HomeMy WebLinkAboutForm - Application for Individual Imporation of Liquor Permit (fillable)DEPARTMENT OF LIQUOR CONTROL COUNTY OF HAWAI'I
Hilo Lagoon Centre, 101 Aupuni Street, Unit 230, Hilo, Hawai’i 96720 *Phone: (808) 961-8218 *Fax: (808)961-8684
E-Mail: cohdlc@hawaiicounty.gov APPLICATION FOR INDIVIDUAL IMPORTATION OF LIQUOR PERMIT Pursuant to §281-33.1 of the Hawai'i Revised Statutes, as amended, application is hereby made for a permit to import the liquors herein described. Applicant affirms that the liquors are for use by my household members, are not for sale and that no household member has received such a permit in the applicable calendar year. Applicant (Type/Print): Date of Birth:
Address:
Telephone: Fax: E-mail:
Hawai‘i Delivery Address:
I. SELECT CATEGORY APPLICABLE TO YOUR REQUEST TO IMPORT LIQUOR: Applicant is an unlicensed adult and requests approval for a single shipment of liquor not to exceed five gallons (19 liters) which are unavailable in the State of Hawai'i. The liquor is an unsolicited gift and does not exceed 3.2 gallons (12 liters). Name of Recipient: DOB: Applicant is establishing a permanent residence in the State and affirms that the liquors are part of applicant's household goods and was purchased, used and stored at: _______________________________________________________________________ (Former residence address if different from above.) Applicant requests approval of shipment of wine or beer which is otherwise available in the State. Proof of payment of the fee equal to the tax imposed by §244D-4, Hawai'i Revised Statutes, as amended, from the Director of Taxation is attached. (Contact the State of Hawai'i, Department of Taxation, for forms and procedures at 1-800-222-3229.) II. COMPLETE OR ATTACH INVENTORY LIST (List or attach liquor inventory and indicate total gallons or liters.) Kind of Liquor Total Gallons or Liters
Applicant:
(Signature)
Date:
PERMIT
The application for individual importation of liquor has been approved effective _____________________. A
common carrier is authorized to make delivery to the person named herein. Except as otherwise provided by law, delivery of such a shipment shall not constitute sale in this State.
Director
Date: Ratified by the Liquor Commission on:
Hawai'i County is an Equal Opportunity Provider and Employer