Form Abl-901 - Application For Beer, Wine, And/or Liquor Page 12
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13SCHEDULE B
Consent and Waiver:
S.C. Code Section 61-2-160 prohibits the issuance of any permits or license under Title 61 if the applicant or any principal
owes delinquent taxes, penalties, or interest to the S.C. Department of Revenue or to the I.R.S. By signing below, a person
authorizes the I.R.S. to release to the S.C. Department of Revenue information concerning that person owing delinquent taxes,
penalties, or interest as of the date of the signing of this document, plus the next five years. This consent may be withdrawn at
any time by writing to the Internal Revenue Service Disclosure Officer, 1835 Assembly Street, MDP15, Columbia, SC 29201.
The signature below also authorizes the S.C. Department of Revenue to release to the applicant, or to the applicant's agent,
attorney, information concerning delinquent taxes, penalties, or interest that is causing the denial of this application.
The following are principals and must complete and sign below. If a required person does not sign, this application will be
denied:
1. The owner (if sole proprietorship);
2. All officers of the business or entity which owns the business;
3. All partners (limited partners that cannot exercise management control need not sign);
4. All persons who own twenty-five percent (25%) or more of the value of the business entity;
5. All persons who own twenty-five percent (25%) or more of the combined voting power of the business or entity;
6. Managers of a limited liability company which is managed by managers;
7. Members of a limited liability company which is not managed by managers;
8. Any fiduciary who manages, controls title, or is otherwise in control of the business;
9. All employees who will have day-to-day operational management responsibility for the business or entity; and,
10. If a publicly traded corporation, the designated license holder (must be over 21 and a resident of S.C.).
Name of Corporation, Partnership, LLC, etc.
FEI
(A) Name:
Home Address:
(print)
Social Security No.:
Sex:
Race:
Date of Birth:
Yr/Date of SC Residency:
Signature:
(B) Name:
Home Address:
(print)
Social Security No.:
Sex:
Race:
Date of Birth:
Yr/Date of SC Residency:
Signature:
(C) Name:
Home Address:
(print)
Social Security No.:
Sex:
Race:
Date of Birth:
Yr/Date of SC Residency:
Signature:
(D) Name:
Home Address:
(print)
Social Security No.:
Sex:
Race:
Date of Birth:
Yr/Date of SC Residency:
Signature:
(E) Name:
Home Address:
(print)
Social Security No.:
Sex:
Race:
Date of Birth:
Yr/Date of SC Residency:
Signature:
(F) Name:
Home Address:
(print)
Social Security No.:
Sex:
Race:
Date of Birth:
Yr/Date of SC Residency:
Signature:
(12)
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