Application For An Abc Commercial Permit Form Page 3
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4NORTH CAROLINA
ALCOHOLIC BEVERAGE CONTROL COMMISSION
APPLICATION FOR AN ABC COMMERCIAL PERMIT
Amount Fee Paid
Temporary # ________________
Application # __________________
Date Issued __________________
Approved
Exp. Date ___________________
Rejected
By
Date Rec'd: _________________________________
Date __________________________
Rec'd By: __________________________________
Do Not Write Above This Line
County ________________________________
in which business is located
Reason for Application:
Additional Permit
New Business
Additional Location
New Officer
Ownership Change
Address Change
New Manager (LLC)
I hereby make application to the North Carolina Alcoholic Beverage Control Commission for the following permit(s):
Check Appropriate Block(s).
Unfortified Winery
Fuel Alcohol
Bottler
Liquor Importer/Bottler
Fortified Winery
Wine Importer
Winery Special Event
Air Carrier
Limited Winery
Wine Wholesaler
Cider & Vinegar Manufacturer
Wine Shipper (wineries only)
Brewery
Malt Beverages Importer
Wine Producer
Spirituous Liquor Warehouse
Distillery
Malt Beverages Wholesaler
Malt Beverage Special Event
TYPE OF OWNERSHIP
(Check One):
Individual (complete sections A and B, below)
Partnership (complete sections A and B, below)
Limited Partnership (complete sections A, B, E and F, below)
Limited Liability Company (complete sections A, B, D and F, below)
Corporation (complete sections A, B, C and F, below)
Nonresident Individual or Partnership (complete sections A, B, and G, below)
Section A
Trade Name of Business
Location Address of Business
Street/Route
City
State
Zip Code
Mailing Address of Business
Street/Route/PO Box
City
State
Zip Code
Section B
Applicant's Full Name
(no abbreviations)
First
Middle
Last
Resident Address
Street/Route
City
State
Zip Code
Date of Birth
Social Security #
(last four only)
Home Telephone # (
)
Business Telephone # (
)
Daytime Telephone # (_____)_______________ Fax # (_____)______________ Email Address ___________________________________
Section C
If Incorporated, Corporate Name
If Incorporated, position in Corporation:
President
Vice President
Secretary
Treasurer
Manager
Stockholder - % of Stock ______________________________
(25% or more)
If 25% or more stockholder is another business entity, name of entity: ___________________________________________________
Applicant's position in business entity:
Section D
If LLC, Company Name
Form of Management:
Member-Managed
Manager -Managed
Site Manager
If 25% or more interest is another business entity, name of entity ______________________________________________________
Applicant's position in business entity: _________________________________________________________________________
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