| Paperwork Reduction Act Notice | ||||||||||
| Form Number | Form Name | Average Burden (in hours) | Owner/Officer Application | Winery Application | Wholesaler/Importer Application | Current Paperwork Reduction Act Notice | Proposed Paperwork Reduction Act Notice | |||
| 5000.8 | Power of Attorney | 0.50 | x | x | This request is in accordance with the Paperwork Reduction Act of 1995. This information collection is used by TTB to ensure that only duly authorized individuals are signing documents. The information is voluntary. The estimated average burden associated with this collection of information is X hour/minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current, valid OMB control number. |
This request is in accordance with the Paperwork Reduction Act of 1995. - Power of Attorney Information (OMB No. 1513-0014): This information collection is used by TTB to ensure that only duly authorized individuals are signing documents. The information is voluntary. - Personnel Questionnaire Information (OMB No. 1513-0002): The information collection is used by TTB to determine if an applicant is eligible to receive an alcohol and tobacco permit. The information is mandatory (26 U.S.C. 5712, 27 U.S.C. 204). - Change In Bond/Consent of Surety (OMB No. 1513-0013) : We use this information to determine whether a business may change its bond. We must identify changes to the business, the surety company, and the bond. The information we request is required for you to obtain a benefit and is mandatory by law (26 U.S.C. 5173, 5272, 5354, 5401, and 5711). - Environmental Information (OMB No. 1513-0023): This information collection is used by TTB to determine if any environmental impact statement or environmental permit is necessary for the proposed operation. The information is required to obtain a benefit. - Water Quality Considerations Information (OMB No. 1513-0023): This information collection is used by TTB to determine whether a certification from a State of multi-state authority is needed for discharge of effluent into navigable water of the U.S. This information is required to obtain a benefit. - Signing Authority Information (OMB No. 1513-0036): This information collection is used by TTB to ensure that only duly authorized individuals are signing documents. This information is voluntary. - Basic Permit Information (OMB No. 1513-0018): The information is used to determine eligibility of the applicant to engage in certain operations, to determine the location and extent of operations, and to determine whether the operations will be in conformity with Federal laws and regulations. The infomration requested is required to obtain or retain a benefit and is mandatory by statute (27 U.S.C. 203 and 204 (c)). - Wine Premises Information (OMB No. 1513-0009): The information is used by TTB to determine if the applicant is eligible to receive a wine premises permit. The information is required to obtain a permit. - Wine Bond Information (OMB No. 1513-0009): The information is used by the proprietor, or the proprietor and surety company, as a contract to ensure tax payment. The information requested is required to obtain a benefit and is mandatory by statute (26 U.S.C. 5172) The estimated average burden associated with the Owner/Officer application collection of information is 2 hours, for the Winery application collection of information is 7 hours and 45 minutes or for the Wholesaler/Importer application collection of information is 4 hours and 30 minutes, per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current, valid OMB control number. |
||||
| 5000.9 | Personnel Questionnaire - Alcohol and Tobacco Products | 2.00 | x | x | x | This request is in accordance with the Paperwork Reduction Act of 1995. The information collection is used by TTB to determine if an applicant is eligible to receive an alcohol and tobacco permit. The information is mandatory (26 U.S.C. 5712, 27 U.S.C. 204). The estimated average burden associated with this collection of information is X hour/minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current, valid OMB control number. |
||||
| 5000.18 | Change in Bond (Consent of Surety) | 1.00 | X | This request is in accordance with the Paperwork Reduction Act of 1995. We use this information to determine whether a business may change its bond. We must identify changes to the business, the surety company, and the bond. The information we request is required for you to obtain a benefit and is mandatory by law (26 U.S.C. 5173, 5272, 5354, 5401, and 5711). We estimate the average burden for a business associated with this collection to be X hour/minutes, depending on individual circumstances. Address your comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to: Reports Management Officer, regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current, valid OMB control number. |
||||||
| 5000.29 | Environmental Information | 0.50 | x | This request is in accordance with the Paperwork Reduction Act of 1995. This information collection is used by TTB to determine if any environmental impact statement or environmental permit is necessary for the proposed operation. The information is required to obtain a benefit. The estimated average burden associated with this collection of information is X hour/minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current, valid OMB control number. |
||||||
| 5000.30 | Supplemental information on Water Quality Considerations | 0.50 | x | This request is in accordance with the Paperwork Reduction Act of 1995. This information collection is used by TTB to determine whether a certification from a State of multi-state authority is needed for discharge of effluent into navigable water of the U.S. This information is required to obtain a benefit. The estimated average burden associated with this collection of information is X hour/minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current, valid OMB control number. |
||||||
| 5100.1 | Signing Authority for Coporate and LLC Officials | 0.25 | x | x | This request is in accordance with the Paperwork Reduction Act of 1995. This information collection is used by TTB to ensure that only duly authorized individuals are signing documents. This information is voluntary. The estimated average burden associated with this collection of information is X hour/minutes per respondent or recordkeeper depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current, valid OMB control number. |
|||||
| 5100.18 | Application for Amended Basic Under FAA Act | 0.50 | This request is in accordance with the Paperwork Reduction Act of 1995. The information is used to determine eligibility of the applicant to engage in certain operations, to determine the location and extent of operations, and to determine whether the operations will be in conformity with Federal laws and regulations. The information requested is required to obtain or retain a benefit and is mandatory by statute (27 U.S.C. 203 and 204 (c)). The estimated average burden associated with this collection of information is X hour/minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current, valid OMB control number. |
|||||||
| 5100.24 | Application for Basic Permit Under FAA Act | 1.75 | x | x | This request is in accordance with the Paperwork Reduction Act of 1995. The information is used to determine eligibility of the applicant to engage in certain operations, to determine the location and extent of operations, and to determine whether the operations will be in conformity with Federal laws and regulations. The infomration requested is required to obtain or retain a benefit and is mandatory by statute (27 U.S.C. 203 and 204 (c)). The estimated average burden associated with this collection of information is X hour/minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management Officer,Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current, valid OMB control number. |
|||||
| 5120.25 | Application to Establish and Operate Wine Premises | 0.25 | x | This request is in accordance with the Paperwork Reduction Act of 1995. The information is used by TTB to determine if the applicant is eligible to receive a wine premises permit. The information is required to obtain a permit. The estimated average burden associated with this collection of information is X hour/minutes per respondent depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current, valid OMB control number. |
