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APPLICATION INSTRUCTIONS

Please read these instructions prior to completing this application for an alcoholic beverage

retailer’s permit. These instructions, along with information printed on certain forms, if followed,

will allow you to file a complete document thus reducing the amount of processing time required to

determine your eligibility to hold an ABC permit.

Each applicant, regardless of the type of ABC permit sought, must meet the statutory

qualifications set by the Local Option Alcoholic Beverage Control Laws, Title 67, 1972 MCA. The

Commission, under authority of these laws, has established policies requiring applicants to file

certain documents concerning the applicant’s place of business.

This application asks for

particular information concerning each applicant to allow the Commission to determine the

eligibility of the applicant for permitting as well as the suitability of the business premises to offer

for sale alcoholic beverages.

This application may be typed or neatly printed in ink.

The application immediately follows these instructions. Indicate with an

(X) the permit type sought under this application and include with the completed

application the appropriate permit fee for the permit type selected. The permit

fee includes a non-refundable $25.00 processing fee. The city or county in

which the business will be located will receive 50% of these monies.

Next, complete the appropriate SUPPLEMENTAL INFORMATION portion

of the application for the permit type (whether package store, on-premises, or on-

premises club) desired. (Note: An on-premises club is a chartered organization

formed for a purpose other than the sale of alcoholic beverages. Examples of

qualified clubs are Racket Clubs, Country Clubs, service clubs such as Veterans

of Foreign Wars, etc.)

Then complete the STATEMENT OF OWNERSHIP. Locate on this form

the ownership classification of the applicant, whether a sole owner, partnership,

corporation, trust, or other. This form contains instructions on who must file

qualifying

documents

(PERSONAL

RECORD,

Form

1001;

SUMMARY

FINANCIAL STATEMENT, Form 2007; and fingerprint cards) with this

application. Note that partnerships and corporations must also file a separate

SUMMARY FINANCIAL STATEMENT listing the business financial status.

ABC collects a pass-along fee for fingerprint card processing by the

Federal Bureau of Investigation. This fee is due and payable with the application

submission. Signatures on each PERSONAL RECORD form must be notarized

and the waiver portion of the SUMMARY FINANCIAL STATEMENT form must

be completed. Four (4) PERSONAL RECORD forms and five (5) SUMMARY

FINANCIAL STATEMENT forms as well as eight (8) fingerprint cards are

included in this application packet. Contact ABC Permit Department if you need

additional forms.

Be sure to complete the PERMITTEE CERTIFICATION AND OATH

ending this portion of the application.

Next, complete the WAIVER AND AUTHORIZATION TO RELEASE

INFORMATION. This release will assist us in verifying the information on your

application.

Application Form, New Alcoholic Beverage Permit - Alcoholic Beverage Control Permit Department Of Mississippi Page 2

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