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DRUG STORE <br /> ❑ Yes 0 No if you are the proprietor of a drug store,do you hold a valid permit issued by the State Board of Pharmacy? <br /> tifOTE., You must designate an your floorplan the pharmacy area that has been submitted and approved by the State Board of Pharmacy" <br /> Pharmacy Permit Number Issuance Date E_xpiraEion Date <br /> RIVERBOAT <br /> ❑ Yes❑No Are you applying for a riverboat 1 excursion permit and do you currently hold a valid riverboat owner's license issued by the Indiana Gaming <br /> Commission? <br /> Riverboat Owner's License Number issuance Date t xplratlon Date <br /> ❑ Yes ❑No Are you applying for an adjacent tandsite permit? <br /> HORSE TRACK <br /> ❑ Yes ❑No Are you applying for a horse track permit and do you currently hold a valid recognized meeting permit issued by the Indiana Gaming <br /> Commission? <br /> Recognized Meeting Permit Number Issuance Date Expin3tinn Date <br /> ❑ Yes❑No Are you applying for a satellite permit? <br /> 5ateliite Facility License Issuance Elate icx;A 'on Date <br /> BOAT(SEASONAL) <br /> El Yes❑No" *if you are appiying for a boat permit,do you engage in regular passeriger seivice which makes regular runs in'seasdnal weather between <br /> established locations? <br /> BEER WHOLESALER <br /> ❑ Yes❑No Do you have available for investment capital and cash or property necessary and useful in your business,exclusively as a beer wholesaler,of <br /> at least$15,000(exclusive of motor vehicles),and do you agree that you will,if the application is granted,actually make the investment and <br /> submit proof to the Commission before you engage in business as a beer wholesaler? <br /> BREWER <br /> ❑ Yes ❑No I certify that the projected number of barrels of beer to be manufactured during the permit year will not exceed 20,000 barrels.(A barrel equals <br /> 31 gafforis.)(Small Brewer) <br /> ❑Yes❑No I certify that the projected number of barrels of beer to be manufactured during the permit year will exceed 20,000 barrels,(A barrel equals 31 <br /> gallons.)(Brewer) <br /> WINERY <br /> Check if you qualify,and are applying for one of the following permlts: <br /> ❑Vintner(IC 7.1-3-12-1) <br /> ❑Farm Winery(IC 7.1-3-12-3) <br /> Farm Winery Brandy Distiller(IC 7.1-3-7.5-2) <br /> BOND REQUIREMENTS <br /> The following applicants are required to file with this application the appropriate non-revocable surety bond,made payable to the State of Indiana. Check the <br /> appropriate bond amount if applicable: <br /> [:]Brewer($10,000) <br /> ❑Distitiar($10,000) <br /> []Liquor Wholesaler($10.000) <br /> 0 Rectifier($15,000) <br /> ❑vintner(excludes farm winery)($1,000) <br />