CHAPTER 12
FORMS
[Prior to 10/8/86, Beer and Liquor Control Department[150]]
185—12.1(123,17A) Purpose and scope. These rules shall govern all forms prescribed by the alcoholic beverages commission for use in proceedings before the division. The division may allow different forms to be utilized in a specific case as necessary.
	12.1(1) Forms compliance. All papers filed with the division shall substantially comply with the requirements set forth in this chapter.
	12.1(2) General requirements. All papers, except exhibits, shall be cut or folded so as not to exceed 8½ inches by 11 inches in size with inside margins not less than 1 inch in width. Whenever practical, all exhibits of a documentary character should conform to the foregoing requirements of size and margin.
This rule is intended to implement Iowa Code section 123.21.
185—12.2(123,17A) Specific forms.
	12.2(1) Petition for rule making. Rescinded IAB 5/19/99, effective 6/23/99.
	12.2(2) Statement of position. Rescinded IAB 5/19/99, effective 6/23/99.
	12.2(3) Counterstatement of position. Rescinded IAB 5/19/99, effective 6/23/99.
	12.2(4) Request for rule-making oral presentation. Rescinded IAB 5/19/99, effective 6/23/99.
	12.2(5) Request for rule-making statement. Rescinded IAB 5/19/99, effective 6/23/99.
	12.2(6) Petition for declaratory ruling. Rescinded IAB 5/19/99, effective 6/23/99.
	12.2(7) Retail bond.
ALCOHOLIC BEVERAGES DIVISION
1918 S.E. Hulsizer, Ankeny, Iowa 50021
BOND FOR RETAIL: LIQUOR LICENSES, BEER PERMITS, OR WINE PERMITS
Bond No. 	
KNOW ALL BY THESE PRESENTS THAT 	
(Principal)
of, 	 County,
(City and/or County)
State of Iowa, as Principal and 	
(Surety)
of 	,
(City and State)
as Surety, are held firmly bound unto the State of Iowa in the penal sum of $ ____________ lawful money of the United States, for the payment of which, in Des Moines, Polk County, Iowa, we bind ourselves, our successors and our legal representatives jointly and severally firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH, That whereas, the Principal has made application for:

<fo:wrapper font-size="12pt">□</fo:wrapper> Class ____ Liquor License;	<fo:wrapper font-size="12pt">□</fo:wrapper> Class ____ Wine Permit;	
<fo:wrapper font-size="12pt">□</fo:wrapper> Class ____ Beer Permit;	<fo:wrapper font-size="12pt">□</fo:wrapper> Special Class C Liquor License (Beer and Wine only);	
to be issued by the Alcoholic Beverages Division.
NOW THEREFORE, if the Principal shall pay the amount Principal owes the division for writing the division insufficient funds checks for alcoholic beverages and wine as allowed by Iowa Code section 123.24, and shall faithfully observe and obey all other provisions of Iowa Code chapter 123, any amendments thereto, and the division’s administrative rules, then this obligation to be void, otherwise to be and remain in full force and effect.
THIS BOND shall be effective on _____________________________, 20_____, and shall remain effective continuously without cumulative liability until canceled. This bond may be canceled by the principal or the surety by giving written notice to the other party and the Alcoholic Beverages Division at its office in Ankeny, Iowa, stating the date of cancellation, which in no event shall be less than thirty days after actual receipt of notice; however, no cancellation shall be effective as to forfeiture in the event proceedings for the revocation of the principal’s liquor control license or beer permit have been or are commenced prior to the effective date of cancellation.
□ The Alcoholic Beverages Division by acceptance of this replacement bond gives notice to the Surety canceling prior bond(s) No.(s) _______________________, termination to be effective as of the time this bond becomes effective.
Signed this ________________ day of ________________, 20_____.
Countersigned 	
(Iowa Resident Agent)
	
(Principal)
	
(Principal)
	
