Fill - Free fillable Wisconsin Distilled Spirits / AB-123 Wine Permit Application (Wisconsin) PDF form

AB-123 (R. 08-20) Wisconsin Department of Revenue

Complete reverse side where applicable and sign on page 3.

A separate permit is required for each location from which any distilled spirits or wine is sold or shipped into Wisconsin, including the

location from which invoices are issued for such sales or shipments.

Section A All applicants

Wisconsin Distilled Spirits /

Wine Permit Application

Read instructions before completing.

DEPARTMENT USE ONLY

Permit Number

Date of Issuance

Form

AB-123

1. Permit Type (check one)

Supplemental Business Tax WI

Fee Registration Fee Statute Section

Public warehouse alcohol beverages .................. $200 $20 125.19

Wine direct shipper ............................... $200 $20 125.535

Out-of-state shipper of liquor ........................ $500 $20 125.58

Indicate type of product shipped:

distilled spirits wine cider all

Industrial alcohol ................................. -0- $20 125.62

Industrial wine ................................... -0- $20 125.63

Industrial fermented malt beverage ................... -0- $20 125.275

Medicinal alcohol ................................. -0- -0- 125.61

Sacramental wine ................................ -0- -0- 125.56

Governmental Unit (check one)

Federal County Tribe

Wisconsin State Local

Limited Liability Company – Enter date registered with

Department of Financial Institutions:

For federal income tax purposes, will the LLC be taxed as a:

Partnership Corporation Single member LLC /

disregarded entity

2. Organization (check one)

Sole Proprietor

Partnership General Limited LLP

Wisconsin Corporation– Enter date incorporated:

Out-of-State Corporation – Are you registered with Dept. of

Financial Institutions to do business in WI? Yes No

Other – Describe:

3. Has the business (sole proprietorship, partnership, limited liability company, or corporation):

(a) Held,ordoesitnowhold,apermitorcerticateissuedbytheWisconsinDepartmentofRevenue? ..... Yes No

 IfYes,attachlistincludingpermitorcerticatetype,number,andlocation.

(b) Beenconvictedofviolatingfederalorstatelawsorlocalordinances,excepttracviolationsunrelated

to alcohol beverages?

................................................................. Yes No

If Yes, check type: Federal State Local

Describe violation, including nature, date, place, court, and disposition:

Legal Name (sole proprietor enter your last, rst, MI) Federal Employer ID Number Social Security Number

(required if sole

proprietor)

Business Name (DBA) (if dierent than legal name) Business Telephone Number

( )

Permit Address / Location

CountyStreet (no PO Box)

State Zip

Check one and enter name

City

Village Town

City

State ZipMailing Address (if dierent than permit address)

Instructions

Tab through and use mouse, spacebar,

or Enter to check applicable boxes.

Save

Clear

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AB-123 (R. 08-20) Wisconsin Department of Revenue

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Sign on page 3

I accept appointment as agent for the corporation/limited liability company in Section A.



Agent Sign Here

Signature

Date

(Print or type name of president or member)

(Signature of corporation president or member of a limited liability company)

7. , is given full authority and control of the premises described in this

application and to conduct all business on the premises pertaining to distilled spirits/wine.

Section B Appointment of Agent – Corporation / LLC Applicants Only*

*Not required for an Out-of-State Shipper of Liquor permit.

5. Premises Description – Describe building(s) where distilled spirits/wine are sold and stored, including business records. If additional space

is needed, attach a diagram or written description. Distilled spirits/wine may only be sold from and stored on the premises described.

6. Has the business taken over the business of another permittee? ..................................... Yes No

If Yes, give name, address, and permit number of predecessor:

Section C Wine Direct Shipper Applicants Only

8. Home state winery permit/license number (attach copy with this application)

9. Federal basic permit for winery issued under 27 USC §§ 203 and 204 (attach copy with this application)

10.Wisconsinseller’spermitorusetaxcerticatenumber

  Ifyouhavenonumber,youmustapplyforaWisconsinseller’spermitorusetaxcerticate.

