Form Abl-900 - Application For Temporary Beer, Wine, And/or Liquor (Page 2 of 7) in pdf

Form Abl-900 - Application For Temporary Beer, Wine, And/or Liquor Page 2

STATE OF SOUTH CAROLINA

DEPARTMENT OF REVENUE

ABL-900

APPLICATION FOR TEMPORARY BEER, WINE,

(Rev. 11/29/06)

AND/OR LIQUOR

4281

This application MUST BE FILED at least Fifteen days prior to your special event.

File Number

Check which application type(s) is/are being applied for:

All fields in blocked area except "check" field are for office use.

CHECK

GLDC

END DATE

FEE

DLN

TYPE(S) LICENSE APPLYING FOR

Beer/Wine (TBP)

14-3961 1008

Minibottle (TMP)

14-3951 1009

Alcoholic Liquors (TLP)

14-3951 1010

Valid combinations are: Beer, Wine and Minibottle or

TOTAL PAID $

Beer, Wine and Alcoholic Liquors

Retail Sales License #

1. Applicant's Name

2. Trade Name (doing Business as)

Individual, Corporate Charter Name , or Partnership Name

3. Type of Ownership: ( ) Sole Proprietor

( ) Partnership

( ) LLC/LLP

( ) SC Corporation: enter

date incorporated

( ) Unincorporated Association: enter legal name

4. If a Corporation or Association, are you Publicly Traded?:

( ) Yes

( ) No If no, complete attached schedules.

5. Name(s) of business owner, general partners, principals or officers:

SS#

Name/Title/General Partners

Home Address

Date of Birth

6. Location address where event is to be held

Street

City

County

State

Zip Code

7. Federal Identification No.

6. Telephone #: Bus.

Home

8. Date of Birth

9. Race

10.

Male ( ) Female (

)

11. Social Security Number

12. Mailing Address

Street

City

County

State

Zip Code

13. Is this location within SC municipal limits? ( ) Yes (

) No

If Yes which city

14. Is the location presently licensed to sell beer, wine, or alcoholic liquor? (

) Yes (

) No

If "Yes" list the licensee's name and File# as it appears on their license or permit.

Licensee's Name

File #

Back of form must be filled out

42811018

Form Abl-900 - Application For Temporary Beer, Wine, And/or Liquor Page 2

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