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Montana Winspec Form - Montana Application For Special Permit To Sell Table Wine (Licensed Domestic Winery Only) Page 2

Name of Applicant(s) ____________________________________

Section 3 – Local Law Enforcement

Please have your local law enforcement official complete this section prior to sending in your

application.

 Approve

 Disapprove

I, _______________________________________________ , hereby

the above event.

_________________________________

___________________________

_______________

Signature

Title

Date

Section 4 – Declaration and Affidavit

We understand table wine can only be sold and consumed within the enclosure where the event

is held and only on the above date(s). We declare that the location of the event is not within 600

feet and on the same street as a school or church. We understand that we cannot sell wine for off-

premises consumption.

We will follow all the laws, rules and ordinances relating to the sale of table wine. We understand that

a violation of any law or rule relating to the sale of table wine will be reason to revoke the permit. Any

authorized employee of the department, its representative or any peace officer will have the right to

examine the location of the event at any time.

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

Mail completed application and all necessary documents to:

Montana Department of Revenue

Liquor Control Division

PO Box 1712

Helena, MT 59624-1712

Questions?

Phone: Toll Free at 1-866-859-2254 (in Helena, 444-6900)

Fax: (406) 444-0722

NK - Montana Application for Special Permit to Sell Table Wine (Licensed Domestic Winery Only)

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Montana Winspec Form - Montana Application For Special Permit To Sell Table Wine (Licensed Domestic Winery Only) Page 2