||||||
| 5120.36 | Wine Bond | 1.00 | x | This request is in accordance with the Paperwork Reduction Act of 1995. The information is used by the proprietor, or the proprietor and surety company, as a contract to ensure tax payment. The information requested is required to obtain a benefit and is mandatory by statute (26 U.S.C. 5172) The estimated average burden associated with this collection of information is X hour/minutes per respondent or recordkeeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, DC 20220. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a current, valid OMB control number. |
||||||
| Total Burden per application type/CAP | 2.00 | 7.75 | 4.50 | |||||||
| Will not be turned on for Phase 1 and not used for calculation of total burden per application type/CAP | ||||||||||
| Privacy Act Statement for Permits Online | |||||||||
| We provide this information to comply with Sections 3 and 7(b) of the Privacy Act of 1974 (5 U.S.C.§ 552a(e)(3)): 1. What is TTB’s authority to ask for this information? We require this information under the authority of 26 U.S.C. 5171(b), 5173, 5271(b), 5272, 5354, 5356, 5401, 5401(a), 5502(b), 5511(3), 5711 and 5712; 27 U.S.C. 204(c). You must disclose this information to engage in any of the businesses regulated pursuant to the above described statutes. 2. What is the purpose for this information collection? You give this information to enable TTB to determine your eligibility, suitability, and/or qualifications to engage in a business regulated by TTB. 3. How does TTB routinely use this information? We use this information to make determinations for the purposes described in paragraph 2. Also, we may disclose the information to other Federal, State, foreign, and local law enforcement, or regulatory agency personnel to verify information in your application where such disclosure is not prohibited by law. We may disclose the information to the Justice Department if it appears that the furnishing of false information may constitute a violation of Federal law. Finally, we may disclose the information to members of the public to verify information in your application where such disclosure is not prohibited by law. 4. What happens if I do not supply the information TTB requests? If you do not supply complete information, we may be prevented from making an informed judgment as described above. If you fail to supply the necessary information it may cause us to delay, deny or disapprove your application. 5. How might TTB disclose my Employer Identification Number (EIN) or Social Security Number (SSN)? Pursuant to the statutes above, we are authorized to solicit this information. We use these numbers to identify an individual or business. Your disclosure of these numbers is voluntary. If you do not supply these numbers, your application may be delayed. |
| POWER OF ATTORNEY- TTB F 5000.8 (04/2010) OMB No. 1513-0014 (1/31/2013) | |||||
| FORM FIELD NAME | APPLICATION TYPE/CAP | SCREEN NAME | SECTION HEADER | SCREEN FIELD LABEL | COMMENTS |
| 1. PRINCIPAL | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | Name of Business | |
| 2. BUSINESS IN WHICH ENGAGED | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Business Information: Application | Application Type | Bonded Winery- Producing and Blending Wine Bonded Winery- Blending Wine Only Bonded Wine Cellar Bonded Wine Cellar and Wine Blender Tax Paid Wine Bottling House Distilled Spirits Wine Malt Beverages |
|
| 3. ADDRESS,TELEPHONE NUMBER, and EMAIL ADDRESS | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | Address | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | City | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | State | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | Zip Code | ||
| Application for Owner and Officer Information | Step 1: Contacts and Location | Business Headquarters | Primary Phone Number | ||
| Application for Owner and Officer Information | Step 1: Contacts and Location | Business Headquarters | |||
| 4. PRINCIPAL'S EMPLOYER IDENTIFICATION NUMBER | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | EIN | |
| 5. PERMIT NUMBER/REGISTRY NUMBER | N/A | N/A | N/A | N/A | System Generated |
| 6. NAME, TELEPHONE NUMBER, EMAIL ADDRESS OF APPOINTED ATTORNEY | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Power of Attorney Information | First Name | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Power of Attorney Information | Middle Name | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Power of Attorney Information | Last Name | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Power of Attorney Information | Suffix | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Power of Attorney Information | Phone Area Code | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Power of Attorney Information | Phone | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Power of Attorney Information | Phone Extensions | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Power of Attorney Information | |||
| 7. ADDRESS | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Power of Attorney Information | Address | |
| 8a/b. (Limitations) | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Power of Attorney Information | Type | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Power of Attorney Information | If Limited, Specific Powers to be Conferred | ||
| 9. THE POWER IS TO APPLY TO THE FOLLOWING: | N/A | N/A | N/A | N/A | System Generated with Commodity Type from Reason for Appication |
| 10. SIGNATURE OF APPOINTED ATTORNEY | BLANK | BLANK | BLANK | BLANK | |
| 11. SIGNATURE OF PRINCIPAL IF NOT INDIVIDUAL | BLANK | BLANK | BLANK | BLANK | |
| 12. SIGNATURE IF PRINCIPAL IS PARTNERSHIP | BLANK | BLANK | BLANK | BLANK | |
| 13. SEAL OF CORPORATION | BLANK | BLANK | BLANK | BLANK | |
| 14a. ACKNOWLEDGEMENT | BLANK | BLANK | BLANK | BLANK | |
| 14b. WITNESSING | BLANK | BLANK | BLANK | BLANK | |
| 14c. DECLARATION | BLANK | BLANK | BLANK | BLANK |
| PERSONNEL QUESTIONNAIRE- TTB F 5000.9 (02/2008) OMB No. 1513-0002 (03/31/2012) | |||||
| FORM FIELD NAME | APPLICATION TYPE/CAP | SCREEN NAME | SECTION HEADER | SCREEN FIELD LABEL | COMMENTS |
| TRADE OR CORPORATE NAME TO BE USED | Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | Name of Business | |
| BUSINESS ADDRESS OF FIRM | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | Address | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | City | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | State | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | Zip Code | ||
| TELEPHONE NUMBER | Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | Primary Phone Number | |
| FULL NAME OF APPLICANT | Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | First Name | |
| Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | Middle Name | ||
| Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | Last Name | ||
| NAME USUALLY USED | Application for Owner and Officer Information | Step 2: Application Information | Basic Information | Name Usually Used | |
| MAIDEN NAME & DATE OF MARRIAGE | Application for Owner and Officer Information | Step 2: Application Information | Basic Information | If married, give full maiden name | |
| Application for Owner and Officer Information | Step 2: Application Information | Basic Information | If married, give date of marriage | ||
| LEGAL RESIDENCE | Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | Address Line 1 | |
| Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | Address Line 2 | ||
| Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | City | ||
| Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | State | ||
| Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | Zip Code | ||
| TELEPHONE NUMBER | Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | Primary Phone Number | |
| BUSINESS ADDRESS OF FIRM | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Street # | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Street Direction | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Street Name | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Street Type | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Street Suffix | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | City | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | State | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Zip Code | ||
