Form Ab-157 - Permittees Statement Of Brand Franchise And Sales Area Designation - 2013
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AB-157: PERMITTEES STATEMENT OF
Excise Tax Unit
Wisconsin Department of Revenue
BRAND FRANCHISE AND
PO Box 8900
Madison WI 53708-8900
SALES AREA DESIGNATION
(608) 266-6701
Fax (608) 261-7049
Permit Number
Legal Name
DBA Name
Street Address
City
State
Zip Code
Permittees Statement of Brand Franchise and Sales Area Designation
No Wisconsin liquor wholesaler or rectifier may sell any distilled spirits and wine in Wisconsin until a written statement is filed with the
department indicating that (1) the permittee is a distributor of a particular brand of liquor in Wisconsin, and (2) sales of the brand by
the permittee and anyone purchasing from the permittee will be limited to the franchise sales area specified. The permittee shall notify
the department of any change in the area within seven days of the effective date of the change.
Manufacturer
Franchise Sales Area
Brand or Brand Name
(Name, City, State)
(Counties or portion of counties)
Additional space provided on next page.
I declare under penalties of the law that I have examined this information and to the best of my knowledge it is true, correct, and complete.
Signature (do not print or type)
Title
Date
Signature (do not print or type)
Title
Date
If applicant is a
• corporation, the president and the secretary must sign.
• partnership, two partners must sign
• limited liability company, two members must sign unless the limited liability company only has one member.
AB-157 (R. 12-13)
Wisconsin Department of Revenue
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