Application For Out-Of-State Producer Liquor Licenses- Arizona Department Of Liquor Licenses And Control Page 3
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412. For limited out-of-state winery (series 2L) applicants only.
a) Do you agree to sell and deliver not more than 240 gallons of wine into Arizona per calendar year?
Yes
No
A.R.S. §4-209(B)(15)
b) Do you agree to report annual production to the Arizona Department of Liquor 30 days after your reporting period
ends (December 31) as outlined on the last page of this application?
Yes
No
)
2W = A.R.S. §4-205.04(B
13. For out-of-state farm winery (2W) applicants that produce more than 20,000 gallons annually.
a) Do you agree not to sell or deliver to individuals for personal consumption except persons age 21 or older who
make purchases when physically present at your winery?
Yes
No
A.R.S. §4-205.04(C)(4)
b) Do you agree not to sell or deliver directly to Arizona-licensed retail licensees?
Yes
No
A.R.S. §4-205.04(C)(7)
c) Do you agree to report annual production to the Arizona Department of Liquor 30 days after your reporting period
ends (December 31)?
Yes
No
A.R.S. §4-205.04(B)
14. For out-of-state microbrewery (series 2M) applicants only.
a) Do you agree to sell or deliver beer produced at your location only to Arizona retail locations under common
ownership with the microbrewery on this application?
Yes
No
A.R.S. §4-205.08(D)(4)(a)
b) Do you agree to not sell or deliver more than 93,000 gallons per calendar year of beer produced at this location
to Arizona retail locations that are not under common ownership with the microbrewery on this application?
Yes
No
A.R.S. §4-205.08(D)(4)(b)
c) Do you agree to report annual production to the Arizona Department of Liquor 30 days after your reporting period
ends (December 31)?
Yes
No
A.R.S. §4-205.08(B)
15. If you answered “no” to questions asked in #s 6, 7, 8, 9, 10, 11, 12, 13, or 14 give complete details. Attach additional
sheets if necessary.
FALSE OR INCOMPLETE ANSWERS MAY RESULT IN THE DENIAL OF A LICENSE
I, (
___________________________________________________ hereby declare that I am the applicant/agent filing this
Print Name)
application. I have read this application and the contents and all statements are true, correct, and complete to the best
of my knowledge. I acknowledge that shipments into Arizona contrary to A.R.S. §4-203.04 and contrary to the statements
in Section 5 of this application may result in the immediate suspension of my Arizona liquor license.
X ___________________________________________________
Date: _________/___________/_____________
Signature of Individual Owner/Agent
Day
Month
Year
NOTARY
X
State of ____________________County of ____________________
(Signature) __________________________________________________
Controlling Person / Agent
the foregoing instrument was acknowledged before me this
My commission expires on:
___________________
____________ of ______________________ _____________
Day
Month
Year
___________________________________________________
Signature of NOTARY PUBLIC
2/24/2017
Page 3 of 4
Individuals requiring ADA accommodations please call (602)542-9027
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