Application For Brokerage Representative Permit For Spirituous Liquor

APPLICATION FOR BROKERAGE REPRESENTATIVE PERMITFOR SPIRITUOUS LIQUOR. This form is used in North Carolina and requires applicants to provide personal information, disclose any relationship with ABC Board members or employees, list previous permits held, detail previous employers, disclose any criminal convictions, and attach a recent photo and certified criminal record check. The completed form must be notarized and sent to the NC ABC Commission in Raleigh, NC. Application Requirements: A. Complete this form entirely (please write legibly or type) and signature must be NOTARIZED. B. Include a recent photo. C. Include a Certified Criminal Record Check (obtained from the Clerk of Court in the county where you reside) or a certified copy of a court record(s) from the last jurisdiction where you have maintained a residence for one year or more. If there is no record, please have the Clerk of Court in the jurisdiction so certify. www.FormsWorkflow.com