| TELEPHONE NUMBER | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Premises Phone Number | |
| GENDER | Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | Gender | |
| HEIGHT | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | Height (Ft) | |
| Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | Height (In) | ||
| WEIGHT | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | Weight | |
| COLOR OF HAIR | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | Color of Hair | |
| COLOR OF EYES | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | Color of Eyes | |
| PLACE OF BIRTH | Application for Owner and Officer Information | Step 2: Application Information | Basic Information | Place of Birth City | |
| Application for Owner and Officer Information | Step 2: Application Information | Basic Information | Place of Birth State | ||
| DATE OF BIRTH | Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | Birth Date | |
| SOCIAL SECURITY NUMBER | Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | SSN | |
| POSITION OR TITLE | Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | Title | |
| DESCRIPTION OF DUTIES | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Business Information: Application | Officer/Ownership Information | Description of Duties or Relation to the Proposed Operation: | |
| FATHER'S NAME | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | Father's Name | |
| MOTHER'S MAIDEN NAME | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | Mother's Maiden Name | |
| 1. HAVE YOU EVER BEEN KNOWN BY ANY OTHER NAME? | Application for Owner and Officer Information | Step 2: Application Information | Basic Information | Have you ever been known by any other name (include nicknames, aliases)? | |
| 2. HAVE YOU EVER BEEN ARRESTED FOR ANY VIOLATION OF ANY FEDERAL OR STATE LAW RELATING TO LIQUOR OR TOBACCO PRODUCTS? | Application for Owner and Officer Information | Step 2: Application Information | Basic Information | 1. Have you ever been arrested for any violation of any Federal or State law relating to liquor or tobacco products? | |
| Application for Owner and Officer Information | Step 2: Application Information | Basic Information | If YES to question 1 – explain (Charges for minor traffic violations need not be reported) |
||
| 3. HAVE YOUR EVER BEEN ARRESTED FOR VIOLATION OF ANY OTHER FEDERAL OR STATE LAW? | Application for Owner and Officer Information | Step 2: Application Information | Basic Information | 2. Have you ever been arrested for violation on any other Federal or State Law? | |
| Application for Owner and Officer Information | Step 2: Application Information | Basic Information | If YES to question 2 - explain (Charges for minor traffic violations need not be reported) | ||
| 4. HAVE YOU EVER BEEN CONVICTED OF ANY FELONY OR MISDEMEANOR UNDER FEDERAL OR STATE LAW? | Application for Owner and Officer Information | Step 2: Application Information | Basic Information | 3. Have you ever been convicted of any felony or misdemeanor under Federal or State Law? | |
| Application for Owner and Officer Information | Step 2: Application Information | Basic Information | If YES to question 3 - explain (Charges for minor traffic violations need not be reported) | ||
| 5. HAVE YOU EVER BEEN COMPROMISED, BY PAYMENT OF PENALTIES OR OTHERWISE, FOR ANY VIOLATION OF ANY FEDERAL LAW RELATING TO INTERNAL REVENUW OR CUSTOMS TAXATION OF DISTILLED SPIRITS, WINES, BEER, OR TOBACCO PRODUCTS? | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | 6. Have you ever been compromised, by payment of penalties or otherwise, for any violation on and Federal law relating to internal revenue or customs taxation of distilled spirits, wines, beer, or tobacco products? | |
| Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | If YES to question 6 - explain | ||
| 6. HAS DISAPPROVAL EVER BEEN GIVEN TO ANY APPLICATION OR NOTICE OF INTENTION TO MANUFACTURE, USE, STORE, RECTIFY, BOTTLE, DISTRIBUTE, SELL, IMPORT, OR TRANSPORT ALCOHOL, DENATURED SPIRITS, DISTILLED SPIRITS, BEER, WINES, OR TOBACCO PRODUCTS FILED BY YOU OR ANY FIRM OR CORPORATION OF WHICH YOU WERE PROPRIETOR OR A PARTNER, OFFICER, DIRECTOR, PRINCIPAL STOCKHOLDER, OR RESPONSIBLE EMPLOYEE? IF ANSWER IS "YES", STATE NAME UNDER WHICH APPLICATION WAS FILED AND REASONS FOR DISAPPROVAL |
Application for Owner and Officer Information | Step 2: Application Information | Basic Information | 4. Has disapproval ever been given to any application or notice of intention to manufacture, use, store, rectify, bottle, distribute, sell, import, or transport alcohol, denatured spirits, distilled spirits, beer, wines, or tobacco products filed by you or any firm or corporation of which you were proprietor or a partner, officer, director, principal stockholder, or responsible employee? | |
| Application for Owner and Officer Information | Step 2: Application Information | Basic Information | If YES to question 4 – State name under which application was filed and reasons for disapproval. | ||
| 7. ARE YOU A CITIZEN OF THE UNITED STATES OF AMERICA? | Application for Owner and Officer Information | Step 2: Application Information | Basic Information | Are you a U.S. Citizen? | |
| 7a. IF NATURALIZED, GIVE DATE AND LOCATION WHERE NATURALIZATION PAPERS WERE ISSUED | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | If Naturalized, give Date and Location where Naturalization papers were issued | |
| 7b. IF NOT A CITIZEN, CURRENT CITIZENSHIP STATUS | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | If not a US citizen, give current citizenship status | |
| Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | If not US citizen, give Country of Citizenship | ||
| 8. EVER BEEN CONNECTED WITH A FEDERAL PERMIT OR APPROVED NOTICE… | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | 7. Have you as an individual or in connection with a partnership, firm, or corporation ever been connected with a Federal permit or approved notice to manufacture, use, store, rectify, bottle, distribute, sell, deal in, import, or transport alcohol, denatured spirits, distilled spirits, beer, wines, or tobacco products? | |
| 8a. IF YES, PERMIT NUMBER IF KNOWN | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | If YES to question 7. Permit Number, if known | |
| 8b. PERIOD COVERED | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | Period Covered | |
| 8c.NAME AND ADDRESS UNDER WHICH PERMIT WAS USED | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | Name and Address under which permit was issued | |
| 8d. IF DISCONTINUED, WHEN AND WHY? | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | If discontinued, when and why? | |
| 8e. IF REVOKED, WAS SETTLEMENT MADE OF CIVIL LIABILITIES INCURRED THEREUNDER. IF YES, WHEN? | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | If revoked, was settlement made of civil liabilities incurred thereunder? | |
| 9. EVER BEEN OR ARE YOU NOW EMPLOYED BY ANY PERSON, FIR OR CORPORATION MANUFACTURING OR EXPORTING TAX-EXEMPT TOBACCO PRODUCTS…? | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | 8. Have you ever been or are you now employed by any person, firm, or corporation manufacturing or exporting tax-exempt tobacco products; producing, storing, rectifying, bottling, selling, importing or dealing in distilled spirits, wines, beer, alcohol, or denatured spirits; using or distributing denatured spirits; or using (other than for person use) distilled spirits or alcohol? | |
| 9a. WHEN EMPLOYED | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | If YES to question 8 when Employed? | |
| 9b. IN WHAT CAPACITY | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | In What Capacity | |
| 9c. NAME AND ADDRESS OF PERSON, FIRM OR CORPORATION | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | Name and Address of Person, Firm or Corporation | |
| 10. EMPLOYMENT FOR PAST 10 YEARS PERIOD (FROM) |
Application for Owner and Officer Information | Step 2: Application Information | Employment Information | From | |
| PERIOD (TO) | Application for Owner and Officer Information | Step 2: Application Information | Employment Information | To | |
| POSITION OR TITLE | Application for Owner and Officer Information | Step 2: Application Information | Employment Information | Position | |
