Form Ab-0023 - Application For License To Sell Alcoholic Beverages At Wholesale

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STATE OF TENNESSEE
ALCOHOLIC BEVERAGE COMMISSION
Davy Crockett Tower
One Commerce Square
rd
500 James Robertson Parkway, 3
Floor
40 South Main Street
Nashville, TN 37243
4th Floor, Suite 415
615-741-1602
Memphis TN 38103
901-543-7284
4420 Whittle Springs Road
540 McCallie Avenue, Suite 341
Knoxville, TN 37917
Chattanooga, TN 37402-2055
APPLICATION FEE
865-594-6342
423-634-6434
NON-REFUNDABLE
Business Check, Money Order or Cashiers Check ONLY
ALL signature spaces MUST
be signed and notarized.
APPLICATION FOR LICENSE TO
SELL ALCOHOLIC BEVERAGES AT WHOLESALE
Date ______________, 20 ____
Name of Corp./LLC/LP, SP, etc:
hereby make application for a license to sell alcoholic beverages at wholesale in the following location.
Doing Business As:
Business Address: ___________________________________Business Telephone: (_____)______________Fax Number: (____) _____________
City, State: ____________________________ County: __________________________ Zip Code:
Mailing Address
______________________________ City______________________ State ______Zip Code_________
(if different from Business Address)
Website: _______________________________________ E-mail address:
1.
Are you and all persons having a direct or indirect interest in the business (if any) a United States Citizen? ____ All applicants must complete
form AB-0116 – Declaration of Citizenship
2.
Have you, partners, stockholders, or any other person having any kind of interest in this business, ever been convicted for any offense under
the laws of the State of Tennessee, or of any other State, or of the United States?
3.
Have you or any other person having a direct interest in this business been convicted of any offense under the laws of the State of Tennessee,
of any other State, or of the United States prohibiting, or regulating the sale, possession, transportation, storing, manufacturing or otherwise
handling intoxicating liquors within ten (10) years preceding the date of this application? __________ If yes, please specify:
4.
Have you, partner, or any other person having a direct or indirect interest in this business been engaged in business alone, or with others, in
violation of any laws, or rules and regulations of the State of Tennessee and the Alcoholic Beverage Commission, prohibiting or regulating
the sale, possession, transportation, manufacturing, or otherwise handling intoxicating liquors within ten (10) years preceding the date of this
application? If yes, please specify:
5.
Have you or any other person having a direct or indirect interest in this business ever been cited to appear before the Commissioner of
Revenue or the Tennessee Alcoholic Beverage Commission and charged with a violation of the law or rules and regulations made pursuant to
law?
If yes, please specify
6.
Give the name and address of any other business in which you, or your partners (if any) are actively engaged.
7.
State whether you or anyone connected with this business hold any kind of interest whatsoever in any premises on which alcoholic beverages
are sold at retail.
8.
Is the business to be operated as a corporation, general or limited partnership, or are you the sole owner?
9..
State the names and addresses of all persons other than those whose names appear on this application who have any kind of interest, financial,
stock ownership, loans, gifts, or securing loans, or otherwise, made for carrying on said business:
10.
Who will be in active control and personally conduct the management of this business?
1
AB-0023 (Rev. 9-14)
RDA 2116

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