(Surety)
By: 	
(Attorney-in-Fact)
	12.2(8) Bond for three wholesalers’ permits.
ALCOHOLIC BEVERAGES DIVISION
1918 S.E. Hulsizer, Ankeny, Iowa 50021
Bond No.		
The bond being issued is a:
□ Class “A” beer permit (beer wholesale only)
□ Class “A” wine permit (wine wholesale only)
□ Class “F” beer permit (beer and wine wholesale)
KNOW ALL BY THESE PRESENTS THAT 	
(Principal)
of, 	 County,
(City and/or County)
State of Iowa, as Principal, and 	
(Surety)
of 	,
(City and State)
as Surety, are firmly bound unto the State of Iowa in the penal sum of:
FIVE THOUSAND AND NO/100 DOLLARS if issued for a CLASS “A” BEER PERMIT (beer wholesale only) or for a CLASS “A” WINE PERMIT (wine wholesale only)
OR
TEN THOUSAND AND NO/100 DOLLARS if issued for a CLASS “F” BEER PERMIT (beer and wine wholesale)
lawful money of the United States, for the payment of which we bind ourselves, our successors and our legal representatives jointly and severally firmly by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH, That whereas, the Principal has made application for either a class “A” beer permit, class “A” wine permit, or a class “F” beer permit to be issued by the Alcoholic Beverages Division.
NOW THEREFORE, if the Principal shall faithfully observe and obey all of the provisions of Iowa Code chapter 123, any amendments thereto, and the division’s administrative rules, then this obligation to be void, otherwise to be and remain in full force and effect.
THE SURETY on the bond of any permittee whose permit has been issued by the Alcoholic Beverages Division may at any time notify the Principal and the Alcoholic Beverages Division that the surety desires after a date named, which shall be at least thirty days after the receipt of notification, to be relieved of liability on the bond, shall be terminated and canceled on the date specified, unless supported by other sufficient bond, or bonds, and the Surety shall be relieved of all future liability after the date specified in the notice of cancellation.
THIS BOND shall be effective on ____________________________, 20_____, and shall remain effective continuously without cumulative liability until canceled.
SIGNED THIS __________________________ DAY OF ____________________, 20_____.
	
(Principal)
	
(Surety)

	12.2(9) Surety change rider.
Surety Change Rider
It is hereby understood and agreed that Bond Number ______________________, issued by
_________________________________ to _________________________________, effective
(Surety Company)	(Principal)
	 is amended as follows:
(Effective date of bond)
Class of license is changed from _______________ to _______________
Amount of Bond is changed from _______________ to _______________
Provided, however, that the bond shall be subject to all its agreements, limitations and conditions except as herein expressly modified, and further that this bond and all riders attached thereto, including this rider, shall not be cumulative, and when loss shall occur under this bond during a time within which the penalty of the bond shall vary, then the aggregate liability of the Surety shall in no event exceed the largest penalty of this bond in force during the period of time within which such loss shall occur under this bond.
This rider shall become effective as of the ________ day of ______________________, 20_____.
Signed, sealed, and dated this ________ day of _______________________, 20_____.
	
Principal

Surety Company
Countersigned
By: 	
Resident Agent
By: 	
Attorney-in-fact
	12.2(10) Bond for manufacturer’s license in Iowa Code section 123.41.
ALCOHOLIC BEVERAGES DIVISION
MANUFACTURER’S LICENSE BOND
KNOW ALL BY THESE PRESENTS:
That we, the ______________________________ of ____________________, Iowa, as Principal and ________________ of ____________________, as surety, are held and firmly bound unto the STATE OF IOWA, and the ALCOHOLIC BEVERAGES DIVISION and each of them jointly, or severally, in the penal sum of FIVE THOUSAND DOLLARS ($5,000.00) for the payment of which we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly, severally by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH THAT,
WHEREAS, the said ______________________________ of ____________________ has made application under Iowa Code section 123.41 for a Manufacturer’s license allowing the manufacture, storage and wholesale disposition and sale of alcoholic liquor to the Alcoholic Beverages Division and to customers outside of the state.
Now, therefore, if licensee shall faithfully and fully abide by and keep and perform each and every provision of Iowa Code chapter 123, so far as it applies to the licensee during the period for which license shall be granted, then this bond shall be of no further force or effect; otherwise, it shall remain in full force and effect and the penalty shall become payable to Alcoholic Beverages Division at Ankeny, Iowa, upon demand and equity jurisdiction is hereby consented to for the enforcement hereof.
Second, to fix and determine liability of both the principal and surety upon this bond for the full amount it shall be necessary only to prove by a fair preponderance of the evidence that licensee has violated one or more of the rules and regulations adopted by the Alcoholic Beverages Division and in force when such act or acts shall have been committed.
Third, it is specifically conditioned by the surety that it may, at anytime, on giving of sixty (60) days’ notice in writing to the Alcoholic Beverages Division of a desire to be relieved from further responsibility under this bond, terminate its further responsibility for any act committed by the principal subsequent to sixty (60) days from the receipt of notice by the Alcoholic Beverages Division.
Executed this __________ day of ________________, 20_____, at 	.
This bond shall be effective for a one (1) year term beginning 	, 20_____,
and expiring _____________________, 20_____.
	
