Off-Premises Liquor License Application - Montana Department Of Revenue
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2Return to:
One-Stop Licensing
Montana Department of Revenue
PO Box 8003
Helena, MT 59604-8003
Off-Premises
Liquor License Application
Section 1: Entity/Transaction
Check appropriate boxes:
1. Business Entity
2. Transaction
3. License Type/Fee
Individual (one person)
New License
Processing Fee - $100.00 (All)
Corporation
Transfer of Location - License # _______________________
Off-Premises Beer - $200.00
Other
Off-Premises Wine - $200.00
Corporate Structure Change - License # _________________
Off-Premises Beer/Wine - $400.00
Attach additional pages if more space is needed
Section 2: General Information
Instruction for completing applicant name.
If Individual, list individual’s name.
If Corporation, provide current corporate statement or list of offi cers, directors and shareholders and Certifi cate of Existence/
Authority.
If Other…
-
If more than one individual , list names of all below.
-
If partnership, list partnership name below then, individual partners’ names and provide copy of the partnerships Certifi cate of
Limited Partnership, Certifi cate of Fact or Certifi cate of Registration.
-
If LLC, list LLC name below then, all members’ names and provide a copy of the Certifi cate of Fact.
1.
Name of Applicant(s) __________________________________________________________________________________
___________________________________________________________________________________________________
Business Telephone No. ____________________ Fax No. __________________Federal Tax I.D. No. _________________
2.
Name of Person Managing Business ______________________________________________________________________
3.
Provided Personal History & Release of Information forms for each individual, partner, 10% stockholder, member or manager.
Yes
No
4.
Business/Trade Name ________________________________________________________________________________
(doing business as... Assumed business name must be fi led with the Secretary of State’s Offi ce)
Mailing Address _____________________________________________________________________________________
City, State, Zip ______________________________________________________________________________________
4a. Address of premises to be licensed, if different than mailing address. Give Exact Location of Premises, including a street
and number.
Physical Address ____________________________________________________________________________________
City, State, Zip ______________________________________________________________________________________
5.
Is your location within an incorporated city/town?
Yes
No
6.
Are the premises within any defi ned zones where the sale of alcoholic beverages is prohibited by city/county ordinances?
Yes
No
7.
Is your premises proposed for licensing operated as a
Grocery Store If grocery store - attach copy of inventory (Form G-1)
Drugstore
If drug store - attach copy of pharmaceutical license
8.
Do you now or will you own the building proposed for licensing?
Yes
No
If No, please provide a current or proposed lease or rental agreement. If Yes provide acceptable proof of ownership.
9.
Is the building ready for occupancy?
Yes
No
If No, indicate estimated date of occupancy: _______________________________
10. Will you be remodeling or constructing the premises?
Yes
No
If Yes, indicate estimated date of completion: ______________________________ (Date)
11. Submit copy of current fl oor plan of licensed premises. Floor plan must include external dimensions and general layout on
an 8½” x 11” sheet of paper. Identify trade name of premises, address and date.
12. Please send a copy of your bank signature card.
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