Certificate of Approval License Application

Premises File Number: _______________
License Number: ___________________

Opening Date: _____________________
See Instruction Sheet

Certificate of Approval License Application
Idaho State Police
Alcohol Beverage Control Bureau
700 S. Stratford Dr. Ste 115
Meridian, ID 83642
Ph. (208) 884-7060 Fax (208) 884-7096
www.isp.idaho.gov/abc
1. Application Type
New Transfer [ Applicant Location]
Change Current Application [ Doing Business As Name (See #3)]

2. License Type and Fees
Certificate of Approval No Fee

3. Applicant Information
A. Applicant Name: ________________________________________________________________________________
(Individual, Corporation, LLC, Partnership or other business entity)
Doing Business As Name: ___________________________________ Business Phone No.: ______________________
Business Physical Address: ____________________________________________________________________________
City: _________________________________ State: ____________________________ Zip: ______________________
Mailing Address: ____________________________________________________________________________________
(Include City, State, Zip)
Alternative Phone No.: ______________________________ E-Mail Address: __________________________________
Former Business Name (Transfers Only): ________________________________________________________________

B. Applicants Federal Employee Identification Number (EIN): ___________________________________________
C. Applicants Financial Information
Business Bank Name and Address (Branch): ______________________________________________________________
Persons Authorized to Sign on Account: ___________________________________ Title: _______________________

4. List sole proprietor(s) or all partners, corporate officers, directors, ten primary stockholders,
LLC/LLP members/partners of the applicant. Attach a separate sheet of paper following the format below.
Name: ______________________________________ Address: __________________________________________
Title: _____________________ SSN: ______________________________ DoB: ____________________________
Idaho Resident: (Y/N) _________________________ If YES length of residency: __________________________
B. Has Applicant or anyone listed on #4 ever had an alcohol license suspended, denied or revoked?
No Yes (Attach Explanation)
C. Has Applicant or anyone listed on #4 ever been convicted of a felony or an alcohol-related misdemeanor?
No Yes (Attach Explanation)

5. Has Applicant or anyone listed on #4 ever held any interest in any other business licensed for the
sale of alcoholic beverages? No Yes [Attach Explanation - Include Premises Number]

6. Does anyone have any financial interest in the Applicants business not previously listed on #4,
including silent partners, financial loans, etc.? No Yes [Attach Explanation]

7. Affirmation: The applicant hereby swears or affirms under oath that the applicant is the bona fide owner of the
business which is applying for this license and will be engaged in the sale and distribution of alcoholic beverages. The
applicant hereby affirms that the applicant is eligible and has none of the disqualifications for a license as provided by
Title 23, Chapter 9, 10, 11 and 13, Idaho Code or any amendments thereto.
An application for and acceptance of a license by a retailer shall constitute consent to, and be authority for,
entry by the Director or his authorized agents, upon any premises related to the licensees business, or wherein are or
should be kept, any of the licensees books, records, ledgers, supplies or other property related to said business, and
to make the inventory, check and investigations aforesaid with relation to said licensee or any other licensee. It shall
also constitute consent given to the Director or his authorized agents to view, copy or investigate any documents,
EH 10.02-06 Cert of Approval Page 1 of 2 Rev 4/2010
including state and federal income and sales tax documents, related to the business or person(s) associated with the
business of selling alcohol as granted herein, as per Idaho Code sections 23-907, 23-1006 and 23-1314.
Applicant hereby acknowledges that falsifying this document or submitting any false documents for record can
result in a felony conviction under Idaho Code sections 23-905 or 18-3203.

8. Signature Attestation:
I/we, the applicant of this license, have read all of the above and declare under penalty of perjury that the
information that I/we have provided is true and correct to the best of my/our knowledge.

_________________________________________ _____________________ ___________________
Authorized Agent/Applicants Signature Title Date

_________________________________________
Authorized Agent/Applicants Printed Name

Subscribed and sworn to before me this ___________ day of ________________________, 20_______.

_____________________________________
Notary Publics Signature
(NOTARY SEAL) Residing At: __________________________
My Commission Expires: _________________
EH 10.02-06 Cert of Approval Page 2 of 2 Rev 4/2010
Rev. 4/2010

ALCOHOL BEVERAGE CONTROL
700 S. Stratford Dr. Ste 115 Meridian, ID 83642
(208) 884-7060 E-Mail: ABC@isp.idaho.gov

INSTRUCTIONS FOR CERTICATE OF APPROVAL LICENSE APPLICATION
Complete this application if:
o You are a beer producer located out of the state of Idaho AND
o You will be shipping your manufactured beer to an Idaho Wholesaler

For information regarding ABC licensing, laws, and rules visit our website: www.isp.idaho.gov/abc.
Forms must be legible (printed or typed). Applications must be signed and notarized.
Licenses will not be released until the following business day after the license has been issued.
All blanks must be completed. Follow all instructions printed on each form. Any incomplete application will be returned to
applicant. Alcohol Beverage Control Bureau has 90 days to process and investigate any application received.

Express mail envelopes for return service will be used only when provided by the applicant. The applicant must be listed
as both the sender and receiver with the postage pre-paid.

Completing the application:
* Applications for transfer or change current application only, complete the information in the box in the upper right-hand
corner.
1. Application Type: Mark the appropriate type of application.
2. License Type and Fees: Mark the box next to Certificate of Approval. There is no fee for this license.
3. Complete applicant information. The applicant is the Individual(s), partnership, corporation, LLC, or association that will
be conducting the business.
4-8. Complete the questions as indicated.

Submit the entire completed application, signed and notarized, to ABC at the above address.

NOTE: YOU ARE RESPONSIBLE TO MAINTAIN YOUR OWN COPIES OF YOUR DOCUMENTS. FAXED COPIES OF
APPLICATIONS WILL NOT BE ACCEPTED.

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Premises File Number: _______________

License Number: ___________________

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