State of California
COVID-19 RENEWAL FEE WAIVER SELF-CERTIFICATION FORM
Eligible licensees must use this form to request a waiver of specific annual license renewal fees. A separate form must
be completed for each ABC license number. Prior to submitting this form, you must review the ABC-SCF Instructions to
ensure you and the associated license type(s) are eligible for the fee waiver. Do not submit the waiver request until 60
days prior to the expiration of the license. This form must be submitted to ABC by the license expiration date.
Please visit https://www.abc.ca.gov/waiver for additional information about the COVID-19 Renewal Fee Waiver and to
complete this form online using the Verify Eligibility tool. Licensees holding a type 02 license are encouraged to visit
ABC's website for instructions specific to this license type. Duplicate 02 licenses are not eligible for fee relief. * Indicates
a required field.
Licensee Name* Phone Number*
Email Address*
Mailing Address
*
To make this your permanent mailing address, check the box
License Number* License Expiration Date*
Enter the license type(s) that you are
requesting the fee waiver for
, the
quantity of that license type,
and the
total
renewal fee
amount for that
license type
as listed on your renewal
notice.
Example:
Type
Qty
Renewal
47 M-2 $2815
58 1 $230
Type
Qty Renewal
1.
2.
3.
Type
Qty Renewal
4.
5.
6.
IF THE SELF-CERTIFICATION FORM IS NOT SUBMITTED AS INSTRUCTED, THE LICENSEE MAY NOT BE
ELIGIBLE FOR A FEE WAIVER AND MUST THEREAFTER PAY THE ORIGINAL LICENSE RENEWAL
FEE. VISIT HTTPS://WWW.ABC.CA.GOV/WAIVER FOR FEE WAIVER GUIDELINES.
Licensee Self-Certification
The person whose signature appears below certifies that 1) They have reviewed the ABC-SCF Instructions, 2) Their
licensed business meets the below eligibility criteria, and 3) They are the licensee or authorized designee with authority
to make this request.
By checking the boxes below, you are certifying that you understand the eligibility requirements for this fee waiver and
that your ABC licensed business meets the following criteria:
The licensee holds one or more of the following license types under the above listed license number: 02, 23, 40,
41, 42, 47, 48, 49, 50, 51, 52, 57, 58, 59, 60, 61, 64, 68, 69, 71, 72, 74, 75, 76, 77, 78, 83, 86, 87, 99; and
The ABC license type(s) listed above was in an active status at any time between March 1, 2020 and December
31, 2020 (as defined in #4 on the ABC-SCF Instructions); and
The primary operation of the above listed license was directly impacted by health and safety restrictions imposed
in response to the COVID-19 pandemic.
FOR 02 LICENSEES ONLY: In addition to the above criteria, I certify that under the above license number, I
produced less than 100,000 gallons of wine in fiscal year 2020-2021, and that I will submit the accurate
production volume on my winegrowers annual report.
Printed Name*
Signature*
Date*
Submit your fee waiver online at https://www.abc.ca.gov/waiver, or
m
ail this form, renewal notice, and payment to:
Department of Alcoholic Beverage Control
3927 Lennane Drive, Suite 100
Sacramento, CA 95834
ATTN: Accounting Unit
ABC-SCF (rev. 06/21)
*
*