11. Do you manufacture and bottle wine?....................................................... Yes No

(c) If convicted of a felony, describe the nature of the felony. If pardoned, give date and place of the pardon and attach a copy to this

application.

(d) Arechargesforanyoensepresentlypendingagainstthebusiness,excepttracunrelatedtoalcoholbeverages?

Yes No If Yes, check type: Federal State Local

Describe the status of the pending charges

4. Listname,socialsecuritynumber,homeaddress,andtitleofallpartners,principalLLCmembers,orcorporationocers

Name (Last, First, M.I.)

SS#

Title

Home Address, City, State, Zip

Name Address Permit #

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AB-123 (R. 08-20) Wisconsin Department of Revenue

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Signature Title Date

READ CAREFULLY BEFORE SIGNING: (Individualapplicantoronepartner,corporateocer,orlimitedliabilitycompanymember/

manager must sign.)

Under penalty provided by law, the applicant states that all application questions have been truthfully answered by the applicant to the

best of the knowledge of the signer. Any person who knowingly provides materially false information on this application may be required

to forfeit not more than $1,000. Signer agrees to operate this permitted business according to law and that the rights and responsibili-

ties conferred by the permit(s), if granted, will not be assigned to another. Lack of access to any portion of a permitted premises during

inspection is deemed a refusal to permit inspection. Such refusal is a misdemeanor and grounds for revocation of the permit.

Section D Out-of-State Applicants Only

12. Has the business applied for, or does it possess or hold, any interest, directly or indirectly, in a retail license to sell distilled spirits/

wine in Wisconsin? .................................................................... Yes No

If Yes, give name, location, and explain:

13. Federal Basic Permit # for manufacturer or importer (attach copy).

Section F All Applicants

20. Contact Person Name (Last, First, M.I.)

Telephone Number:

Email Address:

17. Will distilled spirits and/or wine be shipped directly from a foreign country to Wisconsin? ............... Yes No

14. Does the business intend to ship distilled spirits and/or wine into Wisconsin? ........................ Yes No

If Yes, security (surety bond or cash, check, or money order) must be posted for twice your monthly estimated maximum tax liability

(both distilled spirits and wine), but not less than $1,000 or more than $100,000.

Provide the following posted security information:

Surety Bond Number Security Amount $

Surety Company Name

15. Does the business intend to ship or invoice (sell) distilled spirits and/or wine in Wisconsin from any location other than the permit

location in Section A? ................................................................... Yes No

If Yes, list the name and address of companies making such sales or shipments. Include all locations from where product will be shipped or

invoiced. Additional applications and fees must be submitted for each location listed.

16.Onlyonedistilledspirits/winereturnperentityshouldbeledwiththedepartmenteachmonth.IfyouhavemorethanoneWisconsin

distilled spirit/wine permit, give the location of your consolidated monthly Wisconsin liquor tax return:

19. Describe how alcohol or wine will be used:

Section E Industrial and Medicinal Applicants Only

18. Profession or business:

351

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AB-123 (R. 08-20) Wisconsin Department of Revenue

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I declare under penalties of the law that I have examined this information and, to the best of my knowledge, it is true, correct, and complete.

Your Signature

Auxiliary Questionnaire

Submitacompletedquestionnaireforeachindividual,partner,member,andcorporateocer,director,andagent.

If you have been convicted of a felony for which you received a pardon, specify nature of felony, date, and place of pardon.

Yes No HaveyouresidedinWisconsinforatleast90continuousdayspriortothedateoflingthisapplication?

(Agents for an out-of-state wine direct shipper are not required to be residents of Wisconsin.)

Yes No Have you applied for, or do you possess or hold, any interest, directly or indirectly, in a Wisconsin retail license

to sell distilled spirits and/or wine?

Yes No Haveyoueverbeenconvictedofviolatingfederalorstatelawsorlocalordinances,excepttracviolations

unrelated to alcohol beverages?

