Page 1 of 1 L-POA (01/2018)
POWER OF ATTORNEY DESIGNATING
KNOW ALL MEN BY THESE PRESENTS:
I, , as owner/partner/manager/officer of
(Trade Name of Business) (Address)
(Name of Service Agent) (Name of Business/Employer)
located at , Texas,
a resident of Texas, as my service agent in Texas, as required by the Texas Alcoholic Beverage Code; 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 the Texas Alcoholic Beverage Commission for the above described entity.
BEFORE ME, the undersigned authority, on this the day of
A.D., the person whose name is subscribed to the foregoing instrument as owner, partner, manager or
officer personally appeared and acknowledged to me that the matters stated therein are true and that this form was executed
for the purpose and consideration therein expressed.
1. To obtain a Nonresident Seller’s Permit, Nonresident Brewer’s Permit or a Nonresident Manufacturer’s License, the
applicant must file this form with the Texas Secretary of State designating a Texas resident, 18 years or older, as service
2. Your appointed service agent may be a representative of the distributor/wholesaler licensed in the State of Texas.
3. A change in service agent must be reported to this commission within 10 days of the change. Failure to do so may result
in administrative action against your permit/license.
4. The original of this form should be mailed directly to the Secretary of State, Statutory Document Section,
P.O. Box 12079, Austin, Texas 78711-2079.