Personnel Questionnaire-Alcohol And Tobacco Products {TTB F 5000.9} | Pdf Fpdf Doc Docx | Official Federal Forms

Personnel Questionnaire-Alcohol And Tobacco Products {TTB F 5000.9}

Official Federal Forms/Alcohol And Tobacco Tax And Trade Bureau (TTB)/
Personnel Questionnaire-Alcohol And Tobacco Products {TTB F 5000.9} | Pdf Fpdf Doc Docx | Official Federal Forms

Personnel Questionnaire-Alcohol And Tobacco Products Form

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This is a Official Federal Forms form that can be used for Alcohol And Tobacco Tax And Trade Bureau (TTB).

Last updated: 3/17/2017
DATE 1. Name of Business 3. Premises (Physical) Address 2. Primary Business Telephone Number ( ) EXT 4. First Name, Middle Name, Last Name 5. Have you ever been known by ANY other name? 8. Your Email Address 9. Your Primary Personal Telephone Number Yes No 10. Your Place of Birth 11. Your Birth Date 12. Your Social Security No. 1 . Your Height 1 . Your Eye Color 6. Your Legal Residence 1 . Your Gender MALE 7. Your Work Address FEMALE 1 . Your Position or Title ith the Business Section I. n Check if the same as: Item 3 Item 6 1 . Description of Your Duties or Relationship to the Business Listed in Section I. Page 1 of 7 American LegalNet, Inc. www.FormsWorkFlow.com If the answer to any question in this section is " ," please provide full details in the area provided, the additional space on the last page, or on a separate sheet, taking care to number the responses to correspond with the question. Convictions, arrests, or charges for minor traffic violations need not be reported. 1 . Have you ever been any violation of any FEDERAL or STATE law roducts regulated by Chapter 51 (distilled spirits, wine, and beer) or 52 (tobacco products, processed tobacco, and cigarette papers and tubes) of the Internal Revenue Code or the Federal Alcohol Administration No 1 . Have you ever been Yes No Have you been law within the last ten (10) years? a FELONY violation of any other FEDERAL or a MISDEMEANOR violation of any other FEDERAL Yes No 2 . Have you ever been Yes No 2 . Have you ever compromised or settled, by payment (including fines), stipulated suspension, surrender of permit, any violation of FEDERAL law relating to products regulated by Chapter 51 (distilled spirits, wine, and beer) or 52 (tobacco products, processed tobacco, and cigarette papers and tubes) of the Internal Revenue Code or any violation of the conditions of a permit or registration issued to you under the Federal Alcohol Administration Act or the Internal Revenue Code? Yes No 2 . Has disapproval ever been given to any application or notice of intention to distill, produce, brew, manufacture, rectify or blend, bottle, distribute, sell, or import products regulated by Chapter 51 (distilled spirits, wine, and beer) or 52 (tobacco products, processed tobacco, and cigarette papers and tubes) of the Internal Revenue Code or the Federal Alcohol Administration Act filed by you or any firm or corporation of which you were proprietor or a partner, officer, director, principal stockholder, or responsible employee? Yes No 2 a. If your answer is " ," provide the name under which the application was filed and the reason(s) for of any FELONY or MISDEMEANOR under FEDERAL or STATE law? Page 2 of 7 American LegalNet, Inc. www.FormsWorkFlow.com Yes No individual in connection with ith a FEDERAL permit or approval to distill, produce, brew, manufacture, use, store, rectify or blend, bottle, distribute, sell, deal in, or import products regulated by Chapter 51 (distilled spirits, wine, and beer) or 52 (tobacco products, processed tobacco, and cigarette papers and tubes) of the Internal Revenue Code or the Federal Alcohol Administration Act? Yes If your answer is "Yes," please provide details. Name and address under which the permit/approval was issued. American LegalNet, Inc. www.FormsWorkFlow.com To: From: 2 . Your Residences for the Past Five (5) Years 2 a. Period (From/To ­ MM/YY) To: Present From: To: From: To: From: To: From: 2 b. Residence Address 2 . Your Investments in the Business Listed in Section I. 2 a. Have you invested any funds in the business to date? Yes No If yes, please list the amount and the source of the funds, including the name and address of the location where the funds were held and the type of account and account number, if applicable. Savings / Checking Account Amount (in U.S. Dollars): _______________________ Name and Address of Institution: _____________________________________________________________________________________ Account Number: ______________________________________________________________________ Personal or Business (please circle) Loan from a Lending Institution Personal or Business (please circle) Loan from an Individual Credit cards Amount (in USD): ______________ Amount (in USD): ___________________ Amount (in USD): ________________________________________________________ Amount (in USD): _________________________ Relationship(s): ____________________________________ Gift (please specify the source and your relationship) Source(s): ____________________________ Other Page 4 of 7 American LegalNet, Inc. www.FormsWorkFlow.com If other, please describe: 2 b. Do you have plans to invest additional funds in the business over the next 12 months? Yes No If yes, please list the anticipated amount and the source of the funds, including the name and address of the location where the funds are held and the type of account and account number, if applicable. Savings / Checking Account Name and Address of Institution: Amount (in U.S. Dollars): _______________________ Account Number: Personal or Business (please circle) Loan from a Lending Institution Personal or Business (please circle) Loan from an Individual Credit cards Amount (in USD): ______________ Amount (in USD): ___________________ Amount (in USD): _________________________________ Amount (in USD): _________________________ Gift (please specify the source and your relationship) 2 . Bank Reference Name i. Point of Contact at Bank (Full Name and Title): ii. Address iii. Phone Number: Page 5 of 7 American LegalNet, Inc. www.FormsWorkFlow.com 30. Please use this space to provide additional information or explanation, if necessary, taking care to number the responses to correspond to the question (continue on separate sheet, if needed). Under the penalties of perjury, I declare that this statement, including the documents submitted in support thereof, has been examined by me and, to the best of my knowledge and belief, is true, correct, and complete. 3 . Applicant Signature 3 . Date Page 6 of 7 American LegalNet, Inc. www.FormsWorkFlow.com The following information is provided pursuant to Section 3 and 7(b) of the Privacy Act of 1974 (5 U.S.C. 552a(e)(3)): To enable TTB to determine the eligibility, suitability, and/or qualifications of an applicant who proposes to engage in a business regulated by TTB. The information will be used by TTB to make the determinations set forth in paragraph 2. In Failure to provide complete information may prevent TTB