v abc - virginia...for abc use only permit approved approved by date permit number authorization...
Post on 03-Aug-2020
4 Views
Preview:
TRANSCRIPT
V ABC Permit # U7-41
Virginia Department of Alcoholic Beverage Control • www.abc.virginia.gov • 2901 Hermitage Road • Richmond, VA 23220 • (800)552-3200
APPLICATION AND PERMIT TO PURCHASE INDUSTRIAL ALCOHOL AN D/OR ALCOHOLIC BEVERAGES (For the Year Ending December 31, 2017)
Contact Person: 3Agg-11•11 (21.4fidi—i FFE-
Company Name: OE QA.g._Trtr:Cl\s-C \.) -LTEIZ_A/J A MA t (L5
Business Address: )91(1) (2-,,,,A00._c- LAJ 0
City: ,3A1-Erri State: UA zip: Z9153 Phone:9-0) -7-L1bi3 Email address: 5480-WA KATCLA FRE A. 40v The applicant is engaged in the following business: +1 1DIc!AL-
and manufactures the following products in which alcohol and/or alcoholic beverages are used:
Name of Products Manufactured Kind of Alcohol and/or Alcoholic Beverage Used Vendor Name
ETI-01- A LecA-koi_ ro ? K.605 AA PE-(--A L"--0 No- 1) fk) 0 1-t1ANIIA FM-nal 2) NO rtiAtJUFACTU CA iJ • E-n-tAL- A t_Coti 01— 740 pe_oor. AA PE--1-- A Lex) kA 0 1- 3)
*To be purchased from the following vendor(s):
Name of Vendor Vendor Email Annual Quantity to Purchase
1) AA ()E(4-- AL-CO NO L DILEU . RE-rn i A eP KA(1-rne-o,AAPE tz-• ../31-ti 3aNALI-0^6 2)
3)
4)
Application Fees
Application Fees: 1.5 -110 gallons = $5; more than 110 gallons = $10; for alcoholic beverages add 5% mark-up
Calculating Annual Application Fees for Alcohol and/or Alcoholic Beverages:
Kind of Alcohol/Alcoholic Beverage
Amount (Gallons)
Fees "5% Mark-Up for Alcoholic Beverages
Item Total
0 A Total Fees
*Required Field
**Applications for other alcoholic beverages shall be accompanied by a fee of 5% of the delivered cost to the place designated by the permittee. No
fee shall be charged agencies of the United States or of the Commonwealth of Virginia or eleemosynary institutions.
** 1 of 2 Application and Permitto Purchase Industrial Alcohol and/orAlcoholicBeverages I Revised 4/28/2016
Ethyl Alc. 190 & 200 Proof 350 0.00 0.00
0.00
V ABC Permit #1.1911
Virginia Department of Alcoholic Beverage Control • www.abc.virginia.gov • 2901 Hermitage Road • Richmond, VA 23220 • (800)552-3200
When approved by Virginia Alcoholic Beverage Control this document permits transportation of listed alcohol products into the Commonwealth of Virginia.
Contact Person: .3Aga_ifri4 KAT-41-1 FFer
Delivery Address: 101-1-(1), sLQD
City: 3,4L --111 State: Zip Code:-Z-9 I S3
phone5-roiisz-Z_Lki3
Applicant (signature) : 5ainlz4L. P5ch0
Applicant (print) : Age.A giNTel.t
FOR ABC USE ONLY
Permit Approved
Approved by Date Permit Number
Authorization §§ 4.1-103, 4.1-111, 4.1-200, 4.1-204 and 4.1-229 ofthe Code ofVirginia/ 3 VAC 5-70-60
** 2 of 2 Application and Permitto Purchase Industrial Alcohol and/orAlcoholic Beverages I Revised4/28/2016
12/15/2016 674
top related