Form Rbwapp - Restaurant Beer/wine Lottery Application
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1
2MONTANA
RBWAPP
Rev. 7-07
Restaurant Beer/Wine Lottery Application
Section 1: Entity/Transaction
Check appropriate box:
1. Applicant
Individual: Please list individual’s name.
Corporation: On page 1 please list corporate name and on page 2 list all stock holders showing the number of
shares.
Other: If more than one individual, on page 1 please list all individuals’ names and on page 2 list the names with
percentage of ownership. If a partnership, LLP, or LLC, list the partnership, LLP, or LLC name on page 1 and on page
2 list all individual partners’ or members’ names showing percentage of ownership.
2. City quota area: _______________________
Section 2: General Information
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.
1. Name of Applicant/Business Entity __________________________________________________________________
Address _______________________________________________________________________________________
City, State, Zip __________________________________________________________________________________
Contact Person ________________________________________Daytime Contact Phone _____________________
2. Do you currently own a retail on-premises consumption license at the location for which you intend to apply?
Yes
No
If you answered “yes” to this question, you do not qualify for entry in the lottery.
3. Have you sold a retail on-premises consumption license and has it been less than one year since the date of transfer to
a new purchaser?
Yes
No
If you answered “yes” to this question, you do not qualify for entry in the lottery.
4. Has your restaurant existed for one year prior to the lottery deadline and have you operated it continuously since then?
Yes
No
If you answered yes, what is the physical address of the premises? _________________________
_____________________________________________________________________________________________
5. If your business is seasonal, has your restaurant existed for one year prior to the lottery deadline and have you
operated it continously during your normal business season since then?
Yes
No
6. Have you been an unsuccessful entrant in a previous restaurant beer/wine lottery held by the Department of Revenue?
Yes
No
If you answered yes, please provide information requested below.
Date of lottery _______________ City where applied ________________ Applicant name _______________________
7. Check the seating capacity for your restaurant. 60 or fewer
61 to 100
101 or more
Section 3: Declaration and Affidavit
If my application is drawn in the lottery, I agree to return a completed license application, accompanying documents and the
appropriate fees within 30 days of being notified that I was the successful applicant. I further understand that information
concerning ownership on this application must be consistent with the license application or I will be disqualified. For
example, if you complete this application as an “individual,” and are the successful applicant, your subsequent license
application must also be as an individual.
___________________________________________________
____________________________
Signature
Date
___________________________________________________
____________________________
Printed Name
Title
Important: You must return only this lottery application by the deadline set in the publication notice. If the application is not
complete, it will be disqualified. For information concerning the deadline for the specific area where you are applying, please
call us at (406) 444-6900. Each lottery entrant will be notified of the drawing results.
Return to: Montana Department of Revenue, Liquor Control Division, PO Box 1712, Helena, MT 59624-1712
5004
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