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State Of Illinois Application For Tasting Representative License IL 567-0057 - Illinois

State Of Illinois Application For Tasting Representative License Form. This is a Illinois form and can be used in Liquor Control Commission Statewide .
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Illinois Liquor Control Commission Bruce Rauner 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 STATE OF ILLINOIS APPLICATION FOR TASTING REPRESENTATIVE LICENSE DEFINITION: "Tasting" means a supervised presentation of alcoholic products to the public at an off-premise licensed retailer for the purpose of disseminating product information and education, with consumption of alcoholic products being an incidental part thereof. Only products registered with the Illinois Liquor Control Commission may be tasted in the following amounts: Distilled Spirits - 1/4 oz., Wine - 1oz., and Beer - 2oz.; notice of the tasting may be given. A tasting must be done by a licensee and/or a registered tasting representative in accordance with Section 100.40 of the Illinois Liquor Control Commission Rules. FEE $300.00 Entitles licensee to conduct tastings. First year's certificate will expire the last day of the month previous to the month in which the license was issued. Subsequently, licenses are subject to annual renewal. ADD $25.00 The application must be received at Commission offices no less that fourteen (14) days prior to the first tasting session. Otherwise a $25 late fee will be assessed according to Section 100.40 of the Rules and Regulations. GENERAL INFORMATION: NOTE: Employees of an off-premise retail liquor licensee who wish to conduct tastings at the licensee's premises are not required to obtain a Tasting Representative license from the Illinois Liquor Control Commission. 1. TASTING REPRESENTATIVE: Any non-licensee wishing to conduct a tasting pursuant to Section 100.10(r) of the Commission's Rules and Regulations must obtain a license from the Illinois Liquor Control Commission. 2. TASTING REPRESENTATIVE LICENSEE EMPLOYEES: Employees of a corporation, partnership or limited liability company that has obtained a tasting representative license are not required to be licensed individually. Employees of these businesses will act as agents of the licensee. However, the licensee must provide a list of all employees who will be acting as agents under this license. This information shall include full name, home address, city, state, Zip Code, social security number, date of birth, sex, and home telephone number. This information must be updated immediately as changes occur. Persons who have had their liquor license revoked are not eligible to hold a asting representative license or act t as an agent on behalf of a tasting representative licensee. ASTINGS WILL BE PERFORMED: 3. LISTING MANUFACTURERS/DISTRIBUTORS/RETAILERS FOR WHICH T Each licensee is required to list the manufacturers/distributors/retailers whose products will be tasted. If additional manufacturers/ distributors/retailers are added throughout the year, the licensee must submit the appropriate information in writing along with a check for $12.00 to have a corrected license issued. 4. TASTING REPRESENTATIVE LICENSE CERTIFICA TE: The tasting representative must have a valid license certificate available for inspection during any tasting session. If the tasting representative is employed by a tasting representative licensee, a photocopy of the license certificate will suffice. 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 567-0057 (09/2016) Printed on Recycled Paper Page 1 of 4 American LegalNet, Inc. www.FormsWorkFlow.com FOR OFFICE USE ONLY LICENSE NO. DATE ISSUED EXPIRATION DATE COUNTER ! Application for State of Illinois Tasting Representative License 1. APPLICANT INFORMATION Provide the corporate/organization name; provide applicant name, if different; applicant telephone number; provide your corporate/organization mailing address; city, state,and Zip Code; Federal Employer Identification Number or Social Security Number; and date of first tasting. AGENCY NAME APPLICANT NAME BUSINESS AREA CODE/TELEPHONE NO. EXT. BUSINESS ADDRESS CITY STATE ZIP CODE FEIN OR SOCIAL SECURITY NUMBER DATE OF FIRST TASTING 2. STATUS OF BUSINESS Check the applicable box (assumed name/sole proprietorship, partnership, Illinois corporation, foreign corporation, limited liability company) which corresponds to your business' official papers filed with the Office of the Secretary of State. Based on the box that you check, provide the date of the filing of the sole proprietorship/assumed name with the county clerk; in the case of a copartnership, the date of formation of the partnership; in the case of an Illinois corporation, the date of its incorporation; in the case of a foreign corporation, the foreign state where it was incorporated and the date, as well as the date of its becoming qualified under the "Business Corporation Act of 1983" to transact business in the State of Illinois; in the case of a limited partnership, the date of formation of such partnership; or in the case of a limited liability company, the date of formation of such entity. A. B. C. D. E. ! ! ! ! ! ASSUMED NAME PARTNERSHIP ILLINOIS CORPORATION FOREIGN CORPORATION LIMITED LIABILITY COMPANY DATE FILED WITH COUNTY CLERK: DATE OF FORMATION: DATE OF INCORPORATION: STATE OF INCORPORATION: DATE FORMED: DATE QUALIFIED TO DO BUSINESS IN ILLINOIS: 3. OWNERSHIP INFORMATION Provide the owner/officer/partner information in accordance with the business status described under Question 2. This information must be submitted for all owners/officers/partners. The same information must be submitted for shareholders with interests equal to or exceeding 5%. The following information must be provided by every individual applicant, sole proprietor, partner, corporate officer or director (whether or not they own any stock), shareholder owning in the aggregate equal to or more than 5% of the stock, (including officers, directors and stockholders of equal to or more than 5% for all corporate shareholders), and/or manager or agent conducting the business. Indicate the total percentage of stock of the corporation, if any, which is held by persons who have less than a 5% interest. If addition
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