NAME OF THE LICENSEE CORPORATION, LLC, PARTNERSHIP, OR INDIVIDUAL) $500.00 CHECK NUMBER: IF USED EPAY, CONFIRMATION NUMBER: A.B.C.C. LICENSE NUMBER (IF AN EXISTING LICENSEE): LICENSEE NAME: ADDRESS: CITY/TOWN: STATE ZIP CODE LICENSE TYPE SHIP MASTER LICENSE FOR SALE OF ALCOHOLIC BEVERAGES TO PASSENGERS FEE $500.00 # OF PERMITS 1 COST $500.00 YOU MUST MAIL THIS TRANSMITTAL FORM ALONG WITH YOUR CHECK AND COMPLETED APPLICATION TO: ALCOHOLIC BEVERAGES CONTROL COMMISSION P. O. BOX 3396 BOSTON, MA 02241-3396 American LegalNet, Inc. www.FormsWorkFlow.com Application for a License to Sell Alcoholic Beverages on a Ship YEAR 20 1. LICENSEE INFORMATION: Name of Applicant: Business Name (if different) : Manager of Record: Address of Premises: Address of Warehouse (if different from above) Phone Number of Premises: Email: CITY/TOWN: CITY/TOWN: Other Phone: Website: STATE STATE ZIP ZIP 2. LICENSEE STRUCTURE: The Applicant is a(n): Please select Other : If the applicant is a Corporation or LLC, complete the following: State of Incorporation/Organization: Shares of stock are authorized: Date of Incorporation/Organization: Shares of stock are issued: IMPORTANT ATTACHMENTS: Attach the vote by the Board of Directors or LLC Managers appointing a manager or principal representative as well as the Articles of Organization as filed with the Secretary of State's Office. 3. INTERESTS IN THIS LICENSE: List all individuals involved in the entity (e.g. corporate stockholders, directors, officers and LLC members and managers) and any person or entity with a direct or indirect, beneficial or financial interest in this license (e.g. landlord with a percentage rent based on alcohol sales). IMPORTANT ATTACHMENTS: All individuals or entities listed below are required to complete a Personal Information Form. Name Title Beneficial Interest Stock or % Owned *If additional space is needed, please use last page. American LegalNet, Inc. www.FormsWorkFlow.com Application for a License to Sell Alcoholic Beverages on a Ship 4. PRIOR LICENSE ACTION: Has any person or entity who has a direct or indirect beneficial interest in this license ever had a license to sell alcoholic beverages suspended, revoked or cancelled? If yes, list said interest below: Yes No DATE LICENSE REASON WHY LICENSE WAS SUSPENDED, REVOKED OR CANCELLED 5. SHIP INFORMATION: Name of Ship to be Licensed: License Category: Ship to be Docked at: Months of Operation From: Yes Yes To: No No All Alcoholic Wine and Malt Is the ship fully built and ready for ABCC inspection? Does the ship have current Coast Guard Certification? (Must be provided) 6. DESCRIPTION OF SHIP: Please provide a complete description of the premises to be licensed. The description should include the location of all entrances and exits. Attach a diagram with dimensions and square footage for each level. Maximum Capacity Crew Size: Pursuant to M.G.L. Ch. 62C, Sec. 49A, I certify under the penalties of perjury that, I have filed all state tax returns and paid all state taxes required under law. I further understand that each representation in this application is material to the determination of the application and state under penalty of perjury that all statements and representations therein are true. Signature Title Date American LegalNet, Inc. www.FormsWorkFlow.com The Commonwealth of Massachusetts Alcoholic Beverages Control Commission 239 Causeway Street Boston, MA 02114 www.mass.gov/abcc PERSONAL INFORMATION FORM Each individual listed in Section 10 of this application must complete this form. 1. LICENSEE INFORMATION: B. Business Name (dba) A. Legal Name of Licensee C. Address E. City/Town F. Phone Number of Premise D. ABCC License Number (If existing licensee) State G. EIN of License Zip Code 2. PERSONAL INFORMATION: A. Individual Name C. Address D. City/Town E. Social Security Number G. Place of Employment State F. Date of Birth Zip Code B. Home Phone Number 3. BACKGROUND INFORMATION: Have you ever been convicted of a state, federal or military crime? Yes No If yes, as part of the application process, the individual must attach an affidavit as to any and all convictions. The affidavit must include the city and state where the charges occurred as well as the disposition of the convictions. 4. FINANCIAL INTEREST: Provide a detailed description of your direct or indirect, beneficial or financial interest in this license. IMPORTANT ATTACHMENTS (8): For all cash contributions, attach last (3) months of bank statements for the source(s) of this cash. *If additional space is needed, please use the last page I hereby swear under the pains and penalties of perjury that the information I have provided in this application is true and accurate: Signature Title Date (If Corporation/LLC Representative) American LegalNet, Inc. www.FormsWorkFlow.com The Commonwealth of Massachusetts Alcoholic Beverages Control Commission 239 Causeway Street Boston, MA 02114 www.mass.gov/abcc MANAGER APPLICATION All proposed managers are required to complete a Personal Information Form, and attach a copy of the corporate vote authorizing this action and appointing a manager. 1. LICENSEE INFORMATION: Legal Name of Licensee: Address: City/Town: ABCC License Number: (If existing licensee) State: Zip Code: Business Name (dba): Phone Number of Premise: 2. MANAGER INFORMATION: A. Name: B. Cell Phone Number: C. List the number of hours per week you will spend on the licensed premises: 3. CITIZENSHIP INFORMATION: A. Are you a U.S. Citizen: Yes No B. Date of Naturalization: C. Court of Naturalization: (Submit proof of citizenship and/or naturalization such as Voter's Certificate, Birth Certificate or Naturalization Papers) 4. BACKGROUND INFORMATION: A. Do you now, or have you ever, held any direct or indirect, beneficial or financial interest in a license to sell alcoholic beverages? If yes, please describe: Yes No B. Have you ever been the Manager of Record of a license to sell alcoholic beverages that has been suspended, revoked or cancelled? If yes, please describe: Yes No C. Have you ever been the Manager of Record of a license that was issued by this Commission? If yes, please desc
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