If Yes, check type violated  Federal State Local

Describe the violation (nature, date, place, court, and disposition):

Date

Name (Last, First, M.I.)

Home Address

Email Address

Social Security Number

Zip CodeStateCity

Date of BirthTelephone Number

Your Signature

Auxiliary Questionnaire

Submitacompletedquestionnaireforeachindividual,partner,member,andcorporateocer,director,andagent.

Date

Name (Last, First, M.I.)

Home Address

Email Address

Social Security Number

Zip CodeStateCity

Date of BirthTelephone Number

I declare under penalties of the law that I have examined this information and, to the best of my knowledge, it is true, correct, and complete.

If you have been convicted of a felony for which you received a pardon, specify nature of felony, date, and place of pardon.

Yes No HaveyouresidedinWisconsinforatleast90continuousdayspriortothedateoflingthisapplication?

(Agents for an out-of-state wine direct shipper are not required to be residents of Wisconsin.)

Yes No Have you applied for, or do you possess or hold, any interest, directly or indirectly, in a Wisconsin retail license

to sell distilled spirits and/or wine?

Yes No Haveyoueverbeenconvictedofviolatingfederalorstatelawsorlocalordinances,excepttracviolations

unrelated to alcohol beverages?

If Yes, check type violated  Federal State Local

Describe the violation (nature, date, place, court, and disposition):

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AB-123 (R. 08-20) Wisconsin Department of Revenue

- 5 -

Instructions - Application for Liquor / Wine Permit (Form AB-123)

This application is used for the following permits:

• public warehouse alcohol beverages • industrial wine

• wine direct shipper • industrial fermented malt beverage

• out-of-state shipper of liquor • medicinal alcohol

• industrial alcohol • sacramental wine

An application is required for each premises or location where distilled spirits and/or wine are sold or shipped into Wisconsin,

including the location from which invoices are issued for such sales or shipments. See Fact Sheet 3102, Alcohol Bever-

age Permits, for information on permit requirements.

OTHER PERMITS OR CERTIFICATES

Salesperson’s Permit An agent, salesperson, or other representative personally soliciting orders for the applicant in

Wisconsin must apply for a salesperson’s permit using Form AB-121, Liquor/Wine Salesperson’s Permit Application. The

BusinessTaxRegistrationfeeis$20and$10forrenewal.Thepermitfeecannotbeproratedorrefunded.

Exception: A salesperson’s permit is not required if orders are only solicited by correspondence (no salesperson, agent,

or representative is in Wisconsin).

Note: A salesperson’s permit will not be granted to any person who has a direct or indirect interest, either as an employee

or owner, in a Wisconsin retail establishment that sells distilled spirits and/or wine.

Wisconsin Seller’s Permit or Use Tax Certicate A wine direct shipper selling wine subject to Wisconsin sales or use

taxmusthaveaWisconsinseller’spermitorusetaxcerticate.

Applyforaseller’spermitorusetaxcerticateonlineat https://www.revenue.wi.gov/Pages/Businesses/New-Business-

home.aspxoruseFormBTR-101at https://www.revenue.wi.gov/TaxForms2017through2019/btr-101.pdf.

GENERAL INSTRUCTIONS

All applicants must complete Sections A and F. Sections B through E are completed depending on which permit you se-

lect. Missing or incomplete information will delay issuing your permit(s). You may copy any of the accompanying forms.

Before you mail your application, verify you have:

• Fully completed the application for each permit requested.

• Enclosed the appropriate fee for each permit. Fees are listed on page 1 of the application. Fees apply to new permits

andtwo-yearpermitrenewals.OnlyoneBusinessTaxRegistration(BTR)feeisrequiredperentity.Ifyoualreadyhave

aBTRcerticate,youdonotneedanotherone.Permitfeesarenotrefundable.

