Malt Beverage Manufacturer – Inspection Form Department of Business and Professional Regulation

Division of Alcoholic Beverages and Tobacco

Bureau of Law Enforcement

Licensed Premises (DBA): _______________________________________ Date: ____________________

License #: ______________________ Series: ___________ Inspection #: __________________

Question	Malt Beverage Manufacturer Inspection Form	violATION CODE	reference authority	RESULT (A “No” Response is a Violation)
1	Is the alcoholic beverage license conspicuously posted?	12.01	561.23(2)	YES / No
2	Does the business name (DBA) of the licensed premises match the business name (DBA) on the alcoholic beverage license?	17	561.33(2)	YES / No
3	Does the physical address of the licensed premises match the location address on the alcoholic beverage license?	22.04 24	561.33(1) 562.06	YES / No YES / No
4	Is the name of the licensee on all required or other licenses, permits, and certificates? (Department of Revenue, Occupational License, Hotels & Restaurants License, if applicable, Lottery Retail License, if applicable)	3.01	561.17(1)	YES / No
5	Does the manufacturer possess the required bond?	89.03	561.38	YES / No
6	Does the manufacturer keep and maintain at the licensed premises for a period of three years the required records of alcoholic beverages received, sold, or delivered?	10.04	561.55(3)(a)	YES / No
7	Does the manufacturer have printed or reproduced, and available for the Division’s use, inventory forms listing all alcoholic beverages sold?	10.08 -	561.29(1)(e) 61A-4.011	YES / No YES / No
8	Does the manufacturer have invoices or sales tickets of all sales and deliveries of malt beverages contain all required information as defined in 61A-4.045(1)?	10.08 -	561.29(1)(e) 61A-4.045(1)	YES / No YES / No
9	Are all records reviewed of sales made only to distributors or other entities as authorized by law?	22.03 22.05	562.12(1) 561.14(1)	YES / No YES / No
10	Are all brands or labels of malt beverages offered for sale registered with the division?	67.17	563.045	YES / No
11	Any property rented or leased by the manufacturer is rented or leased from persons or entities not issued a vendor license?	18.22	561.42 61a-4.018	YES / No YES / No
12	Are all delivery vehicles owned or leased by the manufacturer?	67.10	561.57(2)	YES / No
13	Do all delivery trucks possess required loading sheet or manifest showing the date and number of cases or containers loaded on the truck?	10.15	61a-4.044	YES / No
14	Does the sketch of the licensed premise match the physical location?	57.04 23 24	561.01(11) 562.03 562.06	YES / No YES / No YES / No
15	Is the manufacturer in compliance with Tied House Evil laws and rules based on observations during this inspection?	18.01-18.22	561.42(1) 561.42(2) 561.42(3) 561.42(5) 561.42(10) 561.42(11) 561.42(13) 561.42(14)(a) 561.42(14)(c) 561.42(14)(e) 561.42(14)(f) 561.423 561.424 561.424(2) 565.03(2)(c)	YES / No
16	Records Request	99.04 99.05 99.06 99.07 99.08	561.29(2)	YES / No / N/a

Member Name: ______________________________ Signature: __________________________________

Comments: ________________________________________________________________________________________

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