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Form 5 - Montana Alcoholic Beverage - Gambling Operator Combined License Application Page 12

Section VII

Alcoholic Beverage Temporary Authority

A. Please indicate whether or not you wish to have alcoholic beverage temporary authority issued.

 Yes  No

Alcoholic beverages License Number ________________________________________

Temporary Authority cannot be granted on an alcoholic beverage transfer of location or issuance of a new license. If an

alcoholic beverage Temporary Authority is granted before a gambling license application is approved, all current gambling

activities at the establishment must cease until a gambling license application is approved.

The undersigned requests authority to operate pending final approval of the transfer. The undersigned agrees that during

the period of Temporary Operating Authority, the applicant shall be responsible for all beer and wine purchased pursuant

to Montana Code Annotated §16-3-243 (the seven-day credit limitation). Temporary Authority will be immediately revoked

if any employees or I violate any provisions of Title 16, Montana Code Annotated or the department rules.

Signature of Applicant _______________________________________

Date _________________

I would like Temporary Authority issued on: ______________________

Date

To Be Co mp leted By Reco rd ed Own er/Cu rren t Licens ee:

I authorize Temporary Operating Authority be granted to the applicant by the Department of Revenue, pending final approval

of this application. I understand the applicant may not operate until Temporary Authority has been granted. I understand

Administrative Rule of Montana 42.12.208 states in part “Any proposed fine, suspension or revocation arising out of a

violation will be assessed against and is the responsibility of the recorded owner of the license.”

Signature of Recorded Owner/Current Licensee

Date

______________________________________

__________________________

Form 5 - Montana Alcoholic Beverage - Gambling Operator Combined License Application Page 12