Application For License Of Industrial Alcohol Distributor In Vermont printable pdf download

Application For License Of Industrial Alcohol Distributor In Vermont

License year 20_____

May 1st through April 30th

Vermont Department of Liquor Control

13 Green Mountain Drive

Montpelier, VT 05602

Phone: 802-828-2339 Fax: 802-828-1031

Email: DLC-enf.lic@vermont.gov

Fee $200.00

APPLICATION FOR LICENSE OF INDUSTRIAL ALCOHOL DISTRIBUTOR IN VERMONT

We hereby make application for a license to sell alcohol to persons holding permits to purchase alcohol duly

issued by the Liquor Commissioner under and in accordance with Title 7 of the Vermont Statutes Annotated, as

amended, and certify that all statements, information, and answers to questions contained herein are true, and in

consideration of such license being granted, we promise and agree to comply with the law; to comply with all

regulations made and promulgated by the Liquor Control Board; to allow the Liquor Commissioner, or any of his

assistants or inspectors, to examine at any time our premises, supply of alcohol, records and papers in reference to

alcohol, and to keep such records as the Liquor Control Board may require, and that the Liquor Control Board may, in

its discretion, revoke such License whenever it determines we have violated the law, or violated any regulation of the

Liquor Control Board, or violated any regulation of the liquor Commissioner approved by the Liquor Control Board, or

violated any condition of such License, or that any statements, information or answers herein are untrue, after giving

us an opportunity to be heard at a hearing before it.

Name of applicant:

Address:

Email address:______________________________________________________

Federal Permit Number: _____________________ (attach copy of Permit)

Permit/ License number in State where warehouse is located: ________________

Is applicant a Manufacturer? _________ Agent? ________

Location of warehouse: Street address _________________________________

City ______________________________________

State _______________________

I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full

compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of

the date of this application. (VSA, Title 32, Section 3113).

I/We hereby certify that the information in this application is true and complete.

Dated at ____________________________ in the County of _________________________ and State

of_____________________ this ______day of ________________20_______

By ______________________________

Applicant

Application For License Of Industrial Alcohol Distributor In Vermont