Connecticut > Statewide > Department Of Consumer Protection > Liquor Control Division
Application For Out-Of-State Shippers Permit CPLOS-01 - Connecticut
| Application For Out-Of-State Shippers Permit Form. This is a Connecticut form and can be used in Liquor Control Division Department Of Consumer Protection Statewide . |
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CPLOSINST New 1/06 STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION Liquor Control Division Telephone: (860) 713-6200 Email: liquor.control@ct.gov Website: www.ct.gov/dcp Instructions for Completing the Application for Out-of-State Shipper's Permit Enclosed is an application for an Out-of-State Shipper's Permit allowing the sale of alcoholic liquor, beer or wine. Please note the following when filing the application: · Applicant The name of the permittee is the applicant for the liquor permit. This is the individual who operates/manages an establishment holding a liquor permit. The permittee may, in some cases, also be the owner/backer of the business that holds the permit. Backer An individual or legal business entity that owns the business to which the liquor permit is issued. In the event that you must attach additional sheets of explanation for certain items on the application, additional sheets should be identified with the first and last name of t he permittee, the name of the business and the city in which the business will operate. · As an Out-of-State Shipper, you are required to; · Register Brand Labels A brand label registration application must be completed with brand name and unimerc code numbers. All applications except for an Out-of-State Winery permit which will be used for direct consumer sales only, must appoint wholesaler(s) with geographical territories of distribution. If franchise agreements or contracts are executed between an Out-of-State Shipper and Wholesaler, a copy must be filed with the Department of Consumer Protection. Home State Permit - Every application for an out -of-state shipper's permit shall be accompanied by a photostatic copy or by other documentary evidence of a permit or license issued by the state in which the applicant derives authority to manufacture, sell or distribute alcoholic liquors. Federal Basic Permit - Every application for an out-of-state shipper's permit shall be accompanied by a photostatic copy of the federal basic permit. Winery Out-of-State winery applicants shall furnish an affidavit affirming that the out -of-state winery did not produce more than one hundred thousand gallons of wine during the most recent calendar year, in order to be eligible to ship directly to retailers. F.O.B. Prices Every out-of-state shipper shall, annually on or before the 6t h day of January, file a complete schedule of all alcoholic liquors offered for sale in Connecticut. New items and changes in prices must b e submitted by the 6t h of the month to become effective on the 1st of the following month. Fees & Form of Payment The application must be accompanied by the application filing fee and the appropriate initial permit fee. Please refer to the chart below for the appropriate fee. Checks or money orders should be made payable to "Treasurer, State of Connecticut". The application filing fee is not refundable. Type of Permit Out-of-State Shipper's Permit for Alcoholic Liquor *Connecticut Out-of-State Shipper's Permit for Alcoholic Liquor Out-of-State Shipper's Permit for Beer *Connecticut Out-of-State Shipper's Permit for Beer Out-of-State Winery Shipper's Permit for Wine Application Filing Fee $100.00 + $100.00 + $100.00 + $100.00 + $100.00 + Initial Permit Fee $1000.00 = $ 45.00 = $1000.00 = $ 45.00 = $ 250.00 = Total Fee Due $1100.00 $ 145.00 $1100.00 $ 145.00 $ 350.00 · · · · · *Only Connecticut Wholesalers or an applicant for a Connecticut Wholesaler permit may apply for a Connecticut Out -of-State Shipper permit [ Return the completed application, appropriate documentation and fee to: + License Services Division Department of Consumer Protection 165 Capitol Avenue Hartford, CT 06106 American LegalNet, Inc. www.FormsWorkflow.com CPLOS-01, Rev 10/06 For Official Use Only STATE OF CONNECTICUT DEPARTMENT OF CONSUMER PROTECTION LIQUOR CONTROL DIVISION Telephone: (860) 713-6200 Email: liquor.control@ct.gov Website: www.ct.gov/dcp Application for Out-of-State Shipper's Permit INSTRUCTIONS: All spaces must be completed - please print in ink or type. A check or money order for the appropriate fee must accompany this application made payable to "Treasurer, State of Connecticut." Please check (ü) the permit type you are applying for: Alcoholic Liquor Beer Only Wine Only (Only Wineries May Apply) Applicant Name of Shipper Permittee (First Name, Middle Initial, Last Name) Street Address Telephone Number (w/ area code) Date of Birth City Social Security Number Email Address State Zip Code / / Have you, or any member of your family, either as permittee or backer ever been refused a permit or had a permit revoked by the Liquor Control Division? Yes No If yes, please attach name(s) and date(s) on a separate sheet of paper. Jurat for Applicant I affirm, under penalty of false statement, that my statements and answers to all questions in this application are true and complete. ____________________________________________________________ Signature of Applicant (Permittee) ______________________ Date Notary Seal Subscribed and sworn to before me , this __________ day of ______________________________ 20_________ ___________________________________________________________________ Signed: (Commissioner of Superior Court/Notary Public/Justice of the Peace _______________________ My Commission Expires Backer Name of Backer (The legal entity that owns the business) Business Street Address Telephone Number (w/ area code) Indicate Organizational Structure: Sole Proprietor Corporation Limited Liability Company (LLC) Limited Liability Partnership (LLP) Partnership If a corporation, please indicate date of incorporation and state where incorporated. If not a Connecticut corporation, please indicate the date of authorization to conduct business in the State of Connecticut. Have you or any of your employees or agents loaned any money or extended any credit in any form for a period in excess of thirty (30) days, directly or indirectly, to any person, firm or organization holding a permit for the sale of alcoholic liquor in the State of Connecticut? Yes No If yes, please attach on a separate sheet of paper, the names of permittees and the amounts of credit given. Have you, or any member of your family, either as permittee or backer ever been refused a permit or had a permit revoked by the Liquor Control Division? Yes No If yes, please attach name(s) and date(s) on a separate sheet of paper. American LegalNet, Inc. www.FormsWorkflow.com City FEIN
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