Form Abl 500 - South Carolina Producer Of Beer And Wine Registration Application Page 4

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SOUTH CAROLINA DEPARTMENT OF REVENUE
Alcoholic Beverage Licensing
301 Gervais St, PO Box 125, Columbia, SC 29214
Telephone No. (803) 734-0470
APPLICATION FOR REGISTRATION OF BRANDS OF BEER
License Year Ending August 31, 19_____
In accordance with Chapter 7, of Title 61, Code of Laws of South Carolina, 1976, as amended, the Registered Producer
noted below does hereby make application to register the following brands of beer for shipment into South Carolina:
Registered Producer and address__________________________________________________________________
____________________________________________________________________________________________
List Permit No. BP________________ or check if application for permit is pending
(
)
Contact Person________________________________
Telephone (
)_____________________________
INSTRUCTIONS:
You must list all brands you intend to ship. If additional space is needed this formmay be reproduced.
*****BEER MUST NOT CONTAIN MORE THAN FIVE PERCENT ALCOHOL*****
Brand Name (List full brandname)
Alcoholic Content
Percentage by Weight
_______________________________________________________________________ ____________________
_______________________________________________________________________ ____________________
_______________________________________________________________________ ____________________
_______________________________________________________________________ ____________________
_______________________________________________________________________ ____________________
_______________________________________________________________________ ____________________
For SC Department of Revenue and Office Use Only
The above listed brands are approved for shipment into South Carolina
Approved by:______________________________________
Date______________________________
ABL 500 (10/96)

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