Form Ps 09101D is an important tax form for businesses and individuals who have made business-related payments during the year. The form is used to report various types of payments, including dividends, interest, rents, royalties, and other types of payments. It's important to understand how this form works so that you can accurately report all your business-related payments. Let's take a closer look at Form Ps 09101D. Form Ps 09101D is an important tax form for businesses and individuals who have made business-related payments during the year. The form is used to report various types of payments, including dividends, interest, rents, royalties and other types of payments. Use this guide to learn more about what each type of payment means and how it should be reported on Form Ps 09101D. This post provides a comprehensive guide on Form ps 09101d - one of the most important tax forms for businesses and individuals making business related-payments. First we'll go over what each paym
| 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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Phone |
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License period |
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From |
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Warehouse |
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Date of incorporation |
State of incorporation |
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
Name
Address
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Social Security # |
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Title |
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Percent stock of partnership interest |
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Percent stock of partnership interest |
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DOB |
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Social Security # |
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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