Montana > Statewide > Department Of Revenue > Liquor Licensing
Lottery Application - Montana
| Lottery Application Form. This is a Montana form and can be used in Liquor Licensing Department Of Revenue Statewide . |
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Lottery Application General Information 1. 2. Montana Clear Form LOTAPP Rev. 07-09 Quota Area Applying For: ______________________________________ (Required) Transaction: (choose one) New City Beer New "Floater" All-Beverages New All-Beverages Please Note: Only one lottery application per person will be accepted. "Person" as defined in ARM 42.12.401 means any individual, firm, partnership, limited liability company, corporation or association. 3. Legal Applicant/Owning Entity _____________________________________________________________ (Please do not use "Doing Business As") Mailing Address _________________________________________________________________________ City, State, Zip __________________________________________________________________________ Contact Person ___________________________________ Daytime Contact Phone ___________________ If not filing as an individual, please list all individuals with 10% or more ownership interest on the statement on the back of this form. Floater Section "Floater" means an all-alcoholic beverages license that may be transferred to a new location outside the quota area for which it was originally issued. This type of license cannot be mortgaged or sold for 5 (five) years after the transfer. A floater license which is issued as the result of a lottery will have a gaming restriction. If applying for a "Floater" All-Alcoholic Beverages license, answer the following: · · · Hastheapplicantappliedfora"Floater"All-AlcoholicBeverageslotterywithintheprevious12months? (Ifyouanswered"yes"tothisquestion,youdonotqualifyforentryinthelottery) Yes No DoestheapplicanthaveanyownershipinterestinanAll-AlcoholicBeverageslicense? Yes No (Ifyouanswered"yes"tothisquestion,youdonotqualifyforentryinthelottery) Theapplicanthasprovidedwiththisapplicationanirrevocableletterofcreditfromafinancialinstitutionthat guaranteesavailablecreditintheamountof$100,000. Yes No ("Irrevocableletterofcredit"means aletterofcreditinwhichtheissuingbankguaranteesthatitwillnotwithdrawthecreditorcanceltheletter.A letterofcreditmaynotbemodifiedorrevokedwithoutthecustomer'sconsent.)Includeacopyoftheletterof creditwiththeapplication.Ifnoletterofcreditisattachedwiththislotteryapplication,theapplicationwillbe disqualified. Please Note:AlicensetransferredpursuanttoalotteryafterJuly1,2007,toaquotaareaoutsidethequotaareafor whichitwasoriginallyissued,isnoteligibletooffergamblingunderTitle23,chapter5,part3,5,or6. Asuccessfullotteryapplicantfora"floater"licenseisrequiredtobeginbusinesswithinoneyearofthelottery. *** Return to: Montana Department of Revenue, Liquor Control Division, PO Box 1712, Helena, MT 59624-1712 American LegalNet, Inc. www.FormsWorkFlow.com Ownership Information (includes Corporations, LLC's, LLP's and Partnerships) Thestockholders,members/partnersare(pleaseprint): Number of Shares/ Percentage of Ownership Name Address Social Security Number Date of Birth Theofficersanddirectorsofthecorporationare(pleaseprint): Name Address Title ALL APPLICANTS ARe RequIReD TO SIgN AND COMPLeTe THe SeCTION BeLOw: I, _________________________________________________________ ,declareunderpenaltyoffalseswearingthatthe Print Name informationonthiscorporatestatementistrueandcomplete. Signature _________________________________________________________ Date ____________________________ Declaration and Affidavit Ifmyapplicationisdrawninthelottery,IunderstandthatImustsubmitacompletedlicenseapplicationandthe appropriatefeeswithin30days(60daysfora"floater")ofbeingnotifiedthatIwasthesuccessfulapplicant.Ifurther understandthatinformationconcerningownershiponthisapplicationmustbeconsistentwiththelicenseapplicationand supportingdocumentsorIwillbedisqualified.Forexample,ifyoucompletethisapplicationasan"individual,"andare thesuccessfulapplicant,yoursubsequentlicenseapplicationmustalsobeasanindividual. Important:Youmustreturnthislotteryapplicationbythedeadlinesetinthepublicationnotice.Iftheapplicationisnot complete,itwillbedisqualified.Forinformationconcerningthedeadlineforthespecificareawhereyouareapplying, pleasecallusat(406)444-6900or(866)859-2254.Eachlotteryapplicantwillbenotifiedofthedrawingresults. Signature _________________________________________________________ Date ____________________________ Printed Name ________________________________________ Title _________________________________________ American LegalNet, Inc. www.FormsWorkFlow.com
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