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APPLICATION FOR NONRESIDENT SELLER’S PERMIT, NONRESIDENT BREWER’S PERMIT AND NONRESIDENT

MANUFACTURER’S LICENSE

FIRST READ ALL INSTRUCTIONS	TYPE OR PRINT IN INK
	FORM L-103 (11/2011)

TABC USE ONLY

ISSUE DATE

1A. APPLICATION FILED FOR:

S NONRESIDENT SELLER’S PERMIT U NONRESIDENT BREWER’S PERMIT

BS NONRESIDENT MANUFACTURER’S LICENSE


FEE	SURCHARGE	LATE FEE (RENEWAL ONLY)

Registry No.

FOR ALL APPLICANTS

FOR INDIVIDUAL

ONLY

FOR ALL APPLICANTS

TABC USE

B. APPLICATION FILED FOR:

Original

Renewal Change

Change of:

C. If renewal or change, enter license/permit no(s).:

S-			U-			BS-
2. APPLICATION IS FILED BY:
	Individual	Corporation		Limited Liability Company	Other:
	Partnership	Limited Partnership		Limited Liability Partnership

3.Trade Name of Business

4.Address or Location

	City			County	State	Zip Code (9 digits)
						-

5.	Mailing Address				City/Foreign Country State	Zip Code (9 digits)
						-

6.	Area Code + Business		Area Code + Alternate		E-mail Address (optional)
	Telephone Number		Telephone Number
	( )	-	( )	-

FOR INDIVIDUAL

7. Social Security Number			Issuing State and Driver’s License Number	Date of Birth (mm/dd/yyyy)
-		-		/	/

	Full Legal Name (Last, First, Middle)

	Residential Address		City	State	Zip Code ( 9 Digits )
					-

ALL APPLICANTS

8.Give name, address, and phone number of appointed agent, resident of Texas, certified by applicant to the Secretary of State at Austin, Texas, as the person upon whom notice of a hearing may be served concerning matters, proceedings, hearings and causes involving the refusal, cancellation or suspension of a permit or license issued by this commission. Name shown here must be the same as that shown on Form L-20.2.

Name:

Address:

Phone Number: ( )

INITIAL APPLICATION

ADDITIONAL

PROCESSOR REVIEW

YES - NO

INCOMPLETE

CORRESPONDENCE

DATE

YES - NO

# OF PAGES

CROSS CHECK DATE

CROSS CHECKED

WRITTEN	/	/	END PROCESS	/	/	PROCESSOR	PROCESSOR	YES	-	NO
PROCESS DATE			DATE			I.D.	ERROR

Page 1 of 4

FOR ALL OFFICER(S), PARTNER(S), DIRECTOR(S), MANAGER(S), STOCKHOLDER(S) AND MEMBER(S).

P A R T N E R S H I P S / C O R P O R A T I O N S

TRADE NAME:

FORM L-106-PC (8/2005)

1A. Indicate type of ownership and complete the information below:

Corporation

Limited Liability Company

Partnership

Limited Partnership

Limited Liability Partnership

B. Federal Employer’s I.D. No.:

C. Entity Name:

D. Charter No.:

Date Approved:

State:

E. Number and class of shares, memberships or units issued:

2. COMPLETE THE FOLLOWING PER INSTRUCTIONS:

Social Security Number

Issuing State and Driver’s License Number

Date of Birth (mm/dd/yyyy)

Class & No. Shares Held

or % Memberships

or % Interest

Full Legal Name (Last, First Middle)

Officer

Partner

Director/

Stockholder/

Title

Manager

Member

Residential Address

City

State

Zip Code (9 digits)

Social Security Number

Issuing State and Driver’s License Number

Date of Birth (mm/dd/yyyy)

Class & No. Shares Held

or % Memberships

or % Interest

Full Legal Name (Last, First Middle)

Officer

Partner

Director/

Stockholder/

Title

Manager

Member

Residential Address

City

State

Zip Code (9 digits)

Social Security Number

Issuing State and Driver’s License Number

Date of Birth (mm/dd/yyyy)

Class & No. Shares Held

or % Memberships

or % Interest

Full Legal Name (Last, First Middle)

Officer

Partner

Director/

Stockholder/

Title

Manager

Member

Residential Address

City

State

Zip Code (9 digits)

Social Security Number

Issuing State and Driver’s License Number

Date of Birth (mm/dd/yyyy)

