North Carolina > Statewide > Alcoholic Beverage Control Commission
Special One-Time Permit Application - North Carolina
| Special One-Time Permit Application Form. This is a North Carolina form and can be used in Alcoholic Beverage Control Commission Statewide . |
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NORTH CAROLINA ALCOHOLIC BEVERAGE CONTROL COMMISSION Location: 400 EAST TRYON ROAD RALEIGH NC 27610 (919)779-0700 APPROVED REJECTED BY: DATE: AMOUNT FEE PAID: DATE: RECEIVED BY: TEMP. #: MAIL TO ADDRESS ON BACK OF FORM (Do Not Write Above This Line) SPECIAL ONE-TIME PERMIT APPLICATION Application Instructions: A. B. C. D. Complete the application by typewriter or print in ink. Applicant's signature must be notarized. Special One-Time fee is $50.00. The fee must be submitted by certified check, cashier's check, or money order, and made payable to the North Carolina Alcoholic Beverage Control Commission. I hereby make application to the North Carolina Alcoholic Beverage Control Commission for a Special One-Time permit allowing the sale, transportation, or possession of alcoholic beverages because of the following circumstances: Please check applicable boxes. Required documents for each circumstance are in BOLD. I have acquired ownership or possession of alcoholic beverages through a special occurrence such as bankruptcy, inheritance, foreclosure, or judicial sale and I do not currently possess a permit for the sale of alcoholic beverages. - Official documentation explaining the details of how you came into possession of alcoholic beverages, such as a court order in a bankruptcy case, etc. - Inventory in detail of alcoholic beverages by quantity and brand. -------------------------------------------------------------------------------------------------------------------------------------------I am a collector of wine and/or decorative decanters of spirituous liquor needing authorization to bring into the state, transport or possess as a collector, a greater amount of alcoholic beverages than is otherwise authorized, or to sell those decanters in a manner to be authorized by the Commission - Give specific details on a separate sheet of paper explaining where you are traveling from and the destination; (home address) - Detailed inventory of products, by quantity and brand. -------------------------------------------------------------------------------------------------------------------------------------------I, as permittee, am going out of business and desire to sell my remaining stock to another permittee. - An inventory report containing those mixed beverage bottles you desire to sell. State the name, trade name, and address of permittee who will purchase the alcoholic beverages. - Complete Seller/Buyer information below. Seller(s) Name: Trade Name: Address: Street ` City State Zip Code Buyer(s) Name: Trade Name: Address: Street City State Zip Code American LegalNet, Inc. www.FormsWorkFlow.com COMPLETE THIS SECTION FOR ALL CIRCUMSTANCES: Beginning Date and Time: Month Day Year AM (circle one) PM Ending Date and Time: Month Day Year AM (circle one) PM PERSONAL INFORMATION OF APPLICANT: Applicant's Name: First (no abbreviations) Middle Last Date of Birth Applicant's Home Address City State Zip Code Applicant's Mailing Address, if different ( ) Home Telephone # ( ) Business Telephone # City ( ) State Zip Code FAX # I CERTIFY UNDER OATH OR AFFIRMATION THAT: - I am not less than 21 years of age. - I have not been convicted of a misdemeanor controlled substance offense or alcoholic beverage offense within the past two years. - I have not been convicted of a felony within the past three years, and if convicted of a felony before then, I have had my citizenship restored. - I have not had an alcoholic beverage permit revoked within the past three years. - All of the information supplied by me in this application is complete and accurate. Signature of Applicant Sworn to and subscribed before me this the Day Month Year My commission expires: Notary or other person qualified by law to administer oaths If sending by U.S. Postal Service (regular mail): MAIL THIS APPLICATION TO: If sending by U.S. Postal Service EXPRESS MAIL or by FEDEX/UPS: NC ABC COMMISSION 4307 MAIL SERVICE CENTER RALEIGH NC 27699-4307 NC ABC COMMISSION 400 EAST TRYON ROAD RALEIGH NC 27610 Special One Time Permit Application 11/2010 American LegalNet, Inc. www.FormsWorkFlow.com
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