Form Abl-571 - Out Of State Wine Shippers License

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STATE OF SOUTH CAROLINA
1350
DEPARTMENT OF REVENUE
ABL-571
(Rev. 10/1/08)
OUT OF STATE WINE SHIPPERS LICENSE
4310
Mail to: SCDOR, ABL Section, Columbia, SC 29214-0907.
For Office Use Only
Telephone: (803) 898-5864
DOR Website:
File Number
License Period Ending
8/31
DLN
PLEASE PRINT OR TYPE ALL INFORMATION
DLN
Fee: $600 Biennially
(Expires August 31st of even numbered years)
14-3977
Amount Paid
Sled
34-3973-9000
1.
Owner, Partnership, or Corporate Charter Name
2.
Physical Location of Business Required
(No P.O. Box)
STREET
CITY
COUNTY (REQUIRED)
STATE
ZIP
3.
Mailing Address
(For all Correspondence)
STREET
CITY
COUNTY
STATE
ZIP
4.
Type of Ownership
Sole Proprietor (one owner)
Partnership (two or more owners)
LLC/LLP
SC Corporation Date Inc.
Foreign Corporation (Attach copy of Articles of Certificate of Authority)
Non-Profit Organization
Other (Explain)
5.
Trade Name
(Doing Business As)
6.
Business Phone Number
Daytime Phone Number
7.
Federal Identification Number and/or Social Security Number
8.
Location of Records (No P.O. Box)
9.
Must provide SC Retail Sales Tax License Number:
10.
Federal Alcohol Administrators Producers and Blenders Basic Permit Number
(Attach a Copy)
Applicant (owner, partner, or corporate officer)
43101021

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