Form Abl-500 - Producer Of Beer And Wine Registration Application

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STATE OF SOUTH CAROLINA
ABL-500
DEPARTMENT OF REVENUE
PRODUCER OF BEER AND WINE
(Rev. 5/27/99)
4270
REGISTRATION APPLICATION
For Office Use Only
The undersigned Registered Producer does hereby make
application for the licensing of a warehouse to store alcoholic liquors
DLN
Fee: $200 Biennially
File Number
8/31/
License Period Ending
Amount Paid
14 3961 0009
General Information:
The South Carolina statute defines the word 'producer' as a brewery, winery, manufacturer,
bottler or an importer into the United States of beer or wine or both. Only products manufactured
and/or imported into the United States exclusively by your company can be shipped into South
Carolina to wholesalers licensed by the State of South Carolina.
1. Applicant's Name
FEI
Applying on behalf of producer
SSN
2. Trade Name (doing Business as)
Individual, Corporate Charter Name , or Partnership Name
3. Type of Ownership: ( ) Sole Proprietor ( ) Partnership ( ) LLC/LLP
( ) Unincorporated Association: enter legal name
( ) SC Corporation: enter date incorporated
4. If a Corporation, are you a Publicly Traded Corporation? ( ) Yes ( ) No
IE. Listed on a Stock Exchange.
5. Name(s) of business owner, general partners, principals, or officers:
SS#
Name/Title/General Partners
Home Address
Date of Birth
6. Business location of producer:
Street
City
County
State
Zip Code
7. Mailing Address:
Street
City
County
State
Zip Code
8. Is this location within SC municipal limits? ( ) Yes (
) No
If Yes which city
9. Federal Identification No.
10. Telephone # Bus.
Home
11. Check one:
(
) Brewery
(
) Winery
Importer (
) Beer
(
) Wine
12. If Importer, enter Importer Permit Number
Back of Form must be completed.

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