Form Abl-500 - Application For Producer Of Beer And Wine Certificate Of Registration And Form Abl-569 - Beer And Wine Producers Authorization Of Wholesalers And Brands

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STATE OF SOUTH CAROLINA
ABL-500
DEPARTMENT OF REVENUE
APPLICATION FOR PRODUCER OF BEER AND
(Rev. 2/9/05)
WINE CERTIFICATE OF REGISTRATION
4270
For Office Use Only
Mail to: SCDOR, ABL Section, Columbia, SC 29214-0908
Telephone: (803) 898-5864
DOR Website:
File Number
License Period Ending
8/31
DLN
PLEASE PRINT OR TYPE ALL INFORMATION
DLN
Fee: $400 Biennially
14-3961-0009
SLED
34-3973-9000
1.
Owner, Partnership, or Corporate Charter Name
2.
Physical Location of Business Required
(No P.O. Box)
STREET
CITY
COUNTY (REQUIRED)
STATE
ZIP
3.
Mailing Address
(For all Correspondence)
STREET
CITY
COUNTY
STATE
ZIP
4.
Type of Ownership
Sole Proprietor (one owner)
Partnership (two or more owners)
LLC/LLP
SC Corporation Date Inc.
Foreign Corporation (Attach copy of Articles of Certificate of Authority)
Non-Profit Organization
Other (Explain)
5.
Trade Name
(Doing Business As)
6.
Business Phone Number
Daytime Phone Number
7.
Federal Identification Number and/or Social Security Number
8.
Location of Records
(No P.O. Box)
9.
Is this Location within SC Municipal Limits?
Yes
No
If Yes which city
10.
Check One:
Brewery
Winery
Importer
Beer
Wine
Enter Importer Permit Number
11.
Name(s) of business owner, general partners,prinicipals, or officers:
Social Security Number
Name/Title/General Partners
Home Address
Date of Birth
Back of Form must be completed.

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