Form Abl-901 - Application For Beer, Wine, And/or Liquor (Page 3 of 13) in pdf

Form Abl-901 - Application For Beer, Wine, And/or Liquor Page 3

7. Has any partner or member or person with management responsibilities been convicted of a crime in South Carolina

or any other state? (You must reveal any convictions whether the partner or member went to jail or not. The S.C.

State Law Enforcement Division will check for convictions, and your application may be denied if you do not correctly

answer this question)

Yes

If yes, give details in Schedule A.

C. Corporation or Limited Liability Company (LLC). Check this block if the business is owned by a corporation,

L.L.C.

1. Name of corporation or L.L.C.

2. FEI#

3. Is the stock of your corporation traded on any exchange?

Yes

No.

If yes, what exchange?

4. If your stock is not traded on any exchange, list below all persons who own any interest in the corporation. Those

owning 25% or more interest in the corporation must be listed on Schedule B.

Number of Shares

% of Corporation

Name

Owned

5. List all employees who will have day-to-day operational management responsibilities for the business. These

employees should also be listed on Schedule B.

Name

6. List all officers of the corporation. Each should be listed on Schedule B.

Name

CorporateTitle

7. Has any person with day-to-day management responsibilities, any corporate officer, or any person owning 25% or

more of stock had revoked or suspended, in this or any other state, any license to sell beer, wine, or alcoholic

liquors?

Yes

If yes, give details in Schedule A.

(3)

Form Abl-901 - Application For Beer, Wine, And/or Liquor Page 3