Texas > Statewide > Alcoholic Beverage Commission
Application For Out-Of-State Winery Direct Shippers Permit L-106 - Texas
| Application For Out-Of-State Winery Direct Shippers Permit Form. This is a Texas form and can be used in Alcoholic Beverage Commission Statewide . |
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APPLICATION F O R OUT-OF-STATE WINERY DIRECT SHIPPER'S PERMIT TRADE NAME: TABC USE ONLY FORM L-106 (9/2011) ISSUE DATE FEE SURCHARGE LATE FEE (RENEWAL ONLY) DS 1. APPLICATION IS FOR: / / $150 Registry No. $376 FIRST READ ALL INSTRUCTIONS - TYPE OR PRINT IN INK Original Renewal/Change Change of: If renewal or change, enter the Permit No. DS2. APPLICANT IS: Individual Corporation Limited Liability Partnership Limited Liability Company Other: Partnership ALL APPLICANTS Limited Partnership 3. Trade Name of Business 4. Address of Location (must be in the United States) 5. Mailing Address 6. Business Telephone Number ( ) Alternate Telephone Number ( ) - City City E-Mail Address (optional) State State Zip Code (9 digits) Zip Code (9 digits) - 7. Provide the applicant's Texas Sales Tax Permit Number: NOTE: Your application cannot be approved without a valid Texas Sales Tax Permit Number. 8. Does the applicant hold a Winery Permit in the State of Texas? 9. Does the applicant operate a winery located in the United States and hold all state and federal permits necessary to operate the winery, including the federal winemaker's and blender's basic permit? If "YES,"please indicate your TTB Permit Number: 8. 9. YES NO YES NO INSTRUCTIONS: If Individual Owner, complete question 10. For all others, refer to Instructions on this page. INDIVIDUALS 10. Social Security Number - Issuing State / Driver's License Number Date of Birth (mm/dd/yyyy) / / 11. Full Legal Name (Last, First, Middle) 12. Permanent Mailing Address 13. Residential Address City City State State Zip Code (9 digits) Zip Code (9 digits) INSTRUCTIONS FOR: CORPORATIONS, LIMITED LIABILITY COMPANY, PARTNERSHIP, LIMITED PARTNERSHIP, LIMITED LIABILITY PARTNERSHIP, OTHER. For Corporations or Limited Liability Companies: Complete L-106-PC for all officer(s), partner(s), director(s), manager(s), stockholder(s), and member(s). For Partnership, Limited Partnership, or Limited Liability Partnership: Complete L-106-PC ensuring you include all partners involved in business. If one or more of your general or limited partners is a limited partnership or limited liability partnership complete L-106-PC for each partnership. If one or more of your general or limited partners is a corporation: Complete L-106-PC for each corporation or limited liability company. If applicant is a publicly held corporation: Provide pertinent information as indicated in 2 on L-106-PC on all stockholders holding 5% or more of the shares. INITIAL APPLICATION INCOMPLETE ADDITIONAL CORRESPONDENCE YES - NO PROCESSOR I.D.: Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS PROCESSOR REVIEW DATE: / YES - NO / PROCESSOR ERROR TABC USE ONLY YES - NO PROCESS DATE: / / PARTNERSHIPS/CORPORATIONS TRADE NAME: 1A. Indicate type of ownership and complete the information below: Corporation Limited Liability Company Partnership B. Federal Employer's I.D. No.: C. Entity Name: D. Charter No.: Date Approved: / / State: E. Number and class of shares, memberships or units issued: Limited Partnership FORM L-106-PC (8/2005) Limited Liability Partnership FOR ALL OFFICER(S), PARTNER(S), DIRECTOR(S), MANAGER(S), STOCKHOLDER(S) AND MEMBER(S). 2. COMPLETE THE FOLLOWING PER INSTRUCTIONS: Social Security Number Issuing State and Driver's License Number Date of Birth (mm/dd/yyyy) / / Stockholder/ Member Title Class & No. Shares Held or % Memberships or % Interest Full Legal Name (Last, First Middle) Officer Partner Director/ Manager Residential Address City State Zip Code (9 digits) - Social Security Number - Issuing State and Driver's License Number Date of Birth (mm/dd/yyyy) / / Stockholder/ Member Title Class & No. Shares Held or % Memberships or % Interest Full Legal Name (Last, First Middle) Officer Partner Director/ Manager Residential Address City State Zip Code (9 digits) - Social Security Number - Issuing State and Driver's License Number Date of Birth (mm/dd/yyyy) / / Stockholder/ Member Title Class & No. Shares Held or % Memberships or % Interest Full Legal Name (Last, First Middle) Officer Partner Director/ Manager Residential Address City State Zip Code (9 digits) - Social Security Number - Issuing State and Driver's License Number Date of Birth (mm/dd/yyyy) / / Stockholder/ Member Title Class & No. Shares Held or % Memberships or % Interest Full Legal Name (Last, First Middle) Officer Partner Director/ Manager Residential Address City State Zip Code (9 digits) - Social Security Number - Issuing State and Driver's License Number Date of Birth (mm/dd/yyyy) / / Stockholder/ Member Title Class & No. Shares Held or % Memberships or % Interest Full Legal Name (Last, First Middle) Officer Partner Director/ Manager Residential Address City State Zip Code (9 digits) - Social Security Number - Issuing State and Driver's License Number Date of Birth (mm/dd/yyyy) / / Stockholder/ Member Title Class & No. Shares Held or % Memberships or % Interest Full Legal Name (Last, First Middle) Officer Partner Director/ Manager Residential Address City State Zip Code (9 digits) - (IF YOU NEED ADDITIONAL SPACE FOR MORE NAMES, USE ADDITIONAL COPIES OF THIS PAGE) Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION F O R OUT-OF-STATE WINERY DIRECT SHIPPER'S PERMIT CONTINUTED TRADE NAME: FORM L-106 (9/2011) The applicant or permit and license holder may have an interest, directly or indirectly in only one level of the alcoholic beverage industry; i.e., manufacturing, wholesaling or retailing. You or your agent, servant or employee may not be employed in any capacity at different levels, may not rent or lease property or equipment from or to an entity operating at another level, may not secure credit or a loan in any form for an entity at another level, cannot control in any fashion the interests of a permittee or licensee at a different level. ALL APPLICANTS 15. Are you or anyone indicated in questions 10 on L-106 or 2 on L-106-PC in violation of the above requirements? If "YES," explain below or attach page: 11. YES NO 16A. Has any person named in questions 10 on L-106 or 2 on L-106-PC or his or her spouse been finally convicted or received deferred adjudication for a felony offense? B. If answer to 12A is "YES," has it been five years since the termination of a sentence, parole or probation served for any offenses indicated above? If "NO," attach an explanation. C. Has any person named in questions 10 on L-106 or 2 on L-106-PC been convicted of any offense(s) under federal or s
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