Class & No. Shares Held

or % Memberships

or % Interest

Full Legal Name (Last, First Middle)

Officer

Partner

Director/

Stockholder/

Title

Manager

Member

Residential Address

City

State

Zip Code (9 digits)

Social Security Number

Issuing State and Driver’s License Number

Date of Birth (mm/dd/yyyy)

Class & No. Shares Held

or % Memberships

or % Interest

Full Legal Name (Last, First Middle)

Officer

Partner

Director/

Stockholder/

Title

Manager

Member

Residential Address

City

State

Zip Code (9 digits)

Social Security Number

Issuing State and Driver’s License Number

Date of Birth (mm/dd/yyyy)

Class & No. Shares Held

or % Memberships

or % Interest

Full Legal Name (Last, First Middle)

Officer

Partner

Director/

Stockholder/

Title

Manager

Member

Residential Address

City

State

Zip Code (9 digits)

(IF YOU NEED ADDITIONAL SPACE FOR MORE NAMES, USE ADDITIONAL COPIES OF THIS PAGE)

Page 2 of 4

A L L A P P L I C A N T S

FOR ALL APPLICANTS

TRADE NAME:

FORM L-103 (11/2011)

ALL APPLICANTS

9.The applicant or permit and license holder may have an interest, directly or indirectly in only one level of the alcoholic beverage industry; i.e. manufacture, wholesale or retail. You or your agent, servant or employee may not:

1.be employed in any capacity at different levels,

2.rent or lease property or equipment from or to an entity operating at another level,

3.secure credit or a loan in any form for an entity at another level,

4.control in any fashion the interests of a permittee or licensee at a different level.

A. Are you or anyone indicated in questions 7 on L-103 or 2 on L-106-PC in violation of the above

requirements?	9A. YES NO
If “YES,” explain below: (If more space is needed, attach a page.)

FOR NONRESIDENT SELLER’S PERMIT

NOTE: Section 37.10(a) and (b) provides: “ No holder of a nonresident seller’s permit may solicit, accept, or fill an order for distilled spirits or wine from a holder of any type of wholesaler’s permit unless the nonresident seller is the primary source for the brand of distilled spirits or wine that is ordered. In this section, “primary American source of supply” means the distiller, the producer, the owner of the commodity at the time it becomes a marketable product, the bottler, or the exclusive agent of any of those. To be the “primary American source of supply” the nonresident seller must be the first source, that is the manufacturer or the source closest to the manufacturer, in the channel of commerce from whom the product can be secured by American wholesalers.”

10.Is the applicant “the primary American source of supply” for any brands of distilled spirits or

wine within the meaning of Section 37.10(a) and (b) of the Texas Alcoholic Beverage Code?

10.

YES NO

If “YES,” specify the manufacturer and brands of distilled spirits and/or wine. (If more space is needed, attach a page.)

	FOR NONRESIDENT MANUFACTURER’S LICENSE
	FOR NONRESIDENT MANUFACTURER’S LICENSE


NONRESIDENT		BREWER’S PERMIT

FOR NONRESIDENT MANUFACTURER’S LICENSE

NOTE: IF APPLYING FOR A NONRESIDENT BREWER’S PERMIT AND/OR NONRESIDENT MANUFACTURER’S LICENSE, EACH LOCATION WHERE PRODUCT IS MANUFACTURED AND SHIPPED INTO THIS STATE MUST APPLY FOR AND OBTAIN A PERMIT OR LICENSE.

11A. Will the applicant actually engage in the business of brewing and packaging beer within a three
year period covered by its original license and two successive renewals thereof in such
quantities as will make its operation that of a bona fide brewing manufacturer?	11A.	YES	NO
B. Is applicant the actual manufacturer of the beer to be imported into the State of Texas?	B.	YES	NO
C. Is location in question 4 the actual manufacturing location of the product being shipped into
Texas?	C.	YES	NO
If answer is “NO,” application cannot be approved.
D. Will the applicant transport beer into Texas in vehicles owned or leased by applicant?	D.	YES	NO
If answer is “YES,” refer to #5 of the instructions shown on page 4 for necessary bond
requirement.
FOR NONRESIDENT BREWER’S PERMIT

12.Is location in question 4 the actual manufacturing location of the product being shipped into

Texas?	12.	YES NO
Texas?
If answer is “NO,” application cannot be approved.

