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PART 1: APPLICATION FOR RETAIL LICENSE

PART 1: APPLICATION FOR RETAIL LICENSET otal paid: $ (office use only)Receipt number: (office use only)Agent: (office use only)Record number: (office use only)Form 806-4 (Rev. 09/2021). This is an official state document and all information contained or submitted therein is public information. Refer to Privacy Statement on the bottom of page two regarding personal/tax 1: RETAIL LICENSE APPLICATION | | | 7450 Freight Way . Mechanicsville VA 23116 | PO Box 218 . Mechanicsville VA 23111A. INSTRUCTIONSPART 1 OF THE APPLICATIONMail or deliver the following to Virginia ABC Headquarters in Hanover (address located at the top of each page of the APPLICATION ). Applications can be accepted at regional offices; however, delays in administrative processing may result from this method of submission as regional offices must forward all applications to the Central Part 1, Sections D U of the Nonrefundable APPLICATION fee(s) of $195 per APPLICATION .

Beverage Control Authority (ABC) considers all personal/tax information collected as confidential information and will not provide information to any entity except as authorized by the Code of Virginia §58.1-3 or 2.2-3700 through 2.2-3714. In the event a refund is requested, a state tax identification number will be required.

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