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Application Form, New Alcoholic Beverage Permit - Alcoholic Beverage Control Permit Department Of Mississippi Page 3

You must submit with this application a copy of your lease, if leasing the

business premises, or your deed, if you own the business premises. If a lease,

the leasee must be the applicant for the alcoholic beverage permit (sole owner,

partnership, or corporation) and the lease may not expire for at least twelve (12)

months. Include, also, a floorplan of the business premises.

Each applicant for an alcoholic beverage permit is required to post a

$5000.00 BOND.

This bond may be a Surety Bond, a Cash Bond, or an

approved Certificate of Deposit. This packet contains a surety bond form for

your insurance company to complete for proof of issue. The bond must be

issued in the APPLICANT’S NAME (name of sole owner, partnership,

corporation, or trust). NATIVE WINE MANUFACTURER APPLICANTS MUST

USE THE NATIVE WINE SURETY BOND FORM.

Please contact ABC Permit Department for forms and instructions if you

desire to post either a cash bond or certificate of deposit in lieu of a surety bond.

You are required to publish notice of your application in two consecutive

issues of a newspaper published in the town in which the business will be

located.

If no local newspaper exists, the notice may be published in the

newspaper produced in the town located nearest your business and within the

same county. The notice must be published in its entirety in ten point bold face

type. An acceptable legal notice format is included in this packet. Submit with

this application a PUBLISHER’S AFFIDAVIT (obtained from the newspaper) as

proof of publication.

You must apply for, and furnish with this application proof of application

for, a Federal Special Tax Stamp. Form #ATF F 5630.5 (10-93) is provided in

this packet. Include a copy of this application and payment (cancelled check or

receipt) as proof of application. If you have questions, or need assistance, you

may call the Bureau of Alcohol, Tobacco, and Firearms at 601-965-4205 (within

Mississippi) or 205-290-7189 (outside Mississippi).

You must register with the State Tax Commission and obtain a sales tax

number. An application is included in this packet. You may return this form with

your application.

Last, review the application check list. Be sure to include proper payment

for the permit type applied for, and send the completed forms to:

Alcoholic Beverage Control

Permit Department

P.O. Box 540

Madison, Mississippi 39130-0540

Please allow four to six weeks for processing of your application.

If you need assistance, call ABC Permit Department at (601) 856-1330.

ABCD 1000

PERMIT DEPT. USE ONLY

(Revised 11/95)

AMT. OF CHECK _________

CHECK NUMBER _________

Application Form, New Alcoholic Beverage Permit - Alcoholic Beverage Control Permit Department Of Mississippi Page 3

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