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Application For State Of Illinois Non-Resident Dealers Liquor License IL 567-0059 - Illinois
| Application For State Of Illinois Non-Resident Dealers Liquor License Form. This is a Illinois form and can be used in Liquor Control Commission Statewide . |
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Illinois Liquor Control Commission Rod R. Blagojevich Governor 100 W. RANDOLPH ST. SUITE 7-801 CHICAGO, ILLINOIS 60601 TELEPHONE: 312-814-2206 FAX: 312-814-2241 TDD: 312-814-1844 101 W. JEFFERSON ST. SUITE 3-525 SPRINGFIELD, ILLINOIS 62702 TELEPHONE: 217-782-2136 FAX: 217-524-1911 WEB SITE: www.state.il.us/LCC APPLICATION FOR STATE OF ILLINOIS NON-RESIDENT DEALER'S LIQUOR LICENSE DEFINITIONS A Non-resident Dealer's license shall permit such licensee to ship into and warehouse alcoholic liquor in this State from any point outside of this State, and to sell such alcoholic liquor to Illinois-licensed foreign importers and importing distributors and to no one else in this State; provided that said Non-resident Dealer shall register with the Illinois Liquor Control Commission each and every brand of alcoholic liquor which it proposes to sell to Illinois licensees during the license period; and further provided that it shall comply with all of the provisions of Section 6-9 of the Liquor Control Act with respect to registration of such Illinois licensees as may be granted the right to sell such brands at wholesale. Please note that you must appoint an Illinois-licensed distributor (see page 3). If you have agents, representatives or persons acting on your behalf in Illinois that sell or discuss pricing terms of alcoholic liquor you are required to register each of these individuals by submitting forms IL 567-0053 "Application for Registration - Manufacturer's Registered Agent", and IL 567-0054 "Statement of Representation - Registration of Manufacturer's Agent". ! ! ! Currently licensed Illinois manufacturer - Class 1- Distiller, Class 2- Rectifier, or Class 3-Brewer. Non-resident dealer who is a manufacturer of less than 500,000 gallons per year combined plant total, or agent thereof AND/OR Primary U.S. Importer exporting less than 500,000 gallons into Illinois yearly, or agent thereof. Non-resident dealer who is a manufacturer of 500,000 gallons or more per year combined plant total, or agent thereof AND/OR primary U.S. importer exporting 500,000 gallons or more into Illinois yearly, or agent thereof. FEE: NONE FEE: $90.00 FEE: $270.00 Please include the following REQUIRED supporting documents: · The enclosed Registration Statement; · The following U.S. Department of the Treasury Tax and Trade Bureau applicaton forms (please visit the TTB website at www.ttb.gov or call 1-877-882-3277 or for further information regarding these forms): a) A copy of the Label Approval. Visit www.ttb.gov to download the F 5100.31 application form; b) A copy of the Basic Permit. Visit www.ttb.gov to download the F 5100.24 application form; · The enclosed Schedule L (RL-26-L) from the Illinois Department of Revenue (please call IDOR at 217-785-2622 should you require further assistance); · The enclosed Application for Registration Manufacturer's Registered Agent (if applicable*); · The enclosed Statement of Representation Registration of Manufacturer's Agent (if applicable*). *If you have agents, representatives or persons acting on your behalf in Illinois that sell or discuss pricing terms of alcoholic liquor, you are required to register each of these individuals by submitting the above two forms. IMPORTANT NOTICE: THE ILLINOIS LIQUOR CONTROL COMMISSION IS REQUESTING DISCLOSURE OF INFORMATION THAT IS NECESSARY UNDER THE ILLINOIS LIQUOR CONTROL ACT (235 ILCS 5/1 ET SEQ.). DISCLOSURE OF THIS INFORMATION IS MANDATORY. FAILURE TO PROVIDE ANY INFORMATION WILL RESULT IN THE NON-ISSUANCE OF YOUR LICENSE. FORM APPROVED BY THE STATE FORMS MANAGEMENT CENTER. IL 567-0059 (03/2006) Printed on Recycled Paper Page 1 of American LegalNet, Inc. 4 www.FormsWorkflow.com FOR OFFICE USE ONLY LICENSE NO. DATE ISSUED EXPIRATION DATE Application for State of Illinois Non-resident Dealer's Liquor License A. CORPORATE/BUSINESS(DBA) INFORMATION 1. FEIN Enter your Federal Employer Identification Number (FEIN) in this box. The FEIN is a nine-digit number issued by the U.S. Internal Revenue Service. This number is used for verification purposes only. If you do not have an FEIN number, call 1-800-829-3676 for general information on how to apply and to obtain the forms you will need. NOTE, if you have filed an application for your FEIN number, the Commission will accept your application. FEIN # 2. TELEPHONE Enter the area code/telephone number/extension of the corporation, partnership etc. AREA CODE/TELEPHONE NO. ( ) EXT. 3. CORPORATE NAME (Also list trade or business name, if different from corporate name) Enter the name of the corporation (Illinois, national, or foreign), partnership or limited liability company in this box. CORPORATE NAME DBA NAME 4. CHIEF OPERATING ADDRESS Enter the street address, city, state, and Zip Code of the corporation, partnership, etc.. ADDRESS CITY STATE ZIP CODE 5. CONTACT PERSON List the name and address of the person upon whom all "Service of Process" shall be made on behalf of the applicant and to be contacted in the event of any other problems or questions (person need not be an Illinois resident). NAME ADDRESS CITY STATE ZIP CODE IL 567-0059 (03/2006) Printed on Recycled Paper AmericanPage 2 of 4 LegalNet, Inc. www.FormsWorkflow.com B. APPLICANT INFORMATION 6. Applicant is the: Actual Manufacturer of the products described herein. Primary United States importer of products described herein which are manufactured outside of the United States (Provide an appointment letter from the manufacturer). Duly registered agent of the manufacturer or duly registered agent of the primary U.S. importer of products described herein. (Provide an appointment letter from the manufacturer). 7. (a) (b) List, alphabetically, on separate sheet and attach, all of the alcoholic beverage products for distribution in Illinois, which you manufacture, by their full product name as shown on their federally (BATF)approved labels. If you are not the actual manufacturer of any given alcoholic beverage product(s) which you distribute for sale within Illinois, list alphabetically, by manufacturer on a separate sheet, all of the alcoholic beverage products which you distribute as primary United States importer or duly registered agent. NOTE: THE ANSWERS TO QUESTIONS 7(a) AND 7(b) DO NOT FULFILL THE SEPARATE REGISTRATION REQUIREMENTS SET FORTH IN SECTION 5/6-9 OF THE ACT AND SECTION 100.60 OF THE RULES OF THE COMMISSION. THE SAME ARE TO BE REPORTED ON THE REGISTRATION FORM OF THIS COMMISSION. PRODUCTS NOT SO REGISTERED MAY NOT
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