Kentucky > Statewide > Alcohol Beverage Control > Licensing
Schedule T Transporter License - Kentucky
| Schedule T Transporter License Form. This is a Kentucky form and can be used in Licensing Alcohol Beverage Control Statewide . |
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Schedule T 01/19/10 SCHEDULE "T" TRANSPORTER LICENSE LEAVE BLANK FOR ABC USE ONLY Site I.D. # License # _____________________________ License # _____________________________ $ ________________________ $ ________________________ Validating Number _____________________________ Validating Number _____________________________ Malt Beverage Administrator's Approval _______________________________________________ Date ________________________________ Distilled Spirits Administrator's Approval ________________________________________________ Date ________________________________ (A) Applicant's name(s) or company to be licensed ________________________________________________________________________________ DBA (Name of Business) _________________________________________________________________________________________________ Address of premises to be licensed _________________________________________________________________________________________ City _______________________________________________ County __________________ State ____________9 digit zip code ____________ Mailing address if different from above ______________________________________________________________________________________ Telephone ( ) ________________________ Fax ( ) ______________________ Other Phone ( ) __________________________ Enter amount of fee enclosed $ ___________________________ List the type(s) of licenses(s) you are applying for ______________________________________________________________________________ Enter the date you want this license to become effective (month)___________, (day) _____, (year) _______, through December 31st. (year)_____ (B) 1. Complete the following for the business proprietor, partner(s) and all persons interested in the business to be licensed. List all owners, officers, directors, partners, managing members, members, and shareholders (unless publicly held). Show 100% of the ownership. If additional space is needed, please make an attachment. H W F O H W F O H W F O Yes No USA CITIZEN NAME AND ADDRESS ALL PHONE NUMBERS H = HOME W = WORK F = FAX 0 = OTHER SOCIAL SECURITY NUMBER TITLE DATE OF BIRTH LIST DATE & STATE WHERE YOU RESIDED IN PAST 5 YRS. % OF OWNERSHIP % Yes No % Yes No % American LegalNet, Inc. www.FormsWorkFlow.com Page 2-Schedule - T 01/19/10 SCHEDULE "T" PAGE 2 SITE ID # (C) 2. Are you a commercial airline system, charter flight system, or a commercial cargo system company applying for an Air Transporter License? J Yes If yes, under KRS 243.050 (2)(3) list the storage location(s) if operating from more than one airport in Kentucky. ________________________________________________________________________________________. Are you a contract or common carrier for hire applying for a Liquor Transporter License? J Yes This license will authorize drop-offs, pick-ups and traveling through Kentucky. If yes, under KRS 243.200 attach a copy of your certificate of authority to transport as a common carrier issued by the Department of Transportation Federal Motor Carrier Safety Administration. Are you an out-of-state distiller, rectifier, vintner, wholesaler or distributor, applying for a Non-Resident Liquor Transporter License? J Yes If yes, attach a copy of your certificate of authority to transport as a common carrier issued by the Department of Transportation Federal Motor Carrier Safety Administration. 804 KAR 4:030 requires you to attach a corporate surety bond in the amount of $2,500. Is your bond attached? J Yes Are you applying for a Through Transporter Liquor License? J Yes If yes, list your ICC (Interstate Commerce Commission) number issued by the Kentucky Department of Transportation. ________. Attach a copy of your certificate of authority to transport as a common carrier issued by the Department of Transportation Federal Motor Carrier Safety Administration. 804 KAR 4:170 requires a Through Transporter to be a common carrier or a licensed vintner or distiller operating company owned trucks traveling over Kentucky highways. Are you applying for a Liquor Freight Forwarder License? J Yes If yes, 804 KAR 4:180 will allow you to receive, hold, and ship distilled spirits and wine by common carriers who are licensed by this Office. Are you a contract or common carrier for hire applying for a Malt Beverage (beer) Transporter License? Under KRS 243.210 this license will authorize drop-offs, pick-ups and traveling through Kentucky. If yes, attach a copy of your certificate of authority to transport as a common carrier issued by the Department of Transportation Federal Motor Carrier Safety Administration. J Yes J No 3. J No 4. J No J No J No 5. 6. J No 7. J No 8. Are you a beer distributor, wholesaler, or licensed transporter applying for a Special Beer Transporter License? J Yes J No If yes, 804 KAR 4:160 restricts transportation of malt beverages for export only through Kentucky. List the type of license you hold ________________________the state of issuance __________the license number__________. Do you understand that, if granted a license, authorized field representatives of the Ky. ABC Office may stop and examine cargo of any truck or vehicle in which distilled spirits, wine or malt beverages are being transported within the boundaries of the Commonwealth of Kentucky? J Yes Is the entire license fee paid by the applicant and by no other person? J Yes 9. J No J No J No J No J No 10. 11. Does anyone named in this application have an interest in any kind of alcoholic beverage business or the premises of any alcoholic beverage business other than that for which you are herein applying? J Yes If yes, describe the interest(s). _______________________________________________________________. a. Has the applicant or any person named in this application been convicted of any felony? b. Has the applicant or any person named in this application been convicted of a misdemeanor, directly or indirectly, related to alcohol or a controlled substance? If yes, to either question attach a statement giving a full explanation, including dates and convictions. J Yes J Yes 12. (D) AFFIDAVIT OF PERSON APPLYING FOR THE KENTUCKY ABC LICENSE(S) I, __(print your name here)___________________________________________________), do hereby swear or affirm that all statements contained in this application and all its attachments are true and correct to the best of my knowledge, information and belief. I further agree that I shall not engage in any activity involving alcoholic beverages at t
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