Massachusetts > Statewide > Alcoholic Beverages Commission
Application For A Public Warehouse To Store Alcoholic Beverages - Massachusetts
| Application For A Public Warehouse To Store Alcoholic Beverages Form. This is a Massachusetts form and can be used in Alcoholic Beverages Commission Statewide . |
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Commonwealth of Massachusetts Alcoholic Beverages Control Commission 239 Causeway Street Boston, MA 02114 www.mass.gov/abcc The APPLICATION FOR A PUBLIC WAREHOUSE TO STORE ALCOHOLIC BEVERAGES MONETARY TRANSMITTAL FORM [APPLICATION MUST BE COMPLETED ONLINE] ECRT CODE: WARE $500.00 CHECK PAYABLE TO ABCC OR COMMONWEALTH OF MA: (CHECK MUST DENOTE THE NAME OF THE LICENSEE CORPORATION, LLC, PARTNERSHIP, OR INDIVIDUAL) 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 FEE # OF PERMITS COST WAREHOUSE $500.00 1 $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 Application for a Public Warehouse to Store Alcoholic Beverages (M.G.L. Chapter 138, §20A) 1. Licensee Information: Name of Applicant: Business Name (d/b/a, if different) Address of Premises: Telephone: City/Town: E-mail Address State Zip The undersigned being the holder of a Warehouseman's license, issued under §1 of Ch.105 of the General Laws, hereby applies for a permit to store and warehouse alcoholic beverages during the year 20 . IMPORTANT ATTACHMENT: Attach a copy of the Warehouseman's license. 2. Description of Premises: Provide a complete description of the premises to be used for storage including the number of rooms on each floor. 3. F.D.A. Compliance: Have you registered with the Food and Drug Administration? Yes No Registration Date: 4. Location of Premises: Is the premises located within 500 feet of a school or building devoted to divine worship such as a church or synagogue? Yes No (If yes, state information accurately and in full detail.) 5. Entities for which applicant will store alcoholic beverages: Name Address 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 Additional Space American LegalNet, Inc. www.FormsWorkFlow.com
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