Form 37 - Liquor And Gambling Short Form
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3State of Montana
Form 37
Liquor and Gambling Short Form
Check the Appropriate Box to Designate the Purpose of this Application
Check the Appropriate Box to Designate the Purpose of this Application
The use of this short application is limited to report a change of location for a Gambling Manufacturer/Distributor/Route Operator
(only); change in ownership due to the death of a licensee and transfer of ownership interest to an estate, or to a joint tenant with
right of survivorship; transfer of interest resulting from divorce if the spouse to whom the interest is transferred is already identified
as an owner of the license; transfer of ownership resulting from a foreclosure; transfer of ownership interest by gifting if the person
to whom the interest is transferred is already identified as an owner of the license; transfers of ownership by sale if the person to
whom the interest is sold is already identified as an owner of the license. In addition, transfers under any of the above
circumstances must be to a person already disclosed in a liquor only or combined application owning at least 10% of the license.
NOTE: An ownership interest in a licensed gambling and/or liquor operation may not be transferred to a complete
stranger to the license (someone not already listed and approved as an owner) unless a new Alcoholic
Beverage/Gambling Operator Combined License Application (Form 5) reflecting the proposed transfer is sent to and
approved by the divisions. See the attached pages for a checklist of the documents and information that will be required for
each transaction type.
Change of Location (Gambling Manufacturer/Distributor/Route Operator Only)
Death of a Licensee
Divorce among Licensees
Foreclosure
Gifting among Licensees
Sale among Licensees
Explain briefly the reason for this application:
________________________________________________________________________________________________________
______________________________________________________________________________________________________
Fees
Fees
Processing Fee: $200 for Foreclosure ONLY
Fingerprint Fee: $27.25 per set (two) when required. (See individual transaction type.)
General Information
General Information
Account ID _______________________ FEIN ____________________ Liquor License No. _______________________
Name of Licensee _________________________________________________________________________________________
Business/Trade Name ______________________________________________________________________________________
Mailing Address___________________________________________________________________________________________
Address of Licensed Premise ________________________________________________________________________________
City, State, Zip____________________________________________________________________________________________
Business Phone_____________ Cell Phone ________________
Email Address______________________________________
Authorization
Authorization
I affirm I am authorized to make this application for the applicant and that the answers contained herein are true and complete. If
this application or attachments contain false information, I understand I may be subject to the criminal penalties of Mont. Code Ann.
§ 45-7-202, 45-7-203, 45-7-208, 16-4-402 and/or revocation of any gambling and/or liquor licenses granted pursuant to this
application.
Signature of Licensee/Authorized Agent _____________________________________________ Date ______________________
Print Full Name of Licensee/Authorized Agent ___________________________________________________________________
Form 37 Revised 12/2012
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