LT 01 2 Rev 2.2020
CERTIFICATE OF COMPLIANCE APPLICATION INSTRUCTIONS
plier/Certificate of Compliance Holder – (NRS 369.430) The first person having ownership of alcohol in the
United States , holding a valid certificate of compliance to ship to Nevada importers, and/or directly to Nevada
Limitations on engaging in business of importing, wholesaling or retailing alcoholic beverages – (NRS 597.210)
A supplier shall not engage in the business of importing, wholesaling or retailing alcoholic beverages.
1. Name of Company: Enter the name as registered on the State Business License.
2. DBA: Enter the name as it will be known to the public. The name you will be doing business as. A trade name listed
on your TTB permit can also be used.
3. Address from where the Liquor Ships: Enter the liquor shipping address. If the address is different than what is
listed on your Federal Basic Permit issued by the Alcohol and Tobacco Tax and Trade Bureau (TTB), please complete
and submit the Certificate of Compliance Address Affidavit attached to this application.
4. Business Address: Enter in the complete company address.
5. Mailing Address: This address will be used by the Department to mail licenses, renewals and correspondence.
6. Email Address: Enter Email (Internet) Address Information.
7. FEIN: Enter the Federal Tax Identification Number for this business. For information regarding a FEIN, contact the
Internal Revenue Service at 1-800-829-4933 or go to http://IRS.gov/businesses. If you have applied for your
number and have not received it, write “PENDING”. If your FEIN changes, you must complete a new Application.
8. Application is being submitted for: Check if you are applying for a new business, if the licensed name or location
has changed or if adding a new location. Please note: Any changes to your name or location must be reflected on your
federal basic permit.
9. Applicant will be selling to: Check the boxes that apply. You may check both boxes if both apply, if applicable
10. Business Entity Type: Indicate entity type as filed on your State Business License.
11. List Owners, Officers, Members, Partners, etc.: Include the full name and title of each owner, officers, members,
partners, etc. for the business.
12. Business is Operating as a: Indicate the type of business that the company will be operating as in Nevada.
13. Applicant Requirements: (1) Comply with Taxation rules and regulations; (2) file a Designation and Acceptance
form (LT 08) filled out by the supplier, accepted by signature of the Importer/Wholesaler, and returned to the
Department’s Carson City office prior to shipping to Nevada; (3) file a Report of Shipment (LTD 04) on or before the
of each month, only if shipping to Nevada Licensed Importers/Wholesalers; (4) file a LIQ- STC Tax Return with
corresponding invoices on or before the 20
of the month, only for months that you shipped directly to Nevada
14. Applicant’s Affirmation (required): Legal signatures include sole proprietor- owner, corporate officer, managing
member, partner or power of attorney holder (must be attached). By signing the application you are making a
declaration the information provided is correct and you have read and understand NRS 369.
15. Date: Date the document was signed by responsible party.
16. Authorized Agent: Any authorized agent, such as a compliance company, must attach a Power of Attorney from the
business to be registered in order to be authorized on the account.
Submit the completed application with the $50 license fee, a copy of your Federal Basic
Permit or Brewers Notice and, if applicable, a Power of Attorney to the Carson City