Embarking on the journey of obtaining a Micro Distillers License in Minnesota is a detailed process that requires comprehensive understanding and meticulous attention to documentation, as outlined in the PS 09101D form issued by the Minnesota Department of Public Safety Alcohol and Gambling Enforcement Division. This form serves as an application for both new applicants and those seeking license renewal, and it meticulously covers various aspects necessary for the licensing process. It requires applicants to provide personal and business information, including but not limited to, the business name, address, Tax identification numbers, and a detailed list of partners or corporate officers along with their stakes in the business. The form also delineates financial obligations such as fees and bond amounts varying with production capacity, underscoring the state's commitment to regulating the industry for the sake of public safety and compliance. Furthermore, it addresses the need for integrity and transparency by asking about any potential legal issues with partners or officers and by requiring details on the production, storage, and purity testing of the distilled spirits. The inclusion of provisions for applicant's acknowledgment of the responsibility towards ensuring product purity for human consumption, along with the necessity to keep records available for inspection, emphasizes the regulatory oversight intended to maintain high standards within the industry. Prospective and renewing licensees are guided through a procedural path that not only involves financial commitments but also necessitates a demonstrated adherence to legal and ethical standards, showcasing the thoroughness of the PS 09101D form in facilitating a regulated yet thriving micro-distillery sector in Minnesota.
| Question | Answer |
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| Form Name | Form Ps 09101D |
| Form Length | 2 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 30 sec |
| Other names | warehousing, DBA, LLC, Distiller |
Minnesota Department of Public Safety
ALCOHOL AND GAMBLING ENFORCEMENT DIVISION
444 Cedar Street/Suite 222, St. Paul, MN
(651)
APPLICATION FOR MICRO DISTILLERS LICENSE
LICENSE EXPIRATION DATE _____________ LICENSE # _________________________ DATE APPROVED____________
WORKERS COMP. INS. CO. __________________POLICY # ________________________ POLICY PERIOD________________
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MINNESOTA TAX ID # |
FEDERAL TAX ID # |
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Licensee's name (business, partnership, LLC, corporation) |
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DOB |
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Social Security # |
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DBA or trade name |
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Business address |
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License period |
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Warehouse |
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Date of incorporation |
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Certificate number |
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is corporation authorized to do business in Minnesota? |
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Yes |
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No |
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Indicate type: Submit a certified check and a surety bond in the amount specified.
Manufacturer of Distilled Spirits of 20,000 to 40,000 proof gallons |
Fee - $2,000.00 plus $150.00 |
Bond - $3,000.00 |
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OET Surcharge Total Due $2,150.00 |
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Manufacturer of Distilled Spirits of fewer than 20,000 proof gallons |
Fee - $1,000.00 plus $100.00 |
Bond - $2,000.00 |
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OET Surcharge Total Due $1,100.00 |
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Give full name, address, DOB, Social Security # and title of the applicant and for all partners or officers and principal stockholders for corporations. State below the partnership interest of each partner and for a corporation the percentage of stock held by each officer.
Name
Address
Name
Address
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Address
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Percent stock of partnership interest |
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Percent stock of partnership interest |
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Percent stock of partnership interest |
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MAKE CHECK PAYABLE TO: DIRECTOR ALCOHOL AND GAMBLING ENFORCEMNT
AMOUNT RECEIVED |
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A $30.00 service charges will be added to all dishonored checks. You may also be subjected to a |
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civil penalty of $100.00 or 100% of the value of the check, whichever is greater, plus interest and |
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attorney fees. |
MS 604.113 |
PS 09101D (05/11)
Distiller: State number of proof gallons to be produced per year.____________________________________
Describe the storage and warehousing facilities and/or the bottling and production capacity and the number of floors used. ________________________________________________________________________________
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List Federal Basic Permit numbers and their effective dates:
Permit type _______________________ Permit # __________________________Effective date ___________
Permit type _______________________ Permit # __________________________Effective date ___________
It is the responsibility of the applicant upon license approval to insure purity of product manufactured for human consumption. Periodic batch tests should be conducted to insure purity of product. Records of test results are to be kept at the licensed premises available for inspection by agents of the Alcohol & Gambling Enforcement Division for a minimum of two (2) years after the date of testing.
State method used to determine product composition, alcohol content and purity: In House Lab, Contract Lab, Other:
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State whether applicant or any person named herein own any stock or have any financial interest in any brewery, manufacturer, wholesale distributor or retail alcoholic beverage establishment in this State or any other State.
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State whether applicant, partners, or officers were ever indicted or convicted for any violation of the Minnesota Liquor Control Act or a felony in this State or any other State or under federal laws.
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Manufacturers: Names of Minnesota Wholesalers. (Attach additional sheet if needed)
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All statements and documents submitted with this application shall become a permanent part of the record. The Liquor Control Director has the right to reject or revoke any license or license application containing a false statement.
I certify that the information submitted is true and correct to the best of my knowledge.
Print full name of applicant and title
Signature of applicant
Date
NOTE
If this application is for a new partnership, submit a certified copy of the partnership agreement. For a new corporation, include a certified copy of the articles and