Montana Form Wl-App - Application To Add Wine To Off-Premises Beer License printable pdf download

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

MONTANA

WL-APP

Rev 06 13

Application to Add Wine to Off-Premises Beer License

If you are the owner of an off-premises beer license and wish to also sell wine 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

Annual License Fee ............ $200

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

*11MJ0101*

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