Mississippi > Statewide > State Tax Commission > Office Of Alcoholic Beverage Control
Apppliaction For Transfer In Officers Stock Of Alcoholic Beverage Retailers Permit - Mississippi
| Apppliaction For Transfer In Officers Stock Of Alcoholic Beverage Retailers Permit Form. This is a Mississippi form and can be used in Office Of Alcoholic Beverage Control State Tax Commission Statewide . |
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APPLICATION, ALCOHOLIC BEVERAGE CONTROL TRANSFER IN CORPORATE /OFFICERS/STOCK/STRUCTURE OR TRANSFER IN LLC OWNERSHIP/MEMBERSHIP/STRUCTURE RETURN TO: ALCOHOLIC BEVERAGE CONTROL DIVISION PERMIT DEPARTMENT P. O. BOX 540 MADISON, MS 39130-0540 American LegalNet, Inc. www.FormsWorkFlow.com APPLICATION INSTRUCTIONS Please read these instructions prior to completing this application for a transfer in your principal corporate officers; principal directors; changes in corporate structure; or, transfers in corporate ownership through stock transfers; as well as changes in LLC owners (members). Any ownership changes must be approved by the Department prior to the change actually taking place. Each applicant must meet the statutory qualifications set by the Local Option Alcoholic Beverage Control Laws, Title 67, Chapter 1, 1972 MCA. The Department, under authority of these laws, has established policies requiring applicants to file certain documents concerning the applicant's place of business. This application also asks for particular information concerning each applicant to allow the Department to determine the eligibility of the applicant. This application may be typed or neatly printed in ink. The permit fee includes a non-refundable $25.00 processing fee. If you currently pay for alcoholic beverage orders by certified funds, then you must submit certified funds to pay this fee as well. Complete the APPLICATION FOR TRANSFER. This form must be completed in its entirety. Then, complete the STATEMENT OF OWNERSHIP. This form contains instructions on who must file qualifying documents (PERSONAL RECORD Form 1001; SUMMARY FINANCIAL STATEMENT, Form 2007; and two (2) applicant fingerprint cards) with this application. Note that the officers and the corporation itself must file separate SUMMARY FINANCIAL STATEMENTS. For a LLC, new members and the LLC itself must file separate SUMMARY FINANCIAL STATEMENTS. Also, include a copy of the corporate minutes that reflect any change in officers or corporate structure. If stock was sold, you will also need to submit a copy of the document evidencing the sale/transfer of stock. ABC collects a pass-along fee for fingerprint card processing by the Federal Bureau of Investigation. This fee is due and payable with the application submission. This fee is $32.00 fee for each applicant and should be made payable to the "ABC-FF". Payment must be in the form of certified funds. Each applicant must submit two (2) fingerprint cards with this application. The applicant must be fingerprinted by a law enforcement officer on ABC "Applicant" fingerprint cards. The cards must be complete, legible, and capable of being classified by the Federal Bureau of Investigation. Some law enforcement agencies have ABC fingerprint cards on hand. If you need fingerprint cards, contact the Permit Dept. or visit your local MS Department of Revenue District office. American LegalNet, Inc. www.FormsWorkFlow.com Applicants can't be indebted to the State of Mississippi for any fees or taxes. Your MISSISSIPPI INCOME TAX filing status, if applicable, will be verified for the past three (3) years. If our records indicate that you are delinquent in filing these returns (or you are indebted to the State of Mississippi for any other taxes or fees), you will be notified and must obtain clearance from your local Department of Revenue District Office before we can continue processing your application. Signatures on each PERSONAL RECORD form must be notarized and the waiver portion of the SUMMARY FINANCIAL STATEMENT form must be completed. Be sure to complete the PERMITTEE CERTIFICATION AND OATH along with the WAIVER AND AUTHORIZATION TO RELEASE INFORMATION. This release will assist us in verifying information on your application. You may be required to publish notice of your application. If you are an officer who owns 10% or more of stock, or a stockholder with 10% or more stock, then you will be required to publish your intent. All changes in LLC ownership must be published as well. You are required to publish notice of your application in two (2) consecutive issues of a newspaper published in the town in which the business will be located. If no local newspaper exists, the notice may be published in the newspaper produced in the town nearest your business and within the same county. This notice must be published in its entirety in TEN POINT BOLD FACE TYPE. An acceptable legal notice format is included in this packet. Submit with this application a PUBLISHER'S AFFIDAVIT (obtained from the newspaper) as proof of publication. ALCOHOLIC BEVERAGE CONTROL PERMIT DEPARTMENT P O BOX 540 MADISON, MS 39130-0540 PLEASE ALLOW AMPLE TIME FOR PROCESSING YOUR APPLICATION. If you need assistance, call the ABC Permit Department at 601-856-1330. American LegalNet, Inc. www.FormsWorkFlow.com (REVISED 06/10) PERMIT DEPT USE ONLY AMT OF CHECK CHECK NUMBER PERMIT NUMBER APPLICATION, TRANSFER IN CORPORATE /OFFICERS/STOCK/STRUCTURE OR TRANSFER IN LLC OWNERSHIP/MEMBERSHIP/STRUCTURE To report corporate changes complete all parts, except part II, and complete the Statement of Ownership for Corporate Entities. To report changes in LLC membership/ownership, complete all parts, except for part I, and complete the Statement of Ownership for LLCs. I. I, (corporate officer's name president/vice president, etc.) , hereby submit application for a transfer in officers of: (corporate name) (doing business as) from ______________________________________________________________________________ to ___________________________________________________________________________________ ______________________________________________________________________________________ AND/OR report the following transfer of stock for 10% or greater stock transfers/sales from the following: To: American LegalNet, Inc. www.FormsWorkFlow.com Telephone Number (business) II. I, ( title/position with limited liability company) (cell) , hereby submit application for a change in membership/ownership with : (limited liability company name) doing business as ____________________________________________________________________ from ______________________________________________________________________________ to ___________________________________________________________________________________ ______________________________________________________________________________________ Telephone Number (business) III. (cell) Does the applicant have, or has the applicant
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