(Principal)
BY: 	
SURETY 	
BY: 	
	12.2(11) Bond for wholesaler’s license in Iowa Code section 123.42.
ALCOHOLIC BEVERAGES DIVISION
WHOLESALER’S LICENSE BOND
KNOW BY ALL THESE PRESENTS:
That we, the ____________________________ of _________________________, Iowa, as Principal and ____________________________ of _________________________ as surety, are held and firmly bound unto the STATE OF IOWA, and the ALCOHOLIC BEVERAGES DIVISION and each of them jointly, or severally, in the penal sum of ONE THOUSAND DOLLARS ($1,000.00) for the payment of which we bind ourselves, our heirs, executors, administrators, successors, and assigns, jointly, severally by these presents.
THE CONDITION OF THIS OBLIGATION IS SUCH THAT,
WHEREAS, the said _________________________ of _________________________ has made application under Iowa Code section 123.42 for a Wholesaler’s license allowing the storage and wholesale disposition and sale of alcoholic liquor to the Alcoholic Beverages Division and to customers outside of the state.
Now, therefore, if licensee shall faithfully and fully abide by and keep and perform each and every provision of Iowa Code chapter 123, so far as it applies to the licensee during the period for which license shall be granted, then this bond shall be of no further force or effect; otherwise, it shall remain in full force and effect and the penalty shall become payable to Alcoholic Beverages Division at Ankeny, Iowa, upon demand and equity jurisdiction is hereby consented to for the enforcement hereof.
Second, to fix and determine liability of both the principal and surety upon this bond for the full amount it shall be necessary only to prove by a fair preponderance of the evidence that licensee has violated one or more of the rules and regulations adopted by the Alcoholic Beverages Division and in force when such act or acts shall have been committed.
Third, it is specifically conditioned by the surety that it may, at any time, on giving of sixty (60) days’ notice in writing to the Alcoholic Beverages Division of a desire to be relieved from further responsibility under this bond, terminate its further responsibility for any act committed by the principal subsequent to sixty (60) days from the receipt of notice by the Alcoholic Beverages Division.
Executed this ____________ day of ______________, 20_____, at 	.
This bond shall be effective for a one (1) year term beginning 	, 20_____,
and expiring ____________________, 20_____.
	
(Principal)
BY: 	
SURETY 	
BY: 	
	12.2(12) Certification of dramshop liability. Rescinded ARC 0274C, IAB 8/8/12, effective 9/12/12.
	12.2(13) Hearing complaint.
STATE OF IOWA
BEFORE THE ALCOHOLIC BEVERAGES DIVISION
1918 S.E. Hulsizer
Ankeny, Iowa 50021

IN RE:	)	Date ____________, 20_____	
(insert the name of the	)	 	
licensee, trade name of the	)	 	
establishment and address)	)	 	
 	)	HEARING COMPLAINT	
Liquor Control License no. ____________	)	 	
Beer Permit no. _____________________	)	 	
 	)	 	
Complaint is hereby made that on 	,
at _____________________________, Iowa, the above named licensee/permittee did, or by an agent, clerk, or employee, violate section _____________________ of the Code of Iowa, or violate rule no.	____________ of the Alcoholic Beverages Division.
TO WIT:
(insert the code or rule violation)
WHEREFORE, it is requested that the administrator of the Alcoholic Beverages Division hear the proceeding in accordance with the law and regulations.
Complainant Authority
By 	
List of Witnesses;
(insert names and addresses of witnesses)
	12.2(14) Appeal to hearing board. Rescinded IAB 8/18/93, effective 7/29/93.
[ARC 0274C, IAB 8/8/12, effective 9/12/12]
These rules are intended to implement Iowa Code sections 123.21(4), 123.21(12), 123.30, 123.41, 123.42, 123.125 and 123.127.
[Filed without Notice 7/6/79—published 7/25/79, effective 8/29/79]
[Filed 8/15/80, Notice 5/28/80—published 9/3/80, effective 10/8/80]
[Filed emergency 5/19/82—published 6/9/82, effective 5/19/82]
[Filed 5/3/85, Notice 2/13/85—published 5/22/85, effective 6/26/851]
[Filed emergency 7/1/85—published 7/31/85, effective 7/1/85]
[Filed emergency 10/10/85—published 11/6/85, effective 10/10/85]
[Filed 10/10/85, Notice 7/31/85—published 11/6/85, effective 12/11/85]
[Editorially transferred from [150] to [185], IAC Supp. 10/8/86; see IAB 7/30/86]
[Filed emergency 7/29/93—published 8/18/93, effective 7/29/93]
[Filed 10/20/93, Notice 8/18/93—published 11/10/93, effective 12/15/93]
[Filed 4/28/99, Notice 3/24/99—published 5/19/99, effective 6/23/99]
[Filed 3/14/03, Notice 8/8/01—published 4/2/03, effective 5/8/03]
[Filed ARC 0274C (Notice ARC 0157C, IAB 6/13/12), IAB 8/8/12, effective 9/12/12]
1	Effective date of 12.2(7) delayed seventy days by the Administrative Rules Review Committee on 6/11/85.