Fillable Application Farmers Market (Commonwealth of Massachusetts)

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Application Farmers Market (Commonwealth of Massachusetts)

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The Application Farmers Market (Commonwealth of Massachusetts) form is 4 pages long and contains:

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  • 68 other fields

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File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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APPLICATION BY A FARMER WINERY FOR LICENSE TO SELL AT A
FARMER'S MARKET
(CH.138, §15F)
Name of Applicant:
Business Name (d/b/a if different) :
Manager of Record:
Mailing Address:
Phone Number of Premises:
1. Licensee Information:
City/Town: State
Other Phone:
Email:
Website:
Zip
Contact Person concerning this application (attorney if applicable):
Email:
Fax Number:
Contact Number :
ZipStateCity/Town:
Address:
Name:
YEAR 20
ABCC License Number:
(If Existing Licensee)
B. Contact person for applicant during event:
Name:
Phone number of contact:
2. Event Information:
Date(s) of Event:
C. Description of the premises within the Farmer's Market:
Describe Area to be Licensed:
A. Farmer's Market licenses are only permitted at events that the Department of Agriculture has certified as Agricultural Events.
Please attach document from Department of Agricultural Resources certifying that this is an agricultural event.
Address of Premises for the Sale of Wine:
Zip
State
City/Town:
Phone Number of Premises:
APPLICATION FOR LICENSE BY A FARMER WINERY TO SELL AT A
FARMER'S MARKET
(CH.138, §15F)
4. Are you providing, without charge, samples of wine to prospective customers?
Section 15F specifically requires that "all samples of wine shall be served by an agent, representative or solicitor of the licensee."
Yes No
A. If yes, please provide names and addresses of all agents, representatives and solicitors:
Name Address ABCC License Number
B. Proof of Age for Sale to Consumers:
Please identify all methods by which you will obtain proof of age before providing samples or making any sales of wine to consumers :
3. Existing License(s) to Manufacture, Export and Sell at Retail:
List the license(s) you hold which authorize the manufacture, exportation and retail sale of wine to consumers: (Attach a copy of each license)
Name License Type License Address
Please identify in detail all persons or businesses that are licensed under M.G.L. c. 138, §22 that will be making any delivery of wine on your behalf
to the Farmer's Market in Massachusetts.
5. Transportation and Delivery:
*If additional space is needed, please use last page.
Title
Signature
Date
Note: The LLA may require additional information.
Pursuant to M.G.L. Ch. 62C, Sec. 49A, I certify under the penalties of perjury that, I have filed all state tax returns
and paid all state taxes required under law. I further understand that each representation in this application is
material to the determination of the application and state under penalty of perjury that all statements and
representations therein are true.
APPLICATION FOR LICENSE BY A FARMER WINERY TO SELL AT A
FARMER'S MARKET
(CH.138, §15F)
6. Safety and Tax Registration:
Has the Farmer's Market registered with the Food and Drug Administration?
Yes No
Registration Date:
7. Disclosure of License Disciplinary Action:
Have any of the your licenses to sell alcoholic beverages ever been suspended, revoked or cancelled?
Yes No
Date License Reason why license was Suspended, Revoked or Cancelled
If yes, list said interest below:
Revised: 6/9/11
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Application Farmers Market (Commonwealth of Massachusetts)

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Completed 27 July 2020

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