| NAME AND ADDRESS OF EMPLOYER | Application for Owner and Officer Information | Step 2: Application Information | Employment Information | Name of Employer | |
| NAME AND ADDRESS OF EMPLOYER | Application for Owner and Officer Information | Step 2: Application Information | Employment Information | Address of Employer | |
| 11. NAME AND ADDRESS OF FIVE REFERENCES BANK REFERENCE NAME |
Application for Owner and Officer Information | Step 2: Application Information | Bank Reference Information | Bank Name | |
| BANK REFERENCE BUSINESS NAME AND ADDRESS | Application for Owner and Officer Information | Step 2: Application Information | Bank Reference Information | Business Name | |
| BANK REFERENCE BUSINESS NAME AND ADDRESS | Application for Owner and Officer Information | Step 2: Application Information | Bank Reference Information | Bank Address | |
| BANK REFERENCE TELEPHONE NUMBER | Application for Owner and Officer Information | Step 2: Application Information | Bank Reference Information | Phone Number | |
| CHARACTER/BUSINESS REFERENCE | Application for Owner and Officer Information | Step 2: Application Information | Character-Business Reference | Name of Reference | |
| CHARACTER/BUSINESS REFERENCE RESIDENCE | Application for Owner and Officer Information | Step 2: Application Information | Character-Business Reference | Home Address | |
| CHARACTER/BUSINESS REFERENCE RESIDENCE TELEPHONE NUMBER | Application for Owner and Officer Information | Step 2: Application Information | Character-Business Reference | Home Phone | |
| CHARACTER/BUSINESS REFERENCE BUSINESS NAME AND ADDRESS | Application for Owner and Officer Information | Step 2: Application Information | Character-Business Reference | Business Address | |
| CHARACTER/BUSINESS REFERENCE BUSINESS TELEPHONE NUMBER | Application for Owner and Officer Information | Step 2: Application Information | Character-Business Reference | Business Phone | |
| 12. CREDIT RATINGS | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | 5. Are you rated by any commercial credit reporting agency? | |
| Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | If YES to question 5, give name and address of agency and details of rating | ||
| 13. RESIDENCES FOR PAST TEN YEARS PERIOD (FROM) |
Application for Owner and Officer Information | Step 2: Application Information | Residence Information | From | |
| PERIOD (TO) | Application for Owner and Officer Information | Step 2: Application Information | Residence Information | To | |
| ADDRESS | Application for Owner and Officer Information | Step 2: Application Information | Residence Information | Addresss | |
| 14a. INVESTMENTS | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Business Information: Application | Officer/Ownership Information | Investment in Business | |
| 14b. SOURCE OF FUNDS INVESTED | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Business Information: Application | Officer/Ownership Information | Source of Funds Description | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Business Information: Application | Officer/Ownership Information | How is SOF Documentation submitted? | ||
| PENALTY OF PERJURY STATEMENT | Application for Owner and Officer Information | Step 2: Application Information | Your Declaration | Under the penalties of perjury, I declare that this statement, including the documents submitted in support thereof, has been examined by me and, to the best of my knowledge and belief, is true, correct, and complete. | |
| SIGNATURE OF APPLICANT | N/A | N/A | N/A | N | System Generated with First Name and Last Name for each Officer/Owner listed in the Officer/Ownership Information section |
| DATE | N/A | N/A | N/A | N/A | System Generated |
| REMARKS | Application for Owner and Officer Information | Step 2: Application Information | Supplemental Information | Remarks | |
| ENVIRONMENTAL INFORMATION- TTB F 5000.29 (10/2008) OMB No. 1513-0023 (08/31/2011) | |||||
| FORM FIELD NAME | APPLICATION TYPE/CAP | SCREEN NAME | SECTION HEADER | SCREEN FIELD LABEL | COMMENTS |
| 1. NAME AND ADDRESS | Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | Name of Business | |
| Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | Address | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | City | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | State | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | Zip Code | ||
| 2. DESCRIPTION OF ACTIVITY | Application for New Winery Operation | Step 3: Business Information | Water Quality Information | Describe activity to be conducted in which the Alcohol and Tobacco Tax and Trade Bureau has an interest | |
| 3. NUMBER OF EMPLOYEES | Application for New Winery Operation | Step 3: Business Information | Environmental Information | Enter Number of Employees | |
| 4. LOCATION OF ACTIVITY | Application for New Winery Operation | Step 3: Business Information | Environmental Information | Location Where Activity is to be Conducted (Be specific, Number, Street, City, State, Zip Code; describe locations of buildings and outside equipment and their situation relative to surrounding environment including other structures, land use, lakes, streams, roads, railroad | |
| 5A. HEAT AND POWER- TYPES OF HEAT AND POWER TO BE USED | Application for New Winery Operation | Step 3: Business Information | Environmental Information | Describe types of heat and power to be used and their sources. If they are to be produced in connection with the proposed activity, estimate type and quantity of fuel to be used for each purpose. (Example: 40 tons/yr. anthracite coal for heat, 20 million cu.-ft/yr. natural for power generating.) | |
| 5B. HEAT AND POWER- AIR POLLUTION EQUIPMENT PROPOSED | Application for New Winery Operation | Step 3: Business Information | Environmental Information | Describe any air pollution control equipment proposed for use in connection with fuel burning equipment, boilers, or smokestacks. | |
| 6A. SOLID WASTE- AMOUNT AND CONSUMPTION OF ALL SOLID WASTE | Application for New Winery Operation | Step 3: Business Information | Environmental Information | Describe amount and composition of all solid waste to be generated | |
| 6B. SOLID WASTE- PROPOSED METHODS OF DISPOSAL | Application for New Winery Operation | Step 3: Business Information | Environmental Information | Discuss proposed methods of disposal (Incineration, open burning, landfill, government or commercial garbage collection, etc.) Specify whether on-site or off-site. | |
| 6C. SOLID WASTE- AIR POLLUTION EQUIPMENT PROPOSED | Application for New Winery Operation | Step 3: Business Information | Environmental Information | Describe any air pollution control equipment proposed for use in connection with any incinerators. | |
| 7A. LIQUID WASTE- AMOUNT AND CONTENT OF ANY LIQUID WASTE TO BE GENERATED | Application for New Winery Operation | Step 3: Business Information | Environmental Information | Liquid Waste (Complete this item irrespective of any certification obtained as to compliance with any environmental quality standards of any Federal, State, or local agency having responsibility for environmental protection including any certification under the Federal Water Pollution Control Act.) Describe amount and content of any liquid waste to be generated. | |
| 7B. LIQUID WASTE- PROPOSED METHOD OF DISPOSAL | Application for New Winery Operation | Step 3: Business Information | Environmental Information | Describe proposed method of disposal (sewer, flaming, recycling, etc.) Describe any proposed means to monitor quality and characteristics, and any proposed equipment or facilities for treatment or control of liquid wastes. | |
| 8. NOISE | Application for New Winery Operation | Step 3: Business Information | Environmental Information | Noise (Describe operational noise sources other than those normally associated with office operations, building maintenance, or utilities.) | |
| PENALTY OF PERJURY STATEMENT | Application for Owner and Officer Information | Step 2: Application Information | Your Declaration | Under penalties of perjury, I declare that I have examined this application, including accompanying statements, and to the best of my knowledge and belief, it is true, correct, and complete. | |
| 9. DATE | N/A | N/A | N/A | N/A | System Generated |
