South Carolina > Statewide > Department Of Revenue > Alcoholic Beverage Licensing
ABL Renewal Form ABL-565 - South Carolina
| ABL Renewal Form 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-565 (Rev. 2/23/12) 4278 ABL RENEWAL FORM Renew and pay online. Go to www.scbos.sc.gov Mail to: SCDOR, ABL Section, Columbia, SC 29214-0907 **Renewal Fee Renewal Due Date: License Type 1. Mailing Name and Address Any change of address should be noted to the right of the old address. For Office Use Only File Number License Period Ending 2. A. B. C. Owner/Corporate Name (If Liquor Producer Rep., indicate the company you represent) Federal ID # Social Security # Licensee (If Sole Proprietor) Retail Sales Tax License # (REQUIRED) 3. Trade Name (If Applicable) 4. Business Address Ownership Type 5. If there is a change in your location's address, check why: ( business ( ) Other - Explain: County ) U.S. Postal Service changed address ( ) Moved location of 6. Have you, any partner, any principal, or any employee with day-to-day management responsibilities ever been convicted of a crime? Yes No If "yes", give details: 7. Review and sign this application. Return it with the appropriate renewal fee. If this application with the appropriate fee is not received by the S.C. Department of Revenue prior to the expiration date shown above, you must pay a filing fee along with the license fee. If your renewal is late, you may be required to file an application for a new license, publish a newspaper notice of your application, and wait on a SLED investigation. You must cease all sales of beer, wine, or liquor upon the expiration of your license, and may not resume sales until you receive your new license. Therefore, file your renewal application promptly. *Note: For faster processing renew online. (See information sheet attached for instructions for online renewing www.SCBOS.SC.GOV). By signing this application, I certify that all the information listed above is correct. (Signature of applicant) Date Telephone number from 8 am to 5 pm **61-6-120B: An applicant for license renewal or for a new license at an existing location shall pay a five dollar certification fee to determine if the exemptions provided for in subsection (A) apply. Subsection A refers to the distance requirements for retail liquor stores, business liquor by the drink and nonprofit private club liquor by the drink licenses. 42781021 American LegalNet, Inc. www.FormsWorkFlow.com CONSENT AND WAIVER ABL-946 Rev. 12/16/11 File Number: Name of Corporation, Partnership, LLC, etc. FEI S.C. Code Ann. Section 61-2-160 prohibits the issuance of any permit or license under Title 61 unless the Department determines that the applicant does not owe the State any delinquent taxes, penalties or interest. The signature(s) below authorizes the S.C. Department of Revenue, pursuant to the provisions of S.C. Code Ann. Section 12-54-240 and 30-2-10, et seq., to release to any party, person or entity, law enforcement request(s) for purposes of processing this application or responding to questions related thereto, including but not limited to an information related to problems with the application, reasons for denial, delinquent taxes, outstanding liabilities, failure to file returns, penalties and interest. The signature below also authorizes S.C. Law Enforcement Division (SLED) to check, examine and release to the Department of Revenue the criminal history record of the person(s) having signed below. If an application is made for a license or permit by a person other than an individual, all principals are deemed to be the applicant. S.C. Code Ann. Section 61-2-100(C). All principals of the applicant are therefore required to be disclosed to the Department of Revenue. SOCIAL SECURITY DISCLOSURE "In compliance with the Federal Privacy Act of 1974, the disclosure of an individual's social security number on this form is mandatory*. SC regulation 117-201 provides that any person required to make a return, statement or document to the Department must include identifying numbers on such return, statement or document if the Department requests such information. Social security numbers are primarily used for the purposes of identifying taxpayers and monitoring tax compliance and/or fraud." 1 - 12 is a list of principal types. Each principal type must complete and sign a box below. If a required principal does not sign, this application will be denied. Principal Types: 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. The owner (if sole proprietorship); All officers of the business or entity which owns the business; All partners (limited partners that cannot exercise management control need not sign); All persons who own twenty-five percent (25%) or more of the value of the business entity; All persons who own twenty-five percent (25%) or more of the combined voting power of the business or entity; Managers of a limited liability company which is managed by managers; Members of a limited liability company which is not managed by managers; Any fiduciary who manages, controls title, or is otherwise in control of the business; All employees who will have day-to-day operational management responsibility for the business or entity; and, If a publicly traded corporation, the designated license holder (designated agent) (must be over 21 and a resident of S.C.). All other principals must be listed also. If not a publicly traded corporation, list all stockholders. If a nonprofit organization, list all officers and directors of the organization. Name Home Address City Yr/Mo/Date of SC Residency Social Security No. Principal/Type: (use above #1-12) State Sex Zip Race Date of Birth Federal Employer Identification No. % of ownership Signature Have you as an individual, or as an organization in which you were a principal, had revoked or suspended in this state or any other state any license to sell beer, wine, or alcoholic liquors? Yes No If yes, attach explanation. Have you been convicted of a crime in South Carolina or any other state? Yes No If yes, attach explanation. Additional Space on Back. 44221018 American LegalNet, Inc. www.FormsWorkFlow.com File Number: Name Home Address City Yr/Mo/Date of SC Residency Social Security No. Principal/Type: (use above #1-12) State Sex Zip Race Date of Birth Federal Employer Identification No. % of ownership Signature Have you as an individual, or as an organization in which you were a principal, had revoked or suspended in this state or any other state any license to sell beer, wine, or alcoholic liquors? Yes No If yes, attach explanation. Have you been convicted of a crime in South Caro
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