Date of Submission:

Tennessee Alcoholic Beverage Commission – Substitute Form for Submitted or Pending Documents

This form is being uploaded as part of my Regulatory Licensing and Permitting System request as a substitute for the following required or pending documents:

Form Instructions:1. Fill in the date this form is being submitted.

a. Select License/ Education type for required Documents or Pending Documents as applicable.2. Verify all required documents for your specific request:

a. Select each substituted form from the Required Documents drop down boxes.b. Type each Pending Document name in the provided free form fields.

3. Complete the name field to confirm acknowledgment.4. Save the form on your computer in an easily accessible location for uploading.5. Upload the saved copy of this form for each substituted document (Required or Pending).

As an authorized representative of the applicant/licensee, I hereby declare the following:

1. The documents indicated above have been previously submitted to the Tennessee Alcoholic BeverageCommission or are currently pending as part of a license/permit request.

2. The documents previously submitted are still valid and have not been superseded by new documents.3. If requested, a new copy of the previously submitted document could be provided to the TABC.4. I acknowledge that the TABC will not issue a license before all pending documents have been

submitted.

By typing my name in the name box below, I acknowledge that the previous statements are true.

Representative Name:

Substitute Documents (For Renewals Only)Select License Type

Required Documents

Pending Documents- To Be Submitted Select License/Education Type

Type Document Name in the Provided Space Below

AB- 0205 RDA2116