Idaho Beer And Wine Tax Permit Application {BWA}

NameAddress Social Security Number or EIN Instructions are on page 2. Signature Date Title 5. Federal EIN7. Legal business name8. Doing business as (DBA) nameCERTIFICATION: I agree to comply with reporting, payment, recordkeeping, and license display requirements. I certify that I am authorized as an owner, partner, 6. Social Security Number1. Type of business(Check all that apply)3. Purpose of application9. Mailing address Sole proprietor þ Partnership þ Corporation þ S corporation þ Limited liability corporation þ þ þ Limited liability partnership For State Use OnlyIDAHO BEER AND WINE TAX PERMIT APPLICATION Street address or PO Box Street addressCity City ZIP CodeStateIDAHO STATE TAX COMMISSION800 PARK BOULEVARD, PLAZA IVPO BOX 36BOISE, ID 83722-0410(208) 334-7660 in the Boise area or (800) 972-7660 toll freeBWAEFO0011102-07-1312. Contact person10. Business locations11. Mailing address for report formsCity StateZIP Code 14. Email address 15. Date you began or will begin selling/shipping beer or wine in/into Idaho 19. þ 13. Telephone number State New Application þ Change legal name þ Change assumed business name (DBA) Add new account type þ Add/change location þ Change in partners or shareholders % 17. Tax year endZIP Code YOU MUST ATTACH PROOF OF YOUR BEER AND/OR WINE BOND TO THIS APPLICATION. (See instructions.)Business name Permit number 4. Type of permits/accounts Beer þ Wine þ Sales þ Use Winery þ Brewery þ Wine distributor þ Beer wholesaler þ Wine direct shipper Street address or PO Box FORM American LegalNet, Inc. www.FormsWorkFlow.com EFO00111p202-07-13 þ 1. þ Mark the item that describes the type of business applying for a permit. þ 2. þ Mark all the permits for which you are applying. Mark: þ þ Winery if you make wine or strong beer (beer with an alcohol content of more than 4% by weight) at a facility in Idaho. þ Brewery if you make beer (4% or less alcohol content) at a facility in Idaho. þ Wine distributor if you purchase wine, strong beer, or premixed cocktails for sales to Idaho retailers. þ Beer wholesaler if you purchase beer for sales to Idaho retailers. þ þ Wine direct shipper if your business is a winery that will ship wine directly to Idaho residents. þ 3. þ Mark the item or items that best describe your purpose þ þ þ þ þ þ þ þ þ þ þ þ shareholders, enter the percentage of ownership change on the line. þ 4. þ Mark any other permits you are applying for in the State of Idaho. þ þ þ þ þ þ þ If you're a sole proprietor without employees and don't þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ your Social Security number. þ 7. þ List the legal name of the business. If the business is a sole proprietorship, the legal name is the owner's name. þ þ þ þ þ þ þ þ þ þ þ þ different than the legal business name. (Example: Legal name Sam Jones þ­ -dba Jones Distributing.) þ 9. þ List the mailing address of the business. 10. þ List the business' physical location. If you have more than four locations, list them on a separate paper and attach it to this application. 11. þ If you want to have the report forms mailed to an address different than the one listed on line 8 (such as your accountant's address), list that address here. 12. þ List the person to be contacted if we have questions about this account. 13. þ List the telephone number of the contact person. 14. þ List the e-mail address of the contact person. Instructions for Form BWAIdaho Beer and Wine Tax Permit ApplicationPage 2 15. þ List the date you began or will begin selling beer or wine in Idaho or the date you began or will begin shipping beer or wine into Idaho. 16. þ List your Idaho State Police Alcohol Beverage Control Division license number. þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ þ 18. þ If you're an Idaho wine direct shipper, enter your Alcohol Beverage Control winery license number. If you're an þ þ þ þ þ þ þ þ þ the alcohol beverage license issued to you by your state. 19. þ Indicate whether you've had an Idaho beer or wine tax permit in the past. If you have, list the permit number and the name of the business. If you don't know the old number or name, give as much information as you can. 20. þ List the appropriate information: þ a. If you marked sole proprietor on line 1, list both the proprietor's name and the proprietor's spouse's name, address, and Social Security numbers. þ b. If you marked partnership on line 1, or you have a limited liability company that has elected to be taxed as a partnership, list each partner's name, address, and þ þ þ þ þ þ þ þ þ þ an entity other than an individual. If there are more than three partners, attach another page. þ c. If you marked S corporation or corporation on line 1, or you have a limited liability company that has elected þ þ þ þ þ þ þ þ þ þ name, address, and Social Security number. If there are þ þ þ þ þ þ þ Be sure to sign and date the application. þ You must post a surety bond with the Idaho State Tax Commission. The amount must be equal to three times the average monthly beer or wine tax you owe. must post a $1,000 beer bond if applying for a beer permit and a $1,000 wine bond for a wine permit. þ Instead of posting a surety bond, you can deposit the bond amount into a joint savings account, or deposit, an irrevocable letter of credit, cash, or other must include proof of posting a surety bond or other guarantee. We may drop the requirement after six months if the monthly tax you owe is $100 or less, time. Wine direct shippers may qualify for a bond waiver by completing the Wine Direct Shipper Bond Waiver Request Form. American LegalNet, Inc. www.FormsWorkFlow.com