Page 3 of 4

A C K N O W L E D G M E N T

TRADE NAME:

FORM L-103 (11/2011)

WARNING: Section 101.69 of the Texas Alcoholic Beverage Code is as follows: “…a person who makes a false statement

or false representation in an application for a permit or license or in a statement, report, or other instrument to be filed

with the Commission and required to be sworn commits an offense punishable by imprisonment in the penitentiary for

not less than 2 nor more than 10 years.”

ACKNOWLEDGMENT

sworn by me, states under oath that he or she read the said application

If Applicant is:

Officer or Manager

Who Must Sign:

Individual

Individual Owner

NAME:

NAME MUST APPEAR AS NAME SHOWN IN QUESTION 7 ON L-103 OR 2 ON L-106-PC.

Partnership

Partner

SIGN

HERE:

Corporation

Officer

SIGNATURE MUST APPEAR AS NAME SHOWN IN QUESTION 7 ON L-103 OR 2 ON L-106-PC.

Before me, the undersigned authority, on this

day

Limited Partnership

General Partner

Limited Liability

, 20

the person whose name

General Partner

Partnership

is signed to the foregoing

application

personally

appeared and, duly

Limited Liability

Company

and that all the facts therein set forth are true and correct.

SIGN

HERE:

(S E A L)

NOTARY PUBLIC

INSTRUCTIONS

1. Beginning September 1, 2009 the license covered under this form will be issued for a two-year period. You MUST renew for the entire

two-year period. The total amount of fees plus surcharges to cover the two-year period MUST be paid at the time of renewal. Fees

may NOT be prorated or refunded.

2. Prepare the application in duplicate. Mail the original application to the Texas Alcoholic Beverage Commission, P.O. Box 13127,

Austin, Texas 78711 with the correct license/permit fees, surcharges and bond (if required). Keep duplicate for your files. Fees and

surcharges must be paid with Cashier’s Check, Money Order, or Firm Check from a corporate permittee made payable to the

Comptroller of Public Accounts. We will not accept personal checks.

Class of Permit or License

Annual State Fee

*Surcharge

Total Due

INSTRUCTIONS

Effective 9/01/11

Nonresident Seller’s Permit

$300.00

$376.00

$676.00

Nonresident Brewer’s Permit

$3,000.00

$376.00

$3,376.00

Nonresident Manufacturer’s License

$1,500.00

$576.00

$2,076.00

*SURCHARGE SUBJECT TO ANNUAL CHANGE

3. *Surcharges are subject to annual change. The surcharges assessed each year are determined by the Texas Alcoholic Beverage

Commission and not by the Legislature. The Legislature determines the total dollar amount to be raised in agency revenue. The

revenue is comprised of fees, which are set by the Legislature, and the surcharges which are determined by the agency.

4. A Power of Attorney designating Service Agent on Form L-20.2 must be mailed directly to the Secretary of State of Texas. Only a

Texas resident, 18 years or older, may be appointed as Service Agent. The power of attorney designating Service Agent should

indicate the individual named in question 8 on L-103.

5. Any Nonresident Manufacturer desiring to transport beer into this state in vehicles owned or leased by the Nonresident Manufacturer

will be required to furnish a tax bond on Form 2-52.5 in the amount of $10,000.00. The tax bond must be submitted prior to transporting

the first shipment of beer. The bond must be executed by a Surety Company authorized to do business in Texas.

6. If applicant is a partnership, 100% of the interest in the partnership must be accounted for among the partners listed. If one or more of

your general or limited partners is a limited partnership or limited liability partnership, complete an additional Form L-106-PC for each

partnership. If one or more of your general or limited partners is a corporation, complete Form L-106-PC for each corporation or limited

liability company.

7. If applicant is a publicly held corporation, provide pertinent information as indicated in 2 on L-106-PC on all stockholders holding 5% or

more of the shares.

THE FOLLOWING INFORMATION IS FOR TABC HEADQUARTERS USE ONLY.

DO NOT ENTER ANYTHING BELOW THIS BOX

ONLY

NOTE: TAX SECURITY BS – ONLY REQUIRED IF QUESTION 11D IS ANSWERED “YES.”

NAME

USE

ADDRESS

TABC

CITY, STATE, ZIP

NUMBER

TYPE

AMOUNT

Page 4 of 4

Question	Answer
Form Name	Tabc Form L 103
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	L 103 tabc application form

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