| 10. APPLICANT | N/A | N/A | N/A | N/A | System Generated with First Name and Last Name from Application Contact Address |
| 11. BY (SIGNATURE AND TITLE) | N/A | N/A | N/A | N/A | System Generated with First Name and Title from Applicant Contact Address |
| SUPPLEMENTAL INFORMATION ON WATER QUALITY CONSIDERATIONS- TTB F 5000.30 (10/2008) OMB No. 1513-0023 (08/31/2011) | |||||
| FORM FIELD NAME | APPLICATION TYPE/CAP | SCREEN NAME | SECTION HEADER | SCREEN FIELD LABEL | COMMENTS |
| 1. FORM NUMBER | N/A | N/A | N/A | N/A | System Generated |
| 2. APPLICATION DATE | N/A | N/A | N/A | N/A | System Generated |
| 3. SERIAL NUMBER | N/A | N/A | N/A | N/A | |
| 4. NAME AND PRINCIPAL BUSINESS ADDRESS | Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | Name of Business | |
| Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | Address | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | City | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | State | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | Zip Code | ||
| 5. PLANT ADDRESS | Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Street Number | |
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Direction | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Street Name | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Street Type | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Street Suffix | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Unit Type | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Unit Number | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Rural Address | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Other Address | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | City | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | State | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Zip Code | ||
| 6. DESCRIBE ACTIVITY | Application for New Winery Operation | Step 3: Business Information | Water Quality Information | Describe activity to be conducted in which the Alcohol and Tobacco Tax and Trade Bureau has an interest | |
| 7. DESCRIBE DISCHARGE | Application for New Winery Operation | Step 3: Business Information | Water Quality Information | Describe any direct or indirect discharge into navigable waters which may result from the conduct of the activity described in the question above including the biological, chemical, thermal, or other characteristic of the discharge and the locations at which such discharge may enter navigable waters. | |
| 8. ACTIVITY DATES | Application for New Winery Operation | Step 3: Business Information | Water Quality Information | Give the date or dates on which the activity will begin and end, if known, and on which the discharge will take place. | |
| 9. MONITORING METHODS | Application for New Winery Operation | Step 3: Business Information | Water Quality Information | Describe the methods and means used or to be used to monitor the quality and characteristics of the discharge and the operation of equipment or facilities employed in the treatment or control of wastes or other effluents. | |
| PENALTY OF PERJURY STATEMENT | Application for Owner and Officer Information | Step 2: Application Information | Your Declaration | Under penalties of perjury, I declare that I have examined this application, including accompanying statements, and to the best of my knowledge and belief, it is true, correct, and complete. | |
| 10. APPLICANT | N/A | N/A | N/A | N/A | System Generated with First Name and Last Name from Application Contact Address |
| 11. BY (SIGNATURE AND TITLE) | N/A | N/A | N/A | N/A | System Generated with First Name and Title from Applicant Contact Address |
| SIGNING AUTHORITY FOR CORPORATE AND LLC OFFICIALS- TTB F 5100.1 (12/2007) OMB No. 1513-0036 (11/30/2010) | |||||
| FORM FIELD NAME | APPLICATION TYPE/CAP | SCREEN NAME | SECTION HEADER | SCREEN FIELD LABEL | COMMENTS |
| NAME AND COMPLETE ADDRESS OF CORPORATION OR LLC | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | Name of Business | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | Address | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | City | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | State | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | Zip Code | ||
| rCHECK IF YOU ARE A NEW APPLICANT | N/A | N/A | N/A | N/A | System Generated based on application type selected |
| REGISTRY/PERMIT NUMBER | N/A | N/A | N/A | N/A | System Generated |
| BOARD MEETING | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Signing Authority | Type of Board Meeting | |
| DATE OF MEETING | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Signing Authority | Date of Meeting | |
| AUTHORIZED LIST OF CORPORATE/LLC OFFICIALS, EMPLOYEES, OR INCUMBENTS | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Signing Authority | Authority Granted By | |
| Step 2: Application Information | Signing Authority | First Name | |||
| Step 2: Application Information | Signing Authority | Middle Name | |||
| Step 2: Application Information | Signing Authority | Last Name | |||
| Step 2: Application Information | Signing Authority | Suffix | |||
| Step 2: Application Information | Signing Authority | Title | |||
| Step 2: Application Information | Signing Authority | Source of Authority | |||
| Step 2: Application Information | Signing Authority | Type | |||
| Step 2: Application Information | Signing Authority | Signing Authority Capacity | |||
| Step 2: Application Information | Signing Authority | If Limited, Signing Authority Capacity | |||
| PENALTY OF PERJURY STATEMENT | Application for Owner and Officer Information | Step 2: Application Information | Your Declaration | Under penalties of perjury, I declare that I have examined this application, including accompanying statements, and to the best of my knowledge and belief, it is true, correct, and complete. | |
| SIGNATURE | N/A | N/A | N/A | N | System Generated with First Name and Last Name |
| PRINTED NAME | N/A | N/A | N/A | N | System Generated with First Name and Last Name |
| TITLE | N/A | N/A | N/A | N/A | System Generated with Title from Applicant Contact |
| DATE | N/A | N/A | N/A | N/A | System Generated |
| APPLICATION FOR BASIC PERMIT UNDER ALCOHOL ADSMINISTRATION ACT- TTB F 5100.24 (01/2010) OMB No. 1513-0018 (08/31/2011) | |||||
| FORM FIELD NAME | APPLICATION TYPE/CAP | SCREEN NAME | SECTION HEADER | SCREEN FIELD LABEL | COMMENTS |
| 1. FULL NAME AND PREMISES ADDRESS | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | Name of Business | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Street Number | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Direction | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Street Name | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Street Type | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Street Suffix | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Unit Type | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Unit Number | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Rural Address | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Other Address | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | City | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | State | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Premises Address | Zip Code | ||
| 2. MAILING ADDRESS | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Mailing Address | Name of Business | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Mailing Address | Address | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Mailing Address | P.O. Box | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Mailing Address | City | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Mailing Address | State | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Mailing Address | Zip Code | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Mailing Address | Country | ||
| 3. EMPLOYER IDENTIFICATION NUMBER | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 1: Contacts and Location | Business Headquarters | EIN | |
| 4. OPERATING NAME (DBA) | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Trade Name/Operating Name | Type | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Trade Name/Operating Name | Who Will You be Bottling on Account For? | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Trade Name/Operating Name | Name | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Trade Name/Operating Name | I certify that the listed trade name has been registered with my County (CA) or State (All States) | ||
