Form Mt-39 - Alcoholic Beverages Tax Clearance Return For Tax On Importation Of Alcoholic Beverages Into New York State For Personal Consumption Page 3
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3MT-39 (2/10) Page 3 of 3
Schedule C — Application for temporary license to import liquors for personal use and consumption
25 Dates for which license is requested
.... From:
To:
(license is valid for 14 days)
liters
26 Quantity of liquor expected to be imported with this license ..................................................................... 26.
27 Including the amount shown on line 12 during the year ending on the last day of the period shown on
line 25 how many liters of liquor will you have imported into New York State? ...................................... 27.
liters
28 Number of licenses requested in the previous 12-month period................................................................ 28.
Transporter information
( if other than applicant)
Transporter name
State Liquor Authority transporter number (if applicable)
Street address
City
State ZIP code
County
Method of transportation
Destination of liquor
( if applicant’s address, enter same)
Name
Telephone number
(
)
Street address
City
State ZIP code
Supplier information
( if known at time of application)
Name
Telephone number
(
)
Street address
City
State ZIP code
Mark an X in one box:
New York State only
New York City only
New York State and New York City
I hereby declare that I am 21 years of age or older and that this application has been made with the knowledge that a willingly false
representation is a crime under New York State Tax Law Article 37, section 1813, punishable by fines and penalties stipulated therein,
and affirm that the information provided on this application is true, correct, and complete.
Signature of applicant
Date
For office use only
License number
Issuing agent’s signature
Valid from
to
This certifies that
is licensed to import up to
liters of liquors into this
state during the above 14-day period pursuant to Article 18 of the Tax Law. The liquors must be for the above-named individual’s
personal use and consumption.
The license is not transferable and shall remain in force during the above period and is null and void after this period.
Form MT-39 must be filed before the above-named individual may import any liquor or within 20 days after the end of the above
14-day period if tax is not due. Any person required to file a return or report or to pay tax who willfully fails to pay such tax or file
such return or report at the time or times required is guilty of a misdemeanor.
Persons importing liquors for sale or importing more than 360 liters during any one-year period for personal use and consumption
must undergo full registration as a distributor of liquors and may not sell or import pursuant to this temporary license.
Any person, other than a registered distributor, who imports or causes to be imported any liquor into New York State for sale or
use in New York State without a license is guilty of a class A misdemeanor. If the total quantity of liquors imported is more than
360 liters, the person is guilty of a class E felony.
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