South Carolina > Statewide > Department Of Revenue > Alcoholic Beverage Licensing
Application For Special Bakery License ABL-904 - South Carolina
| Application For Special Bakery License Form. This is a South Carolina form and can be used in Alcoholic Beverage Licensing Department Of Revenue Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
1350 STATE OF SOUTH CAROLINA DEPARTMENT OF REVENUE ABL-904C (Rev. 1/14/09) 4384 ABL 904 CHECKLIST For your application to be processed you must fulfill ALL of the following requirements: ABL 904 Checklist: 1. Completed application, signed, dated and notarized. 2. Submit nonrefundable filing fees, if applicable. 3. Submit an Affidavit of Publication from the newspaper running your ad. The affidavit must include a copy of your ad. If you have just started your ad in the newspaper and have not received the ad and affidavit, you must include the receipt from the newspaper with your application. Forward the ad and affidavit from the newspaper as soon as the newspaper provides it to you. Your license/permit cannot be issued until this is received. 4. Must complete the "Consent and Waiver." 5. All principals must attach a criminal records check (CRC), not more than 90 days old. If the principal has lived in SC for more than 2 years, obtain the CRC from SLED at www.sled.state.sc.us or SLED Headquarters, Criminal Records Department, 4400 Broad River Rd., P.O. Box 21398, Columbia, SC 29221. If the principal has lived in SC less than 2 years, obtain a CRC from previous state of residency AND a CRC from SLED. If principal is not a SC resident, obtain a CRC from current state of residency. 6. Submit a copy of your lease. If you own the property you must submit a copy of the deed or tax bill. 7. EFFECTIVE JULY 1, 2008: Must attach completed appropriate residency status verification affidavit. Use Verification of Lawful Presence in the US (ABL-577) for owners of sole proprietorships. Use Verification of Lawful Background for Applicant's Principals (ABL-920) for each principal, if other than sole proprietor. Each principal, officer, owner, member, and/or partner MUST sign the appropriate form. If applicable, include his/her non-citizen alien registration number and attach a copy of all appropriate immigration documents. 43841014 American LegalNet, Inc. www.FormsWorkFlow.com 1350 STATE OF SOUTH CAROLINA DEPARTMENT OF REVENUE APPLICATION FOR SPECIAL BAKERY LICENSE Mail to: SCDOR, ABL Section, Columbia, SC 29214-0907 Telephone: (803) 898-5864 DOR Website: www.sctax.org PLEASE PRINT OR TYPE ALL INFORMATION Nonrefundable Filing Fee $200 License Fee $1,200 Total Fees Biennally $1,400 File Number License Period Ending DLN DLN ABL-904 (Rev. 1/14/09) 4346 For Office Use Only 14-3976 SLED 34-3973-9100 1. Owner, Partnership, or Corporate Charter Name 2. Physical Location of Business Required (No. P.O. Box) STREET CITY COUNTY (REQUIRED) STATE ZIP 3. Mailing Address (For All Correspondence) STREET CITY COUNTY STATE ZIP 4. Type of Ownership Sole Proprietor (one owner) SC Corporation Date Inc. Non-Profit Organization Partnership (two or more owners) LLC/LLP Foreign Corporation (Attach Copy of Articles or Certificate of Authority) Other (Explain) 5. Trade Name (Doing Business) 6. Business Phone Number 7. Federal Identification Number 8. Social Security Number 9. Location of Records (No P.O. Box) Daytime Phone Number Section 61-6-720. Notwithstanding any other provision of this title, a person who operates in this State a bakery for the preparation of food items, in which food items alcoholic beverages are used as ingredients, and which food items are manufactured for and sold at wholesale, must apply for a special bakery food manufacturer's license from the department, in accordance with Section 61-6-100(2), or from a retailer licensed pursuant to Section 61-6-100(3), or from a manufacturer in containers holding greater quantities of alcoholic liquor than wholesalers or retailers have authority to sell. 43461029 American LegalNet, Inc. www.FormsWorkFlow.com 10. HAS THIS LOCATION BEEN PREVIOUSLY LICENSED TO SELL BEER, WINE AND/OR ALCOHOLIC LIQUORS? IF YES PRINT NAME OF BUSINESS AND BEER, WINE AND LIQUOR LICENSE PERMIT NUMBER. A. PREVIOUS OPERATOR'S LICENSE NUMBER: B. NAME OF BUSINESS : (Full organization name including trade name) DESIGNATED AGENT A. You must designate a person to receive all notices from the Department of Revenue concerning your permit/license. These notices will be sent to the person at the mailing address shown in question 3. It is your responsibility to keep the department advised of any change regarding this person or your mailing address as the law will presume you received all notices sent to the address you have given us. Must be 21 years of age and a resident of South Carolina. Name of Designated Agent: Home Address of Designated Agent STREET ADDRESS, CITY, STATE, ZIP (NO PO BOX) Date of Birth: CONTACT PERSON B. The S.C. State Law Enforcement Division will conduct an investigation on this application, and will need to meet with the contact person at the location for which you are seeking a permit or license, to discuss the business and ownership of the business. Give the name and telephone numbers (daytime and evening) of the contact person who can meet with the SLED agent for this purpose. Name of Contact Person Telephone Number Telephone Number (daytime) (evening) If the agent is unable to contact the Contact Person or if the Contact Person cannot discuss the ownership of the business, your application will be delayed. Processing of this application may take six to eight weeks, or more. If the application is denied by the Department or protested by a member of the public or law enforcement, it could take up to six months or more for a hearing to be held and a decision made on the application by the Administrative Law Court. If applying for an off-premises beer and wine permit, wholesale beer and wine permit, or 7-day beer and wine permit, I do hereby stipulate that I will not permit the on-premise consumption of beer and wine on the licensed premises. I understand that a violation of this stipulation will be a violation against the permit and shall constitute sufficient grounds to suspend or revoke the beer and wine permit. I understand that a misstatement or concealment of fact in an application is sufficient grounds for the revocation of the license or permit. I consent to the inspection of the premises covered by this license or permit by any agent of the SC Department of Revenue or any law enforcement officer. I have read the instructions to this application and to the best of my knowledge, all information provided with this application is true and accurate. SWORN to and subscribed before me this day of Notary Public for My Commission Expires: Notary (L.S.) Notary (printed nam
|
|||||||