• If you are an out-of-state wine direct shipper:

- Enclosed a copy of your home state winery permit or license and federal basic permit

 - AppliedforaWisconsinseller’spermitorusetaxregistrationcerticate

- Appointed an agent if a corporation or limited liability company

• Posted security. Security is a surety bond (Form A-133) or cash, check, or money order guaranteeing payment of distilled

spirits and wine taxes. The security must be twice your maximum monthly estimated Wisconsin distilled spirits and wine

tax liability. The security may not be less than $1,000 or more than $100,000. Security remains posted with the department

while doing business in Wisconsin.

• Enclosed a Salesperson’s Permit Application (Form AB-121)and$20BusinessTaxRegistrationfeeforeachagent,sales-

person, or other representative who personally solicits orders in Wisconsin.

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AB-123 (R. 08-20) Wisconsin Department of Revenue

- 6 -

PERMIT RENEWAL

Yourpermitmustberenewedeverytwoyears.ThedepartmentwillsendtheBTRrenewalnoticewhenthepermitssubject

toBTRprovisionsapproachtheirexpirationdate.Theexpirationdatevariesbytaxpayer.Theexpirationdateisoftentwo

yearsfromtheendofthemonthyouappliedforthepermitorcerticate.TheSecretaryofRevenuemayrevokeapermit

prior to its renewal date for just cause. Permittees with outstanding fees and/or monthly returns may not renew any permit

untilallfeesarepaidandanymissingreturnsled.

LABEL APPROVAL

No distilled spirit or wine can be shipped into Wisconsin until the federal government has approved the labels that appear

ontheproductcontainer.DonotsubmitcopiesofyourfederallabelapprovaltotheWisconsinDepartmentofRevenue.

RESPONSIBILITIES OF PERMITTEE

If you are issued a permit to ship distilled spirits and/or wine into Wisconsin, you have several statutory obligations you

must carry out to retain your permit. These responsibilities follow:

•

File Returns

Out-of-stateshippersofliquormustlemonthlyFormAB-130,WisconsinDistilledSpirits/WineTaxReturn,andschedules,

withthedepartmentcoveringallWisconsintransactionsthatoccurredduringthemonth.Winedirectshippersmustle

FormAB-130quarterly.AreturnmustbeledeventhoughnoshipmentsaremadeintoWisconsin(indicate“NoShip-

mentsMade”onFormAB-130).ReturnsmustbeledelectronicallyusingMyTaxAccount(MTA)orXMLbulktransfer

schema.Moreinformationabouttheelectroniclingisatwww.revenue.wi.gov/html/liquor.html.

The return and tax owed is due 15 days after the close of the month or quarter.

Brand and Type Listings – Permittees liable for tax on distilled spirits must submit with each monthly return Form

AB-132, listing distilled spirits by brand and type, shipped to Wisconsin that month.

Consolidated Returns – If you hold more than one out-of-state shipper’s or wine direct shipper’s permit, the department

requeststhatyouonlyleonemonthlyorquarterlyreturnconsolidatingallliquortransactions.Ifapplicable,complete

applicationquestion16,page3,providingthelocationfromwhichconsolidatedreturnisled.

• Pay Tax Due

Taxes and fees on distilled spirits and wine are due with the monthly or quarterly return. Tax rates are as follows:

◦ Distilled Spirits – 85.86¢ per liter plus a 2.906¢ per liter administrative fee

◦ Wine

- 14% or less alcohol by volume (ABV ) - 6.605¢ per liter

- More than 14% (ABV) but less than 21% - 11.89¢ per liter

◦ Apple or Pear Cider – 7% or less (ABV) - 1.71¢ per liter

Returnssubmittedaftertheduedatearesubjecttoa$10latelingfeeandapenaltyof5%ofthetaxdueforeach

monththetaxisunpaid(notexceeding25%ofthetaxdue).Anytaxnotpaidbytheduedateissubjecttointerestat

therateof1.5%permonthuntilpaid.

Thedepartmentmayinitiateproceedingstorevokeyourpermitforfailuretotimelylereturnsandpaytaxdue.

