Form Abl-903 - Application For Food Manufacturer'S License
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1STATE OF SOUTH CAROLINA
ABL-903
DEPARTMENT OF REVENUE
APPLICATION FOR
(Rev. 7/3/03)
FOOD MANUFACTURER'S LICENSE
4309
For Office Use Only
Mail to: SCDOR, ABL Section, Columbia, SC 29214-0908
Telephone: (803) 898-5864
DOR Website:
File Number
License Period Ending
8/31
DLN
PLEASE PRINT OR TYPE ALL INFORMATION
DLN
Nonrefundable Filing Fee
License Fee
Total Fees
14-3975
$ 200.00
$ 1400.00
$ 1600.00
SLED
34-3973-9100
1.
Owner, Partnership, or Corporate Charter Name
2.
Physical Location of Business Required
(No P.O. Box)
STREET
CITY
COUNTY (REQUIRED)
STATE
ZIP
3.
Mailing Address
(For all Correspondence)
STREET
CITY
COUNTY
STATE
ZIP
4.
Type of Ownership
Sole Proprietor (one owner)
Partnership (two or more owners)
LLC/LLP
SC Corporation Date Inc.
Foreign Corporation (Attach copy of Articles of Certificate of Authority)
Non-Profit Organization
Other (Explain)
5.
Trade Name
(Doing Business As)
6.
Business Phone Number
Daytime Phone Number
7.
Federal Identification Number and/or Social Security Number
8.
Location of Records
(No P.O. Box)
Applicant (owner, partner, or corporate officer)
Section 61-6-710. Notwithstanding any other provision of this title, a person who manufactures in this State food items such as sauces
and marinades in which there is an alcoholic beverage ingredient and who does so under an agreement with the alcoholic beverage
manufacturer must apply for a special food manufacturer's license from the department, in accordance with Section 61-2-100, to
purchase the alcoholic beverage directly from the manufacturer in containers holding greater quantities of liquor than are sold to a
retail consumer. The department must establish the form of the application for the special food manufacturer's license."
Social Security Privacy Act Disclosure
It is mandatory that you provide your social security number on this form.
42 U.S.C 405(c)(2)(C)(i) permits a state to use an
individual's social security number as means of identification in administration. SC Regulation 117-1 mandates that any person
required to make a return to the SC Department of Revenue shall provide identifying numbers, as prescribed, for securing proper
identification. Your social security number is used for identification purposes.
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