Montana Form Bl-App - Application To Add Beer To Off-Premises Wine License

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CLEAR FORM
MONTANA
BL-APP
Rev. 06 13
Application to Add Beer to Off-Premises Wine License
If you are the owner of an off-premises wine license and wish to also sell beer for off-premises consumption, please
complete and return this form with the appropriate fees to the address below.
Department of Revenue
Liquor Control Division
PO Box 1712
Helena, MT 59624-1712
Section 1 – General Information
Name of Licensee(s) ___________________________________________________________________________
Doing Business As _____________________________________________________________________________
-
-
-
License Number
Section 2 – Required Fees and License Information
q
Annual License Fee ............ $200
q
One-Time Processing Fee .. $100
Total Due ............................ $300
Total Enclosed $ ___________
Section 3 - Declaration and Affidavit
I declare under penalty of false swearing that I am the applicant or the duly authorized representative of the entity making
this application, and that the responses provided, including any accompanying information, are true, correct and complete.
Signature
Date
Printed Name
Title

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