Application For Out-Of-State Winery Direct Shippers Permit {L-DS}

P.O. Box 13127, Austin, Texas 78711-3127 (512)206-3333 www.tabc.state.tx.us An Equal Opportunity Employer FORM L-DS-I (01/201) INFORMATION AND INSTRUCTIONS FOR OUT-OF-STATE WINERY DIRECT SHIPPER222S PERMIT OUT-OF-STATE WINERY DIRECT SHIPPER222S PERMIT (DS) 226 Allows the holder to sell and deliver wine that is produced or bottled by the permittee to an ultimate consumer located in a wet or dry area in the State of Texas. Wine must be delivered by a common carrier that holds a carrier222s permit issued by the Texas Alcoholic Beverage Commission. Permittee may not deliver to the same consumer in this state more than nine gallons of wine within any calendar month or more than 36 gallons of wine within any 12-month period; or sell to ultimate consumers more than 35,000 gallons of wine annually. The State fee is $150 with a surcharge of $376 and the permit will expire two years from date of issuance. This permit may only be issued to a person who: Does not hold a winery permit in the State of Texas;Operates a winery located in the United States and holds all state and federal permits necessary to operate thewinery at the permitted location, including the federal winemaker222s and blender222s basic permit;Holds a Texas Sales Tax Permit;Expressly submits to personal jurisdiction in Texas state and federal courts and expressly submits to venue inTravis County, Texas, as proper venue for any proceeding that may be initiated by or against the commission;andDoes not directly or indirectly have any financial interest in a Texas wholesaler or retailer as those terms areused in Section 102.01 of the Alcoholic Beverage Code. Mail the original application, along with the correct permit fees to the Texas Alcoholic Beverage Commission, P.O. Box 13127, Austin, Texas 78711. Make a duplicate copy for your files. The total amount of fees plus surcharges to cover the two-year period MUST be paid at the time of application. Fees may NOT be prorated or refunded. The fee must be paid with a Cashier222s Check, Money Order, or Firm Check from a corporate permittee made payable to the Comptroller of Public Accounts. Personal checks are not accepted. Any questions regarding your Texas Sales Tax Permit, please access the Texas Comptroller222s website at www.window.state.tx.us. Should you require additional assistance contact Tax Assistance at (800) 252-5555. If you have any questions regarding your permit application, please contact the Licensing Division of the Texas Alcoholic Beverage Commission at (512) 206-3360. American LegalNet, Inc. www.FormsWorkFlow.com Page 1 of 3 L-DS (01/201) APPLICATION FOR OUT-OF-STATE WINERY DIRECT SHIPPER222S PERMIT (DS) L-DS (01/201) 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 DS - ISSUE DATE FEE SURCHARGE LATE FEE / / $ 150 $ 376 Registry No. 1. APPLICANT IS FILED FOR: Individual Corporation Limited Liability Company Partnership Limited Partnership Limited Liability Partnership Other: 2 . Trade Name of Business 3 . Address of Location (must be U.S. W inery address as shown on TTB Permit. ) City State Zip Code (9 digits) 4 . Mailing Address City State Zip Code (9 digits) 5.Business Telephone N Alternate Telephone N E-Mail Address 6. Provide the applicant222s Texas Sales Tax Permit Number: NOTE: Your application cannot be approved without a valid Texas Sales Tax Permit Number. 7. Does the applicant hold a Winery Permit in the State of Texas? 7. YES NO 8. Does the applicant operate a winery located in the United States and hold all state and federal permits necessary to operate the winery, including the federal winemaker222s and blender222s basi c permit? 