Form Abl-907 - Alcohol Beverage Licensing Keg Registration Form

STATE OF SOUTH CAROLINA

1350

1350

DEPARTMENT OF REVENUE

ABL-907

Alcohol Beverage Licensing

(Rev. 10/23/07)

KEG REGISTRATION FORM

4362

(Required on all Kegs Sold to Retail Purchaser with a Capacity of over 5.16 Gallons)

Note to License Holder:

This form must be kept for a minimum of 90 days from the date of purchase and be made available for inspection by

the Department or appropriate law enforcement agencies.

Keg Identification Number: _____________________________________________________________

Name of License Holder: _______________________________________________________________

License Holder’s Address: ______________________________________________________________

License Holder’s License or Permit Number: _______________________________________________

Name of Purchaser: _________________________________ Date of Purchase: __________________

Purchaser’s Address: __________________________________________________________________

Purchaser’s Date of Birth: ___________________ Number of Kegs Purchased: _______________

Purchaser’s Driver’s License or Identification Card Number: ___________________________________

Purchaser’s Acknowledgement: The undersigned Purchaser, does hereby attest to the accuracy of the

purchaser’s information, as indicated above; and that he or she acknowledges that unless otherwise permitted by

law, it is unlawful to transfer beer to a person under the age of twenty-one; and that unless otherwise permitted by

law, the beer in the keg that is being purchased will not be consumed by a person under the age of twenty-one.

Purchaser

License Holder shall fill out all information requested below at appropriate time:

Date Returned _____________ Returned with Keg ID Tag(s) Properly Affixed: Yes _____ No ______

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ABL-907

Alcohol Beverage Licensing

(Rev. 10/23/07)

KEG REGISTRATION FORM

4362

Note to License Holder: You must indicate below, and provide this receipt to the Purchaser, indicating whether the

keg(s), when returned, had the Keg ID Tag(s) properly affixed.

Keg Identification Number(s): ______________________________________________________________________

Returned with Keg ID Tag(s) Properly Affixed: Yes _____ No ______ Date Keg(s) Returned: __________________

Signature of License Holder or Authorized Representative: ______________________________________

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