New Alcoholic Beverage Retailers Permit Application Page 2
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13V.
Is the applicant indebted to the State of Mississippi for any taxes, fees, or
payment of penalties imposed by law or by any rule or regulation of the
Commission? _____________ If "yes", explain fully: ________________
__________________________________________________________
__________________________________________________________
VI.
List your Mississippi sales tax number: ___________________________
VII.
List your Federal Special Tax Stamp number: _____________________
Have you ever been denied a Special Tax Stamp? __________ If "yes",
explain fully: _______________________________________________
__________________________________________________________
VIII.
List the company issuing your ABC Retailer’s bond: _________________
__________________________________________________________
SUPPLEMENTAL INFORMATION
CATERER’S PERMIT APPLICANTS ONLY
Complete this section in addition to the STATEMENT OF OWNERSHIP
I.
Include a copy of the health certificate issued by the State
Department of Health. List the certificate number: _____________
II.
Does the applicant understand that ten (10) days prior to each
catered event, written notice of such event must be supplied to the
Alcoholic Beverage Control? _____________ (Contact ABC for
forms used for this notification.)
SUPPLEMENTAL INFORMATION
PACKAGE RETAILER APPLICANTS ONLY
Complete this section in addition to the STATEMENT OF OWNERSHIP.
I.
Is the applicant, if an individual, or, if a partnership, each of its
partners, a legal resident of the State of Mississippi? __________
II.
Is the applicant a corporation? _____________ If "yes", is the
designated manager a legal resident of Mississippi? ___________
NOTE: Managers require Commission approval. Contact the ABC Permit
Department for an application.
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