South Carolina > Statewide > Department Of Revenue > Alcoholic Beverage Licensing
Application For Food Manufacturers License ABL-903 - South Carolina
| Application For Food Manufacturers License Form. This is a South Carolina form and can be used in Alcoholic Beverage Licensing Department Of Revenue Statewide . |
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1350 STATE OF SOUTH CAROLINA DEPARTMENT OF REVENUE ABL-903C (Rev. 12/10/08) 4418 ABL 903 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" on page 3 of the application. 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 Presense 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. 44181014 American LegalNet, Inc. www.FormsWorkFlow.com 1350 STATE OF SOUTH CAROLINA DEPARTMENT OF REVENUE APPLICATION FOR FOOD MANUFACTURER'S LICENSE Mail to: SCDOR, ABL Section, Columbia, SC 29214-0907 Telephone: (803) 898-5864 DOR Website: www.sctax.org File Number License Period Ending DLN PLEASE PRINT OR TYPE ALL INFORMATION DLN Nonrefundable Filing Fee $ 200.00 License Fee $ 1400.00 Total Fees ABL-903 (Rev. 12/4/08) 4309 For Office Use Only 8/31 14-3975 $ 1600.00 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 Other (Explain) Partnership (two or more owners) LLC/LLP Foreign Corporation (Attach copy of Articles of Certificate of Authority) 5. Trade Name (Doing Business As) 6. Business Phone Number 7. Social Security Number 8. Location of Records (No P.O. Box) Daytime Phone Number Federal Identification Number 9. Attach copy of agreement you have with alcoholic beverage manufacturer. Applicant (owner, partner, or corporate officer) Section 61-6-710. Notwithstanding any other provision of this title, a person who manufactures in this State food items such as sauces and marinades in which there is an alcoholic beverage ingredient and who does so under an agreement with the alcoholic beverage manufacturer must apply for a special food manufacturer's license from the department, in accordance with Section 61-2-100, to purchase the alcoholic beverage directly from the manufacturer in containers holding greater quantities of liquor than are sold to a retail consumer. The department must establish the form of the application for the special food manufacturer's license." Social Security Privacy Act Disclosure It is mandatory that you provide your social security number on this form. 42 U.S.C 405(c)(2)(C)(i) permits a state to use an individual's social security number as means of identification in administration. SC Regulation 117-1 mandates that any person required to make a return to the SC Department of Revenue shall provide identifying numbers, as prescribed, for securing proper identification. Your social security number is used for identification purposes. 43091024 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 OPERATORS 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 th
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