Application For Beer/wine Permit Form - Alcohol Beverage - Idaho State Police
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1
2Idaho State Police
ALCOHOL BEVERAGE CONTROL
700 S. Stratford Dr. Ste 115
Meridian, ID 83642
(208) 884-7060
APPLICATION FOR BEER/WINE PERMIT
□ Beer Permit ($20) □ Wine Permit ($20) □ Both Beer and Wine Permit ($40) (Check one)
Applicant Name: ______________________________________________________ Federal Tax ID # (EIN #): _____________________
Mailing Address: _________________________________________________________________________________________________
(Address)
(City)
(State)
(Zip Code)
Dates of event: ___________________________________________ (Not to Exceed 3 Days) Hours of Event: ______________________
(Please include a.m. or p.m.)
Location of event: _________________________________________________________________________________________________
(Address)
(City)
(County)
(Zip)
Name of Event: ___________________________________________________________________________________________________
Number of attendees expected to attend your event: ________________________
Is the location of the event inside city limits?
Yes_________
No_________
Purpose: _________________________________________________________________________________________________________
Proceeds will be donated to: _________________________________________________________________________________________
PROVIDERS OF BEER
BRAND OF BEER
PROVIDERS OF WINE
BRAND OF WINE
I HEREBY CERTIFY THAT THE APPLICANT LISTED ABOVE IS NOT OTHERWISE LICENSED IN THE STATE OF IDAHO TO
SELL ALCOHOLIC BEVERAGES AND THE PROCEEDS FROM THIS EVENT WILL BE DONATED FOR BENEVOLENT,
CHARITABLE, OR PUBLIC PURPOSES.
Applicant’s Signature_______________________________ Title _____________________ Date_________________________________
Applicant’s Printed Name ________________________________________ Phone Number______________________________________
Email Address ___________________________________________
Subscribed and sworn to this _______________________________________day of ________________________________, 20_________
__________________________________________________
Notary Public
Residing at______________________________________________________
Commission Expires______________________________________________
EH 10.03-01 Beer/Wine Permit
9/2014
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