ABC-140 Instructions

Instructions For The Tied-House Certification, Form ABC-140

Item 1 (Applicant’s Name(s)) — This form is to be completed by all applicants, retail and non-retail. List the name of the applicant. If the applicant is an individual, list first name, middle name (if applicable), then last name. For a general partnership, list the name of each individual partner. For a limited partnership, limited liability company, a corporation, etc., list the full name of the entity.

Item 2 (License Types(s)) — Enter the type of license(s) desired. If the application is adding an additional license type to an existing licensed premises under the same licensed entity, include only the information for the license type being applied for.

Item 3 ( Premises Address) — Enter the street address where the license is to be issued. Do not list a post office box number. If applying for a space within a licensed Type 14 Public Warehouse, the premises address must match the address listed under the Public Warehouse. Do not include space number within warehouse.

Item 4 (Email Address) — Enter the email address, to which notifications or correspondence may be sent, for the applicant entity.

Item 5 (Applicant Entity) – Check the box for the type of business ownership.

Item 6 through 9 (Tied-House Certification Questions) —  All boxes marked ‘Yes’ must include a detailed explanation immediately following the question. If more space is needed, attach additional pages. Any attachment must include the applicant’s name(s), license type(s), and premises address.

• For questions 6 through 9, “alcohol business” involves any person or entity creating, distributing, selling, or contributing to the delivery of alcoholic beverages to consumers. This includes, but is not limited to, manufacturing, producing, processing, rectifying, bottling, importing, wholesaling, or selling alcoholic beverages through point-of-sale operators or hospitality providers.
• For questions 6 through 9, “applicant” includes any officer, director, controlling person of a trust (the trustee or any other person with control over trust assets, even if given a different title than trustee, including all persons with power to remove or direct a trustee to act), and any person or entity holding a direct or indirect interest in the applicant entity.
• For questions 7 and 9, “anywhere in the world” includes all locations within the United States of America and any location outside of the United States of America.
• For questions 8 and 9, “employed” means any type of employment relationship, including, without limitation, that of employer-employee, independent contractor, volunteer, or any other mode or method of engagement for services regardless of how it may be characterized by the parties.

Item 10 (Acknowledgment of Instructions) — Check the box to acknowledge that you have read and understand the Tied-House Certification Instructions (this document). Your application cannot proceed, and may ultimately be denied or considered withdrawn, if you do not make this acknowledgment.

Items 11 (Attestation) — Check the box to acknowledge and agree that any missing or incomplete information may constitute a misrepresentation of material fact and could result in denial of the application, revocation of the license, or may extend the processing and approval time of the application. Your application cannot proceed, and may ultimately be denied or considered withdrawn, if you do not make this acknowledgment.

Items 12 (Printed Name of Person Signing for Applicant) — Enter the name of the individual signing on behalf of the applicant entity.

Items 13 (Title of Person Signing Form) — Enter the title of the person signing.

Items 14 (Signature) — Any one signature for the certifying entity is sufficient (e.g., one general partner, one corporate officer, an LLC member if member-run, the LLC manager if manager-run, LLC officer if designated, or Trustee).

Items 15 (Date Signed) — Enter date when form was signed.