Form Ab-0183 - Delivery Service License Application
ADVERTISEMENT
1
2
3STATE OF TENNESSEE
ALCOHOLIC BEVERAGE COMMISSION
Davy Crockett Tower
One Commerce Square
rd
500 James Robertson Parkway, 3
Floor
40 South Main Street
th
Nashville, TN 37243
4
Floor, Suite 415
615-741-1602
Memphis, TN 38103
901-543-7284
4420 Whittle Springs Road
Knoxville, TN 37917
540 McCallie Avenue, Suite 341
865-594-6342
Chattanooga, TN 37402-2055
423-634-6434
Business Check, Money Order or Cashier’s Check ONLY
DELIVERY SERVICE LICENSE APPLICATION
PURSUANT TO PC 285 (2015)
Date ______________, 20 ____
Name of Corp./LLC/LP,SP,etc:__________________________________________________________
makes application for a license to transport and deliver alcoholic beverages from the following location.
Doing Business As: ____________________________________________________________________
Business Address: _________________________Business Telephone :(_____) ____________________
City, State: __________________________ County: __________________Zip Code: __________
Mailing Address (if different from Business Address) _______________City_________ State ___ Zip____
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. Are you and all persons having a direct or indirect interest in the business (if any) twenty-one
(21) years of age or older? _____________________________________________________
3. Have you, partners, stockholders, or any person having any direct or indirect interest in this
business, ever been convicted of any offense, including felonies involving moral turpitude,
under the laws of the State of Tennessee, or of any other State, or of the United States?
_______________ If yes, please specify:__________________________________________
4. Have you, partners, stockholders, or any other person having a direct or indirect interest in this
business been engaged in business as a sole proprietor or with others, in violation of any laws,
rules or regulations of the State of Tennessee, the Alcoholic Beverage Commission of
Tennessee or any other State, or of the United States prohibiting or regulating the sale,
possession, transportation, manufacturing, or otherwise handling of intoxicating liquors within
ten (10) years preceding the date of this application? __________ If yes, please specify
___________________________________________________________________________
AB-0183
RDA 2116
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business