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Application For Special Permit To Sell Beer And Table Wine - Montana

Application For Special Permit To Sell Beer And Table Wine Form. This is a Montana form and can be used in Liquor Licensing Department Of Revenue Statewide .
 Fillable pdf Last Modified 8/29/2015
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CLEAR FORM MONTANA SpecPerm Rev 05 14 Montana Application for Special Permit to Sell Beer and Table Wine A copy of your IRS tax-exempt certificate must be attached or on file with the department. Please send your complete application and the appropriate fee to us at least three (3) days before your event. Section 1 ­ General Information Note: If the applicant is an individual, list the individual's name below. If the applicant is a partnership, limited liability partnership (LLP), corporation, or limited liability company (LLC) list the business' name below. Name of Applicant(s) ____________________________________ FEIN/SSN _________________ Contact Person ___________________________________________________________________ Telephone __________________________________Fax _________________________________ Location of Principal Place of Business_________________________________________________ (Street Address, City, State and Zip Code) Name of Event ____________________________________________________________________ Location of Event __________________________________________________________________ (Street Address, City, State and Zip Code) Date(s) for which Special Permit is Requested ___________________________________________ Section 2 ­ Type of Organization and Fees Type of Organization _______________________________________________ $10 per day ­ 501(c) (3) Organization (limit 3 per year) $10 per day ­ 501(c) (3) Intercollegiate athletic fund-raising organization (limit 12 per year) $10 per day ­ 501(c) (4) Civic League or Organization (limit 12 per year) $10 per day ­ 501(c) (6) Chamber of Commerce or business league (limit 12 per year) * $10 per day ­ Accredited Montana post secondary school (limit 3 per year) $10 per day ­ Organization operated to raise funds for a needy person (limit 3 per year) $10 per day ­ Veterans or fraternal organizations that hold a liquor license (limit 3 per year) $1,000 per season ­ Professional Sports Organization (seasonal) $1,000 per season ­ Junior Hockey Team (seasonal) * Chamber of Commerce or business league need to provide proof of liquor liability insurance. Total Amount Enclosed $ ____________ American LegalNet, Inc. www.FormsWorkFlow.com Name of Applicant(s) _________________________________________ Section 3 ­ Local Law Enforcement Please have your local law enforcement official complete this section prior to sending in your application. I,_______________________________________________ , hereby of the premises where the event is to be held. _________________________________ Signature Approve Disapprove ___________________________ Title _______________ Date Section 4 ­ Declaration and Affidavit We understand beer and table wine can only be sold and consumed within the enclosure where the event is held and only on the above date(s). We state that the location of the event is not within 600 feet and on the same street as a school or church. We will follow all the laws, rules and ordinances relating to the sale of beer and table wine. We understand that a violation of any law or rule relating to the sale of beer or table wine will be reason to revoke the permit. Any authorized employee of the department, its representative or any peace officer will have the right to examine the location of the event at any time. This application needs to be signed by all individuals, partners or members. In the case of a corporate applicant, it may be signed by one shareholder or officer with authority to sign. I/We declare under penalty of false swearing that the information provided on this application and its attachments are true, correct and complete. _______________________ Signature _____________ Date ___________________ ____________________ Printed Name Title Mail completed application as well as all necessary documents to: Montana Department of Revenue Liquor Control Division PO Box 1712 Helena, MT 59624-1712 Questions? Please call us toll free at (866) 859-2254 (in Helena, 444-6900). Application for Special Permit to Sell Beer and Table Wine Page 2 American LegalNet, Inc. www.FormsWorkFlow.com
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