Form Non-Btw - Non-Profit Arts Organization Beer And Table Wine License Application

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CLEAR FORM
MONTANA
NON-BTW
Rev 06 13
Non-Profit Arts Organization
Beer and Table Wine License Application
Note: New license applications will need approvals from the building, health and fire code officials before we can approve
this application. We can accept approvals by telephone, by mail or electronically.
Section 1. General Information
Name of Non-Profit Organization ______________________________________________________________________
Federal Employer Identification Number
-
Doing Business As __________________________________________________________________________________
Contact Person ____________________________________________________________________________________
Business Telephone _________________________________Cell Phone ______________________________________
Fax ___________________________________ Email Address ______________________________________________
Physical Address of Premises to be Licensed _____________________________________________________________
(Street Address, City, State Zip Code)
Mailing Address ____________________________________________________________________________________
(Street Address, City, State Zip Code)
Section 2. Type of Transaction and Fees
This type of license must be renewed annually by June 30.
New License
$250 New License Fee
$100 Processing Fee (required for all transactions)
Total Amount Enclosed
$
Office Use Only
.
Amount Paid $ ____________
Amount Owed $ ___________
New License Number
________________________
Account Number
________________________
Non-Profit Arts Organization Beer and Table Wine Application
Page 1

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