Local Industry Representative License Application

UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL 1625 South 900 West · PO Box 30408 · Salt Lake City, Utah · 84130-0408 (801) 977-6800 · Fax 977-6888 www.abc.utah.gov "LOCAL INDUSTRY REPRESENTITIVE LICENSE" APPLICATION CHECKLIST The items below must be completed and submitted by the 10th of the month before any action can be taken by the Alcoholic Beverage Control Commission. You will be notified of the next monthly commission meeting when your application will be considered for issuance of a license. We request that a representative attend the meeting to make a brief presentation. 1.____Completed application form (enclosed). 2.____Ownership entity organizational papers for business: a) if a corporation, submit a copy of the articles of incorporation; b) if a partnership, submit a copy of the written agreement; c) if a limited liability company, submit a copy of the articles of organization 3.____Criminal history background check information (see application form). 4.____Copy of current local business license. 5.____If applicant holds a federal importer's permit from the Alcoholic and Tobacco Tax and Trade Bureau, submit a copy. 6.____$75 application fee (non-refundable). 7.____$125 initial license fee (make checks payable to UDABC). Enclosed for your information are summaries of the laws pertaining to local industry representatives in Title 32B of the Utah Code and the rules of the Commission. If you have any questions, please contact our Licensing and Compliance Department at (801)-977-6800. Effective 7.1.11 v7.18 page 1 of 50 American LegalNet, Inc. www.FormsWorkFlow.com UTAH DEPARTMENT OF ALCOHOLIC BEVERAGE CONTROL APPLICATION FOR LOCAL INDUSTRY REPRESENTATIVE LICENSE 1. 2. 3. 4. 5. 6. 7. Business Name: _______________________________________________________________ Applicant/Owner of business: ____________________________________________________ Location: ____________________________________________________________________ Street City State Zip Mailing Address: ______________________________________________________________ Street or PO Box City State Zip Business Phone: ___________________Other Phone: ______________ Fax: ______________ Contact Person: __________________________________ E-mail: ______________________ Ownership: Check appropriate box and provide the requested information in the space below (add additional sheets if necessary). [] Applicant is an individual: List below information for: (a) Individual (b) Managers (a) All Partners (b) Managers (a) Any Stockholder owning at least 20% of the corporation (b) All Corporate officers (c) Managers (a) Any members owning at least 20% of the company (b) Managers [] Applicant is a partnership: List below information for: [] Applicant is a corporation: List below information for: [] Applicant is a limited liability company (LLC): List below information for: TITLE____________NAME_______________________HOME ADDRESS______________________ HOME PHONE#____________DR LIC#_____________SS#___________DOB______%OWNED____ Are you a United States Citizen? ________ If no, must attach a copy of residency status. TITLE____________NAME_______________________HOME ADDRESS______________________ HOME PHONE#____________DR LIC#_____________SS#___________DOB______%OWNED____ Are you a United States Citizen? ________ If no, must attach a copy of residency status. 8. Criminal History. The law prohibits any person who has been convicted of a felony under any federal or state law or any violation of any federal or state law or local ordinance concerning the sale, manufacture, distribution, warehousing, adulteration, or transportation of alcoholic beverage from being in the alcoholic beverage business. The law also prohibits any person who has been convicted of any crime involving moral turpitude or, on two or more occasions within the last five years, has been Effective 7.1.11 v7.18 page 2 of 50 American LegalNet, Inc. www.FormsWorkFlow.com convicted of driving under the influence of alcohol, or any drug, or the combination of alcohol and any drug from being in the alcohol business. This proscription also applies to any officers, partners, managers, managing agents, directors, stockholders who hold at least 20% of the total issued and outstanding stock of an applicant corporation, members who own at least 20% of an applicant limited liability company and to any person employed to act in a supervisory or managerial capacity. Please list all criminal offenses other than minor traffic offenses of which you or any of the above persons have ever been convicted: NAME CRIMINAL OFFENSE DATE OF CONVICTION In addition, a criminal history background check must be furnished on each person listed above and in subparagraph 7. This may be done as follows: a. Utah residents: If any person listed has been a resident of Utah for at least two years, he/she shall submit a fingerprint card to the DABC and consent to a fingerprint criminal background check by the Utah Bureau of Criminal Identification. b. Non Residents: Out of state residents or persons who have resided in Utah for less than two years shall submit a fingerprint card to the DABC and consent to a fingerprint criminal background check by the Federal Bureau of Investigation (F.B.I). An informed consent and release of liability form is included with this application. Fingerprint cards are available at law enforcement agencies. You may download the fingerprint card at this web address: http://www.fbi.gov/hq/cjisd/pdf/fpcardb.pdf Submit the form(s) to the DABC with a processing fee of: · $20.00 per card for BCI background checks, or · $39.25 per card for FBI background checks. In the case of an undue delay in the processing of a B.C.I or F.B.I. criminal background check, here are the rules and procedures for obtaining a third-party national background check: An application that requires a B.C.I or F.B.I. criminal history background report(s) may be included on a commission meeting agenda, and may be considered by the commission for issuance of a license, permit, or package agency if: 1). the applicant has completed all requirements to apply for the license, permit, or package agency other than the department receiving the B.C.I or F.B.I. criminal history background report(s); 2). the applicant attests in writing that he or she is not aware of any criminal conviction of any person identified in the application that would disqualify the applicant from applying for and holding the license, permit, or package agency