• Ship Only to Authorized Wisconsin Customers

Out-of-state shipper permit holders may only ship distilled spirits and wine to Wisconsin wholesalers, wineries, and

industrial alcohol, wine, and medicinal alcohol permittees authorized by the department to receive such shipments.

Caution:Shipmentsmadetoanyunauthorizedpersonaresubjecttoconscation.Inaddition,permitsmayberevoked.

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AB-123 (R. 08-20) Wisconsin Department of Revenue

• Recordkeeping

You must keep adequate records so that the department can verify if your return was properly completed and the correct

taxpaid.Recordsmustbekeptforfouryearsandinaplaceandmannereasilyaccessibleforreviewbydepartment

personnel.

• Responsible for Salespersons

All permittees are responsible for the actions of their salespersons, agents, or representatives. Your permit may be in

jeopardy if your salesperson, agent, or representative violates Wisconsin distilled spirits and wine laws and regulations.

• Report Business Changes

Notify the department immediately (in writing) for the following changes to your business:

A. Name Change – Send us:

1. Newapplication(FormAB-123)showingnamechange.Write“NameChangeOnly”atthetopoftheapplication.

2. A rider from your surety bond company with your new name

B. Address Change – To change your permit address, contact the Excise Tax Unit by phone at (608) 266-6701 or email

DORExciseTaxpayerAssistance@wisconsin.gov.Wisconsinlawimposesa$10feeforyourrstaddresschange

during a calendar year. The full permit fee is charged for each additional address change during the same year.

Iftheaddresschangeaectsyoursuretybond,sendanupdatedbondtothedepartment.

If your business moves to a new municipality, or moves more than once during a calendar year, Wisconsin law

requires a new permit. You must complete a new application for an out-of-state shipper’s permit and pay the required

$500supplementalfeeand$20BusinessTaxRegistrationfee.

C. Ownership Change – Submit the following:

1. Form AB-123 and fee. Your old permit is not transferable to the new business

2. Form AB-121 and $20 fee for each salesperson personally soliciting orders in Wisconsin

3. Form A-133 guaranteeing payment to the department of the distilled spirits and wine taxes, if applicable

Examples of ownership changes include:

• Sole proprietorship to partnership or corporation

• Partnership to sole proprietorship or corporation

• PartneraddedordroppedfrompartnershipifnewFederalIdenticationNumber(FEIN)isassigned.Partnerships

that add or drop partners without a new FEIN should notify the department in writing of the changes and submit

Auxiliary Questionnaires for new partners.

• Sole proprietor death

• Business sold

Changingacorporateocerisnotanownershipchange.However,youshouldsubmitAuxiliaryQuestionnaires

fornewocers.

D. Agent Change – To change your agent:

1. Contact the Excise Tax Unit at (608) 266-6701 or DORExciseTaxpayerAssistance@wisconsin.gov.

2. Complete Form AT-201 with the new agent information.

- 7 -

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AB-123 (R. 08-20) Wisconsin Department of Revenue

E. Ceased Operations – You must:

1. Returnyourpermittothedepartment.

2. Indicate the last day you operated in Wisconsin.

3. Fileanalmonthlyreturnforalltransactionsduringthenalmonth.OnyourMyTaxAccounthomepage,under

“IWantTo,”select“CloseAccounts,”checktheappropriateaccounts,andllintheceasedate.

ASSISTANCE

From the department’s website at revenue.wi.gov/Pages/AlcoholBeverage/home.aspx, you can:

•

Access My Tax Account (MTA)

• Completeelectronicll-informs

• Download forms, schedules, instructions, and publications

• View answers to common questions

• Email us for assistance

Physical Address Mailing Address

2135RimrockRoad ExciseTaxUnit

MadisonWI53713 WisconsinDepartmentofRevenue

PO Box 8900

Madison WI 53708-8900

Phone (608) 266-6701

Fax: (608) 261-7049

Email DORExciseTaxpayerAssistance@wisconsin.gov

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Wisconsin Distilled Spirits AB-123 Wine Permit Application (Wisconsin)

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