Form Lotapp - Lottery Application
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1
2MONTANA
LOTAPP
Rev. 7-07
Lottery Application
Section 1: Entity/Transaction
Check appropriate box:
1. Applicant
2. Transaction
Individual: Please list individual’s name.
New City Beer
Corporation: On page 1 please list corporate name and on page 2 list all
New “Floater” All-Beverage
stock holders showing the number of shares.
New All Beverage
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.
3. City/County 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 _______________________________________________________________________________
Address _______________________________________________________________________________________
City, State, Zip __________________________________________________________________________________
Contact Person ________________________________________Daytime Contact Phone _____________________
If applying for a “Floater” All-Alcoholic Beverage license, answer the following:
• Has the applicant applied for a “Floater” All-Alcoholic Beverage lottery within the previous 12 months?
Yes
No
(If you answered “yes” to this question, you do not qualify for entry in the lottery)
• Does the applicant have any ownership interest in an All-Alcoholic Beverage license?
Yes
No
(If you
answered “yes” to this question, you do not qualify for entry in the lottery)
• The applicant has provided with this application an irrevocable letter of credit from a financial institution that
guarantees available credit in the amount of $100,000.
Yes
No
(Include a copy of the letter of credit with
the application.)
Please Note: A license transferred pursuant to a lottery after July 1, 2007, to a quota area outside the quota area for which
it was originally issued, is not eligible to offer gambling under Title 23, chapter 5, part 3, 5, or 6.
A successful lottery applicant for a “floater” license is required to begin business within one year of the lottery.
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 (60 days for “Floater”) 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
5003
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