Mississippi > Statewide > State Tax Commission > Office Of Alcoholic Beverage Control
Alcohol Processing Permit Application - Mississippi
| Alcohol Processing Permit Application 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, ALCOHOL PROCESSING PERMIT RETURN TO ALCOHOLIC BEVERAGE CONTROL DIVISION PERMIT DEPARTMENT P.O. BOX 540 MADISON, MS 39130-0540 American LegalNet, Inc. www.FormsWorkFlow.com INSTRUCTIONS PLEASE READ PRIOR TO COMPLETING THIS FORM The applicant's signature must be notarized by a licensed Notary Public. Submit either an original application for a sales tax number, a copy of the sales tax application, or if already granted a sales tax number, list the number in item II of the application form. Locate on this application form the ownership classification of the applicant, whether a sole owner, partnership, corporation, limited liability company, trust or other. Note the instructions on who must file qualifying documents (PERSONAL RECORD, Form 1001). Be sure to complete the PERMITTEE CERFICATION AND OATH ending this portion of the application. Each manager 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 Dept. of Revenue District office. You must submit certified funds in the amount of $32.00 per person payable to the "ABC-FF" with this application to cover the cost of processing your fingerprint cards. 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 Dept. of Revenue District Office before we can continue processing your application. Complete the WAIVER AND AUTHORIZATION TO RELEASE INFORMATION. This release will assist us in verifying the information on your application. 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 located nearest your business and within the same county. The 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. You must include a check for $25.00 payable to ABC for your permit fee. American LegalNet, Inc. www.FormsWorkFlow.com (06/2010) PERMIT DEPT. USE ONLY CHECK NUMBER PERMIT NUMBER ALCOHOL PROCESSING PERMIT APPLICATION I. APPLICANT: (Name of sole owner, partnership, Limited Liability Company or Corporation) MAILING ADDRESS: (Street/post office box) (City) (State) (Zip) II. BUSINESS: (TRADENAME) ADDRESS: (Street) (City) (Zip) COUNTY: III. Sales Tax Number ( ) Trust TYPE OF APPLICANT ENTITY: ( ) Sole Owner ( ) Partnership ( ) Corporation ( ) Limited Liability Company ( ) Other IV. Have you or any member of your partnership, LLC, association, or any officer, director, or stockholder of your corporation, ever been convicted of any of the following: a felony regardless of its nature in any state of federal court, a violation of the Local Option Alcoholic Beverage Control Laws, a violation of any other law relating to alcoholic beverages, beer or light wine, or a violation of any drug related law? V. How are alcoholic beverages used, or planned to be used, as an integral ingredient in your manufacturing process? (Attach additional explanation if needed). ______________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________ _____________________________________________________________________. VI. Anticipated total amount, in gallons, of alcoholic beverages used in your manufacturing process annually: American LegalNet, Inc. www.FormsWorkFlow.com VII. Will this business be operated as a sole ownership by the person applying for this permit? If "yes", submit a PERSONAL RECORD (Form1001) with this application. Will this business be operated as a partnership? PERSONAL RECORD Form 1001), with this application. NAME HOME ADDRESS VIII. If "yes", submit a AMT. OF INTEREST OWNED NOTE: EACH PARTNER MUST SUBMIT A PERSONAL RECORD FORM (1001) WITH THIS APPLICATION. Additionally, you must submit a copy of the partnership agreement with this application. IX. Will this business be operated as a corporation? If "yes", list the total amount of stock, common and preferred, and each officer, director, and stockholder of the company below. Also include a copy of the corporate charter. NAME CORP. TITLE ADDRESS SHARES OWNED ____ _ _______________ _______________ ____________________ NOTE: Each officer, director, and stockholder owning 10% or m ore of the company's stock must submit a PERSONAL RECORD (Form 1001) X. Will this business be operated as a limited liability company? If "yes", list each member below, address, and percentage of ownership and indicate, where applicable, managing member: NAME TITLE ADDRESS % OWNED ____ _ _______________ _______________ ____________________ NOTE: Each member of the limited liability company must submit a PERSONAL RECORD Form (1001) with this application. Additionally, you must submit a copy of your limited liability company agreement with this application. American LegalNet, Inc. www.FormsWorkFlow.com XI. Will this business be operated as a trust? each beneficiary below: NAME TYPE If "yes", list the trustee and STATE OF RESIDENCY NOTE: Each trustee must submit a PERSONAL RECORD Form (1001) with this application. Additionally, you must submit a copy of your trust instrument with this application. American LegalNet, Inc. www.FormsWorkFlow.com CERTIFICATION AND OATH I, , certify under penalty or perjury that the organization applying for this Alcohol Processing Permit does meet the qualifications for Sections 67-1-37, 67-1-51 (I), 67-1-55, 67-1-57, and 67-1-59. I affirm that this organization, in the exercise of this permit, will comply with the Local Option Alcoholic Beverage Control Laws, Rules, and Regu
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