Fillable Application LiquidationV2.0 (Commonwealth of Massachusetts)

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Application LiquidationV2.0 (Commonwealth of Massachusetts)

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The Application LiquidationV2.0 (Commonwealth of Massachusetts) form is 3 pages long and contains:

  • 1 signature
  • 2 check-boxes
  • 22 other fields

Country of origin: US
File type: PDF

U.S.A. forms for Commonwealth of Massachusetts

BROWSE COMMONWEALTH OF MASSACHUSETTS (MA) FORMS

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The Commonwealth of Massachusetts
Alcoholic Beverages Control Commission
95 Fourth Street, Suite 3
Chelsea, MA 02150
www.mass.gov/abcc
Special Permit Application
Licensee Inventory Liquidation (Going-Out-Of-Business) Application
MONETARY TRANSMITTAL FORM
[APPLICATION MUST BE COMPLETED ONLINE]
REVENUE CODE: SPEC
IF USED EPAY, CONFIRMATION NUMBER:
A.B.C.C. LICENSE NUMBER (IF AN EXISTING LICENSEE):
LICENSEE NAME:
ADDRESS:
CITY/TOWN: STATE ZIP CODE
LICENSE TYPE FEE # OF PERMITS COST
SPECIAL PERMIT $25.00
YOU MUST MAIL THIS TRANSMITTAL FORM ALONG WITH
YOUR CHECK AND COMPLETED APPLICATION TO:
ALCOHOLIC BEVERAGES CONTROL COMMISSION
95 FOURTH STREET, SUITE 3
CHELSEA, MA 02150
(CHECK MUST DENOTE THE NAME OF THE LICENSEE CORPORATION, LLC, PARTNERSHIP, OR INDIVIDUAL)
CHECK NUMBER
1 $25.00
CHECK PAYABLE TO ABCC OR COMMONWEALTH OF MA: $25.00
Print Form
Application for a Special Permit
(M.G.L. Chapter 138, Section 22A)
Signature Date
Telephone Number
1. I hereby apply for a Special Permit to sell alcoholic beverages in Massachusetts from:
Address where alcoholic beverages located:
License Holder Telephone Number:
Under pains and penalty of perjury, I certify that these beverages were obtained by me from a source authorized by
M.G.L. Chapter 138 Section 23, and further certify that these beverages were acquired by purchase from a business
duly licensed to sell alcoholic beverages to retail licensed holders in Massachusetts.
to (License Holder Name)
(License Holder Address)
2. These beverages were acquired by me (describe fully how applicant obtained beverages to be sold) ATTACH INVOICES
3. My age at present is
Please Check
Male Female
4. My Massachusetts residential address is:
5. Area Code and Telephone Number:
6.
The quantity to be sold is as follows: (identify alcoholic beverages by exact brand or trade name, capacity of package,
nature of contents, age and proof where stated on the label and the number of bottles contained in each case).
ATTACH COMPLETE INVENTORY
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Email Address:
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Application LiquidationV2.0 (Commonwealth of Massachusetts)

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Completed 18 July 2020

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