Form Abl 500 - South Carolina Producer Of Beer And Wine Registration Application Page 5

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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 WINE
For license year ending August 31, 19_____
In accordance with Chapter 7, of Title 61, Code of Laws for South Carolina, 1976, as amended, the Registered Producer
noted below does hereby make application to register the following brands of wine 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:
List below all brands you intend to ship. If additional space is needed, this form may be
reproduced.
***WINE MUST NOT CONTAIN MORE THAN TWENTY-ONE PERCENT ALCOHOL BY VOLUME***
Brand Name (List full brand name)
Alcoholic Content
Percentage by Volume
_____________________________________________________________________
____________________
_____________________________________________________________________
____________________
_____________________________________________________________________
____________________
_____________________________________________________________________
____________________
_____________________________________________________________________
____________________
_____________________________________________________________________
____________________
_____________________________________________________________________
____________________
_____________________________________________________________________
____________________
For SC Department of Revenueand 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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