8. YES NO If 223 YES,224 indicate your TTB Permit Number: Copy Must be Attached. INDIVIDUAL OWNER 9 . Social Security Number Issuing State / Driver License Number Date of Birth (mm/dd/yyyy) Full Legal Name (Last, First, Middle) Permanent Mailing Address City State Zip Code (9 digits) Residential Address City State Zip Code (9 digits) TABC USE ONLY INITIAL APPLICATION INCOMPLETE YES - NO ADDITIONAL CORRESPONDENCE YES - NO PROCESSOR REVIEW DATE: / / PROCESS DATE: / / PROCESSOR I.D.: PROCESSOR ERROR YES - NO American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 L-DS (01/201) REPORTING OWNERSHIP If multiple levels of ownership, use this form to disclose each entity at each level. Use additional copies if necessary to disclose each level. If applicant is a partnership, 100% of the interest in the partnership must be accounted for among the partners listed. Ifone or more of your general or limited partners is a limited partnership or limited liabi lity partnership, complete an additional section of question 10 for each partnership. If one or more of your general or limited partners is a corporation, complete question 10 for each corporation or Limited Liability Company. If applicant is a corporation and stockholder is corporation, provide pertinent information as indicated in question 10F. PARTNERSHIPS / CORPO RATIONS / LIMITED LI ABILITY COMPANY 10 A. Indicate type of ownership and complete the information below: Corporation Limited Liability Company Partnership Limited Partnership Limited Liability Partnership B. Federal Employer222s I.D. No.: C. Entity Name: D. Filing No.: Date Approved: State: E. Number and class of shares, memberships or units issued: F .COMPLET E THE FOLLOWING FOR REPORTING OWNERSHIP : Social Security Number Issuing State and Driver222s License Number Date of Birth (mm/dd/yyyy) Class & No. Shares Held or % Memberships or % Interest Full Legal Name (Last, First Middle) Officer Partner Director/ Stockholder/ Manager Member Title Residential Address City State Zip Code (9 digits) Social Security Number Issuing State and Driver222s License Number Date of Birth (mm/dd/yyyy) Class & No. Shares Held or % Memberships or % Interest Full Legal Name (Last, First Middle) Officer Partner Director/ Stockholder/ Manager Member Title Residential Address City State Zip Code (9 digits) Social Security Number Issuing State and Driver222s License Number Date of Birth (mm/dd/yyyy) Class & No. Shares Held or % Memberships or % Interest Full Legal Name (Last, First Middle) Officer Partner Director/ Stockholder/ Manager Member Title Residential Address City State Zip Code (9 digits) Social Security Numbe r Issuing State and Driver222s License Number Date of Birth (mm/dd/yyyy) Class & No. Shares Held or % Memberships or % Interest Full Legal Name (Last, First Middle) Officer Partner Director/ Stockholder/ Manager Member Title Residential Address City State Zip Code (9 digits) (IF YOU NEED ADDITIONAL SPACE FOR MORE NAMES, USE ADDITIONAL COPIES OF THIS PAGE) American LegalNet, Inc. www.FormsWorkFlow.com Page of 3 L-DS (01/201) ALL APPLICANTS The applicant, license/permit holder, agent, servant or employee may not directly or indirectly have any overlapping ownerships or other prohibited relationships (including unfair competition and unlawful trade practices) between those engaged in the alcoholic beverage industry at different levels, that is, between a manufacturer and a wholesaler or retailer, or between a wholesaler and a retailer, as the words "wholesaler," "retailer," and "m anufacturer" are ordinarily used and understood, regardless of the specific names given a license \ permit. Reference Chapter 102 et seq. 11. Is any person, involved in this application, in violation of the above requirements? If 223YES,224 attach an explanation. 1 1. YES NO 12A. Has any person named in questions 9 or 10F or his or her spouse been finally convicted or received deferred adjudication for a felony offense? 1 2A. YES NO B. If answer to 1 2A is 223YES,224 has it been five years since the termination of a sentence, parole or probation served for any offenses indicated above? If 223NO,224 attach an explanation. B. YES NO C. Has any person named in questions 9 or 10F been convicted of any offense(s) under federal or state law, or municipal ordinance involving violations of an individual222s civil rights or discrimination against an indivi