PONL Crosswalk with OMB No. 1513-0018 (TTB F 5100.24)

PONL 5.0 CROSSWALK -- APPLICATION FOR BASIC PERMIT UNDER ALCOHOL ADSMINISTRATION ACT (OMB Control No. 1513-0018; TTB F 5100.24 (08/2015)
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