| 5. LABELING TRADE NAMES | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Trade Name/Operating Name | Type | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Trade Name/Operating Name | Who Will You be Bottling on Account For? | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Trade Name/Operating Name | Name | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Trade Name/Operating Name | I certify that the listed trade name has been registered with my County (CA) or State (All States) | ||
| 6. BUSINESS TO BE CONDUCTED AT PREMISES | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Application Type Business Conducted- Importing Business Conducted- Wholesaling |
Bonded Winery- Producing and Blending Wine Bonded Winery- Blending Wine Only Bonded Wine Cellar Bonded Wine Cellar and Wine Blender Tax Paid Wine Bottling House Distilled Spirits Wine Malt Beverages |
|
| 7a. REASON FOR APPLICATION- NEW BUSINESS | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Reason for Application | New Business | |
| 7b. REASON FOR APPLICATION-Change in Control | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Reason for Application | Change of General Partners | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Reason for Application | Permit Number of Predecessor | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Reason for Application | Registry Number of Predecessor | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Reason for Application | Name and Address of Predecessor | ||
| 7c. REASON FOR APPLICATION-Change in Ownership | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Reason for Application | Change in Proprietorship | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Reason for Application | Permit Number of Predecessor | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Reason for Application | Registry Number of Predecessor | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Reason for Application | Name and Address of Predecessor | ||
| 8. OWNER INFORMATION- NAME | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Officer/Ownership Information | Officer/Owner Classification | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Officer/Ownership Information | First Name | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Officer/Ownership Information | Middle Name | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Officer/Ownership Information | Last Name | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Officer/Ownership Information | Suffix | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Officer/Ownership Information | Company Name | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Officer/Ownership Information | Trust Name | ||
| TITLE | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Officer/Ownership Information | Title | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Officer/Ownership Information | List Additional Titles | ||
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Officer/Ownership Information | Title if Other | ||
| % VOTING/STOCK/INTEREST | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Officer/Ownership Information | Percent Voting-Stock-Interest | |
| INVESTMENT | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Officer/Ownership Information | Investment in Business | |
| SOURCES OF FUNDS | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Officer/Ownership Information | Source of Funds (SOF) Description | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Officer/Ownership Information | How is SOF Documentation Submitted?: | ||
| 9A. FULL GIVEN NAME | Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | First Name | |
| Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | Middle Name | ||
| Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | Last Name | ||
| 9B. DATE AND PLACE OF BIRTH | Application for Owner and Officer Information | Step 2: Application Information | Basic Information | Place of Birth City | |
| Application for Owner and Officer Information | Step 2: Application Information | Basic Information | Place of Birth State | ||
| 9C. SOCIAL SECURITY | Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | SSN | |
| 9D. ARE YOU A U.S. CITIZEN? | Application for Owner and Officer Information | Step 2: Application Information | Basic Information | Are you a U.S. Citizen? | |
| 9E. MALE/FEMALE | Application for Owner and Officer Information | Step 1: Applicant Name & Address | Officer-Owner | Gender | |
| 9F. OTHER NAMES USED | Application for Owner and Officer Information | Step 2: Application Information | Basic Information | Other Names Used (Maiden name, nicknames, aliases) | |
| 9G. RESIDENCES OVER LAST FIVE YEARS | Application for Owner and Officer Information | Step 2: Application Information | Residence Information | From | |
| Application for Owner and Officer Information | Step 2: Application Information | Residence Information | To | ||
| Application for Owner and Officer Information | Step 2: Application Information | Residence Information | Addresss | ||
| 10. DENIED A PERMIT? | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Owner Background information | Has the applicant or any person listed on this application ever been denied a permit, license, or other authorization to engage in any business to manufacture, distribute, import, sell, or use alcohol products (beverage or nonbeverage) by any government agency (Federal, State, local or foreign) or had such a permit, license, or other authorization revoked, suspended, or otherwise terminated? | |
| Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Owner Background information | If Yes, State Details | ||
| 11. ARRESTED? | Application for New Winery Operation OR Application for New Wholesaler and/or Importer |
Step 2: Application Information | Owner Background information | Has the applicant or any person listed in this application ever been arrested for, charged with, or convicted of any crime under Federal, State, or Foreign laws other than traffic violations or convictions that are not felonies under Federal or State law. | |
| PENALTY OF PERJURY STATEMENT | Application for Owner and Officer Information | Step 2: Application Information | Your Declaration | Under penalties of perjury, I declare that I have examined this application, including accompanying statements, and to the best of my knowledge and belief, it is true, correct, and complete. | |
| 12. APPLICANT SIGNATURE | N/A | N/A | N/A | N/A | System Generated with First Name and Last Name |
| 13. TITLE OF PERSON SIGNING | N/A | N/A | N/A | N/A | System Generated with Title |
| 14. DATE | N/A | N/A | N/A | N/A | System Generated |
| 15. EMAIL ADDRESS | N/A | N/A | N/A | N/A | System Generated with Email address from Owner |
| APPLICATION TO ESTABLISH AND OPERATE WINE PREMISES- TTB Form 5120.25 (03/2010) OMB No. 1513-0009 (01/31/2013) | |||||
| FORM FIELD NAME | APPLICATION TYPE/CAP | SCREEN NAME | SECTION HEADER | SCREEN FIELD LABEL | COMMENTS |
| 1. SERIAL NUMBER | |||||
| 2. DATE | N/A | N/A | N/A | N/A | System Generated |
| 3. REGISTRY NUMBER | N/A | N/A | N/A | N/A | System Generated |
| 4. DIRECTOR | N/A | N/A | N/A | N/A | |
| 5. APPLICATION MADE TO OPERATE | Application for New Winery Operation | Step 2: Application Information | Application Type | Bonded Winery- Producing and Blending Wine Bonded Winery- Blending Wine Only Bonded Wine Cellar Bonded Wine Cellar and Wine Blender Tax Paid Wine Bottling House |
|
| 6. NAME AND PRINCIPAL ADDRESS | Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | Name of Business | |
| Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | Address | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | City | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | State | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | Zip Code | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | Phone Number | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | EIN | ||
| 7. ADDRESS | Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Street Number | |
