Application For Forwarding Center Authority {L-FC}

Page 1 of 3 Form L-FC (1/2017) APPLICATION FOR FORWARDING CENTER AUTHORTIY (FC) L-FC (1/2017) Forwarding Center Authority expiration date will be the same as your primary license/permit . Only the holders of the following license/permit classes may obtain this authority: Manufacturer222s License (BA), Nonresident Manufacturer222s License (BS), Brewer222s Permit (B), Nonresident Brewer222s Permit (U), Distiller222s and Rectifier222s Permit (D), Nonresident Seller222s Permit (S) and Winery Permit (G). All statutory and rule references mentioned in this application refer to and can be found in the Texas Alcoholic Beverage Code or Rules located on our website. www.tabc.texas.gov/laws/codeandrules.asp TABC USE ONLY FC - ISSUE DATE FEE SURCHARGE TOTAL / / $2,000 $278 1A. APPLICATION FILED FOR: Registry No. Original Change Manufacturer222s License/Permit Number B.If change, enter Regional Forwarding Center No.: FC - ALL APPLICANTS 2.APPLICATION IS FILED BY: (Indicate c urrent manufacturing License/Permit No. issued by TABC and the name of entity currently holding License/P ermit.) TABC Manufacturer222s License/Permit Number: Entity Name: 3. Name of Regional Forwarding Center 4.Location Address (of Regional Forwarding Center) City County State Zip Code (9 digits) 5.Mailing Address City State Zip Code (9 digits) 6. Business Phone No. Alternate Phone No. E-mail Address: 7.IF YOUR LOCATION IS NOT WITHIN THE CITY LIMITS, CHECK HERE I, the applicant, have confirmed I am not located in the city limits of any city and therefore all citycertificates are not required. TABC USE ONLY PROCESSOR REVIEW DATE / / WRITTEN PROCESS DATE / / END PROCESS DATE / / PROCESSOR I.D. American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 Form L-FC (1/2017) 8 . If Manufacturer Applicant is: Who Must be Listed Below : Individual Individual Owner Partnership All Partners Limited Partnership All General Partners Corporation All Officers Limited Liability Company All Officers or Managers Joint Venture V enturers Trust Trustee(s) Last Name First Name MI Title Last Name First Name MI Title Last Name First Name MI Title REGIONAL FORWARDING CENTER OWNER OF PREMISE INFORMATION 9. Trade Name of Regional Forwarding Cen ter Location 10.Indicate if owner of Regional Forwarding Center Property is: Owner of Land and Building Owner of Land Owner of Building Note: If land and building are owned by different entities, complete this section for each entity. 11 . Owner of Regional Forwarding Center Property (Individual or Business Entity) 12 . Federal Employer Identification Number (FEIN) for Regional Forwarding Center Owner of Property COMPLETE THE FOLLOWING: Information fo r the officers/managers of the owner of p remise SSN Issuing State/DL No. Date of Birth (mm/dd/yyyy) Full Legal Name of Individual, Partner, Officer (Last, First, Middle) Title/Owner SSN Issuing State/DL No. Date of Birth (mm/dd/yyyy) Full Legal Name of Individual, Partner, Officer (Last, First, Middle) Title/Owner SSN Issuing State/DL No. Date of Birth (mm/dd/yyyy) Full Legal Name of Individual, Partner, Officer (Last, First, Middle) Title/Owner SSN Issuing State/DL No. Date of Birth (mm/dd/yyyy) Full Legal Name of Individual, Partner, Officer (Last, First, Middle) Title/Owner American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 Form L-FC (1/2017) READ THIS IMPORTANT STATEMENT BEFORE SIGNING THIS APPLICATION. The holder of this authority may have an interest directly or indirectly, in only the manufacturing level of the Alcoholic Beverage Industry. You or your agent, servant, or employee, including 3rd party operators /regional forwarding center employees, may not be employed in any capacity at wholesale or retail levels, may not rent or lease property or equipment from or to an entity operating at wholesale or retail levels, may not secure credit or a loan in any form for an entity at wholesale or retail levels, cannot control in any fashion the interests of a permittee or licensee at wholesale or retail levels. WARNING: Section 101.69 of the Texas Alcoholic Beverage Code is as follows: 223205a person who makes a false statement or false representation in an application for a permit or license or in a statement, report, or other instrument to be filed with the Commission and required to be sworn commits an offense punishable by imprisonment in the Texas Department of Criminal Justice for not less than 2 nor more than 10 years.224 ACKNOWLEDGMENT If Applicant is: Who Must Sign: PRINT NAME: NAME OF MANUFACTURER SIGN HERE: SIGNATURE OF MANUFACTURER Before me, the undersigned authority, on this day of , 20 the person whose name is signed to the foregoing application personally appeared and, duly sworn by me, states under oath that he or she read the said application and that all the facts therein set forth are true and correct. SIGN HERE: NOTARY PUBLIC Individual Individual Owner Partnership Partner Corporation Officer Limited Partnership General Partner Limited Liability Partnership General Partner Limited Liability Company Office or Manager S E A L CERTIFICATE OF CITY SECRETARY Sections 11.37 & 61.37 I hereby certify on this day of , 20 , the location indicated in question 4 as the place of business is in a 223wet area,224 for Beer / Wine / Distilled Spirits (Circle all that apply) and that such location is inside the boundaries of this city.. SIGN HERE: , Texas City Secretary/Clerk S E A L CERTIFICATE OF COUNTY CLERK Sections 11.37 & 61.37 I hereby certify on this day of , 20 , the location indicated in question 4 as the place of business is in a 223wet area,224 for. Beer / Wine / Distilled Spirits (Circle all that apply) SIGN HERE: County County Clerk S E A L American LegalNet, Inc. www.FormsWorkFlow.com