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Direction | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Street Name | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Street Type | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Street Suffix | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Unit Type | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Unit Number | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Rural Address | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Other Address | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | City | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | State | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Zip Code | ||
| 8. PURPOSE FOR WHICH FILED | N/A | Select Application Type | N/A | Category | |
| Application for New Winery Operation | Step 3: Business Information | Alternation of Premises | Type of Alternating Operation | ||
| Application for New Winery Operation | Step 3: Business Information | Alternation of Premises | Are you alternating with another entity? | ||
| Application for New Winery Operation | Step 3: Business Information | Alternation of Premises | If yes, Name of Alternator | ||
| Application for New Winery Operation | Step 3: Business Information | Alternation of Premises | If yes, Permit Number | ||
| Application for New Winery Operation | Step 3: Business Information | Alternation of Premises | If yes, Registry Number | ||
| Application for New Winery Operation | Step 3: Business Information | Alternation of Proprietors | Type of Arrangement | ||
| Application for New Winery Operation | Step 3: Business Information | Alternation of Proprietors | Host Name | ||
| Application for New Winery Operation | Step 3: Business Information | Alternation of Proprietors | Host Permit Number | ||
| Application for New Winery Operation | Step 3: Business Information | Alternation of Proprietors | Host Registry Number | ||
| Application for New Winery Operation | Step 3: Business Information | Alternation of Proprietors | Tenant Name | ||
| Application for New Winery Operation | Step 3: Business Information | Alternation of Proprietors | Tenant Permit Number | ||
| Application for New Winery Operation | Step 3: Business Information | Alternation of Proprietors | Tenant Registry Number | ||
| Application for New Winery Operation | Step 3: Business Information | Alternation of Proprietors | Co-Tenant Name | ||
| Application for New Winery Operation | Step 3: Business Information | Alternation of Proprietors | Co-Tenant Permit Number | ||
| Application for New Winery Operation | Step 3: Business Information | Alternation of Proprietors | Co-Tenant Registry Number | ||
| Application for New Winery Operation | Step 3: Business Information | Request for Variance | Variance, Alternate Method, Special Permission Type | ||
| Application for New Winery Operation | Step 3: Business Information | Request for Variance | Description of Request | ||
| Application for New Winery Operation | Step 3: Business Information | Non- Contiguous Operations | Does this application include one or more non-contiguous premises locations in addition to your prmiary premises? | ||
| Application for New Winery Operation | Step 3: Business Information | Non- Contiguous Operations | If yes, please provide the physical address for each non-contiguous location other than the primary address shown under the Premises Address fields provided earlier in the this application | ||
| 9a-1. NUMBER OF PAGES ATTACHED TO THIS FORM | N/A | N/A | N/A | N/A | |
| 9b. ORGANIZATIONAL DOCS SUBMITTED WITH THIS FORM | Application for New Winery Operation | Step 3: Business Information | Statements and Documents | Attachment Type, File Name, Attachment Description | |
| 9b-1. ORGANIZATIONAL DOCS FILED WITH PRIOR APPROVED FORM | Application for New Winery Operation | Step 3: Business Information | Statements and Documents | Attachment Type, File Name, Attachment Description | |
| 9c. ORGANIZATIONAL DOC FILED IN CONNECTION WITH ANOTHER ESTABLISHMENT | Application for New Winery Operation | Step 3: Business Information | Statements and Documents | Attachment Type, File Name, Attachment Description | |
| ATTACHED DOCUMENTS AND STATMENTS (BACK OF FORM)- 2. WINE PREMISES | Application for New Winery Operation | Step 3: Business Information | Winery Information | Wine Premises Description: Describe each tract of land comprising the wine premises. Description must be by directions and distances, in feet and inches, with sufficient particularity to enable ready examination of the boundary of the wine premises. | |
| Application for New Winery Operation | Step 3: Business Information | Winery Information | Wine Premises Security: Describe the means employed to afford security of the wine premises. Describe any taxpaid wine premises at the wine premises and the means used to segregate and identify taxpaid wine from un-taxpaid wine. | ||
| Application for New Winery Operation | Step 3: Business Information | Winery Information | Taxpaid Wine Storage: Describe where and how any taxpaid wine will be stored on the premises and the means used to segregate and identify taxpaid wine from untaxpaid wine. | ||
| Application for New Winery Operation | Step 3: Business Information | Winery Information | Bonded Winery in a Residential Building: If operating a bonded winery or bonded wine cellar in a residential building, describe how the bonded premises are segregated from the residence and what direct access to the bonded premises is available. | ||
| Application for New Winery Operation | Step 3: Business Information | Winery Information | Wine Premises Building: Each wine premises building must be described as to size, construction, and use. Buildings not used for the wine operations must be described only as to size and use. If wine premises consists of a partial building, rooms or floors, each must be described separately. Means of ingress and egress from the wine premises to adjoining portions must be described. | ||
| Application for New Winery Operation | Step 3: Business Information | Winery Information | Wine Premises Alternating Areas: Describe any alternating areas. Each wine premises building must be described as to size, construction, and use. Buildings not used for the wine operations must be described only as to size and use. If wine premise consists of a partial building, rooms or floors, each must be described separately. Means of ingress and egress from the wine premise to adjoining portions must be described. | ||
| Application for New Winery Operation | Step 3: Business Information | Winery Information | Spirits Operations: Describe any operation which will involve the use of spirits | ||
| Application for New Winery Operation | Step 3: Business Information | Winery Information | Volatile Fruit-Flavor Concentrate Operations Production: For volatile fruit-flavor concentrate producers, submit a step-by-step description of the production process, commencing with obtaining the juice through each step of the process to removal of the concentrate from the system. | ||
| Application for New Winery Operation | Step 3: Business Information | Winery Information | Volatile Fruit-Flavor Concentrate Operations High Proof Production: For production of high-proof concentrate (more than 24 percent alcohol), indicate any step in the process at which the spirits are potable. Include the maximum quantity in gallons of fruit must and volatile fruit-flavor concentrate produced in 24 hours; the maximum and minimum fold; and the maximum percent of alcohol in the concentrate for each kind of fruit used. | ||
| Application for New Winery Operation | Step 3: Business Information | Winery Information | Other Operations: Describe any other operations not specifically authorized by Part 24 that are to be conducted on the wine premises. This must include a list of the premises and any major equipment used, and a statement as to the relationship, if any, of the operation to the wine operations. These other operations need not be restricted to alcohol-related businesses. | ||
| ATTACHED DOCUMENTS AND STATMENTS (BACK OF FORM)- 3. DISCLOSURE | Application for New Winery Operation | Step 3: Business Information | Winery Information | Disclosure: If this application is not for a bonded wine premises in which production operations will be conducted and, thus a Federal Alcohol Administration Act basic permit is not required, would you agree to the listing of your name in a TTB publication which may be distributed to the general public upon request? A “no” response will have no effect on the consideration of this application. Under U.S.C. 6103, you have a legal right not to give this release | |
| ATTACHED DOCUMENTS AND STATMENTS (BACK OF FORM)- 6. BONDS AND PERMITS | Application for New Winery Operation | Step 3: Business Information | Bonds and Permits | Commodity Type | |
| Application for New Winery Operation | Step 3: Business Information | Bonds and Permits | Bond Form | ||
| Application for New Winery Operation | Step 3: Business Information | Bonds and Permits | Bond Category | ||
| Application for New Winery Operation | Step 3: Business Information | Bonds and Permits | Surety Name if Applicable | ||
| Application for New Winery Operation | Step 3: Business Information | Bonds and Permits | Amount | ||
| Application for New Winery Operation | Step 3: Business Information | Bonds and Permits | Permit Number | ||
| Application for New Winery Operation | Step 3: Business Information | Bonds and Permits | Registry Number | ||
| PENALTY OF PERJURY STATEMENT | Application for Owner and Officer Information | Step 2: Application Information | Your Declaration | Under penalties of perjury, I declare that I have examined this application, including accompanying statements, and to the best of my knowledge and belief, it is true, correct, and complete. | |
| 11. SIGNATURE | N/A | N/A | N/A | N/A | System Generated with First Name and Last Name |
| 12. TITLE | N/A | N/A | N/A | N/A | System Generated with Title from Applicant Contact |
| WINE BOND- TTB F 5120.36 (01/2010) OMB No. 1513-0009 (01/31/2013) | |||||
| FORM FIELD NAME | APPLICATION TYPE/CAP | SCREEN NAME | SECTION HEADER | SCREEN FIELD LABEL | COMMENTS |
| REGISTRY NUMBER | N/A | N/A | N/A | N/A | |
| EFFECTIVE DATE | Application for New Winery Operation | Step 3: Business Information | Wine Bond Information | Effective Date of Bond | |
| PRINCIPAL/OBLIGOR NAME AND PREMISES ADDRESS | Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | Name of Business | |
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Street Number | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Direction | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Street Name | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Street Type | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Street Suffix | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Unit Type | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Unit Number | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Rural Address | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Other Address | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | City | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | State | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Premises Address | Zip Code | ||
| PRINCIPAL/OBLIGOR MAILING ADDRESS | Application for New Winery Operation | Step 1: Contacts and Location | Mailing Address | Name of Business | |
| Application for New Winery Operation | Step 1: Contacts and Location | Mailing Address | Address | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Mailing Address | P.O. Box | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Mailing Address | City | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Mailing Address | State | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Mailing Address | Zip Code | ||
| Application for New Winery Operation | Step 1: Contacts and Location | Mailing Address | Country | ||
| EIN | Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | EIN | |
| BOND KIND | Application for New Winery Operation | Step 3: Business Information | Wine Bond Information | Bond Kind | |
| BOND COVERAGE- OPERATIONS | Application for New Winery Operation | Step 3: Business Information | Wine Bond Information | Bond Coverage- Operations | |
| BOND COVERAGE- DEFERRAL | Application for New Winery Operation | Step 3: Business Information | Wine Bond Information | Bond Coverage- Deferral | |
| BOND COVERAGE- TOTAL PENAL SUM | Application for New Winery Operation | Step 3: Business Information | Wine Bond Information | Bond Coverage- Total Penal Sum | |
| BOND CATEGORY | Application for New Winery Operation | Step 3: Business Information | Wine Bond Information | Bond Category | |
| SURETY NAME | Application for New Winery Operation | Step 3: Business Information | Wine Bond Information | If Surety- Surety Name | |
| BOND NUMBER | Application for New Winery Operation | Step 3: Business Information | Wine Bond Information | If Surety- Bond Number | |
| CHECK NUMBER | Application for New Winery Operation | Step 3: Business Information | Wine Bond Information | If Cash- Check Number | |
| BOND CUSIP | Application for New Winery Operation | Step 3: Business Information | Wine Bond Information | If T-Note or T-Bond- CUSIP Number | |
| BOND MATURITY DATE | Application for New Winery Operation | Step 3: Business Information | Wine Bond Information | If T-Note or T-Bond- Maturity Date | |
| BOND INTEREST RATE | Application for New Winery Operation | Step 3: Business Information | Wine Bond Information | If T-Note or T-Bond- Interest Rate | |
| BOND ISSUE DATE | Application for New Winery Operation | Step 3: Business Information | Wine Bond Information | If T-Note or T-Bond- Issue Date | |
| BOND EXECUTION DATE | Application for New Winery Operation | Step 3: Business Information | Wine Bond Information | Execution Date | |
| SURETY NAME | BLANK | BLANK | BLANK | BLANK | |
| SURETY REPRESENTATIVE SIGNATURE | BLANK | BLANK | BLANK | BLANK | |
| SURETY REPRESENTATIVE PRINTED NAME AND TITLE | BLANK | BLANK | BLANK | BLANK | |
| PRINCIPAL/OBLIGOR NAME | BLANK | BLANK | BLANK | BLANK | |
| PRINCIPAL/OBLIGOR REPRESENTATIVE SIGNATURE | BLANK | BLANK | BLANK | BLANK | |
| PRINCIPAL/OBLIGOR REPRESENTATIVE PRINTED NAME | BLANK | BLANK | BLANK | BLANK | |
| SIGNATURE WITNESS 1 | BLANK | BLANK | BLANK | BLANK | |
| SIGNATURE WITNESS 2 | BLANK | BLANK | BLANK | BLANK |
| CHANGE IN BOND (CONSENT OF SURETY)- TTB F 5000.18 (12/2009) OMB No. 1513-0013 (04/30/2012) | |||||
| FORM FIELD NAME | APPLICATION TYPE/CAP | SCREEN NAME | SECTION HEADER | SCREEN FIELD LABEL | COMMENTS |
| 1.LEGAL NAME OF BUSINESS | Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | Name of Business | |
| 2. EMPLOYER IDENTIFICATION NUMBER | Application for New Winery Operation | Step 1: Contacts and Location | Business Headquarters | EIN | |
| 3. PERMIT NUMBER/REGISTRY NUMBER ON THE BOND | N/A | N/A | N/A | N/A | |
| 4. CORPORATE SURETY | Application for New Winery Operation | Step 3: Business Information | Consent of Surety | What is the corporate surety, if any, listed on the bond that you are changing? | |
| 5. FORM NUMBER OF THE BOND CHANGING | Application for New Winery Operation | Step 3: Business Information | Consent of Surety | What is the form number of the bond that you are changing? | |
| 6. DOLLAR AMOUNT OF BOND CHANGING | Application for New Winery Operation | Step 3: Business Information | Consent of Surety | What is the dollar amount of the bond that you are changing? | |
| 7. EFFECTIVE DATE OF BOND CHANGING | Application for New Winery Operation | Step 3: Business Information | Consent of Surety | What is the effective date of the bond that you are changing? | |
| 8. EFFECTIVE DATE OF THIS CHANGE IN BOND | Application for New Winery Operation | Step 3: Business Information | Consent of Surety | What is the effective date of this change in bond? | |
| 9. WE ARE CHANGING THE ABOVE BOND AS FOLLOWS: | Application for New Winery Operation | Step 3: Business Information | Consent of Surety | We are chaning the above bond as follows: | |
| 10. DATE | N/A | N/A | N/A | N/A | System Generated |
| 10b. SIGNATURE FOR YOUR BUSINESS | BLANK | BLANK | BLANK | BLANK | |
| PRINTED NAME AND TITLE | BLANK | BLANK | BLANK | BLANK | |
| SEAL OF BUSINESS | BLANK | BLANK | BLANK | BLANK | |
| SIGNATURE OF TWO WITNESSES | BLANK | BLANK | BLANK | BLANK | |
| PRINTED NAMES OF TWO WITNESSES | BLANK | BLANK | BLANK | BLANK | |
| 10c. SIGNATURE FOR CORPORATE SURETY | BLANK | BLANK | BLANK | BLANK | |
| PRINTED NAME AND TITLE | BLANK | BLANK | BLANK | BLANK | |
| CORPORATE SEAL OF SURETY | BLANK | BLANK | BLANK | BLANK |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |