Form Wld-612 - Limited Transportation Liquor License Application - Wyoming Department Of Revenue

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WLD-612 (7/02)
State of Wyoming
Department of Revenue
Liquor Division
Cheyenne WY 82002-0110
(307) 777-7233 FAX (307) 777-5866
W.S. 12-2-202
State Law Requires any Transportation Service serving Alcoholic Beverages on board to be licensed.
Limited Transportation Liquor License Application
Type of Business:
Railroad
Bus
Limousine
____________(Other)
Company Name:
(Please Print)
Company Address
(Please Print)
City
State
Zip
(Please Print)
Vehicle License Plate Number:
State:
(If Applicable)
Type of License
Railroad: Annual (Fee $250.00/direction) 24 Hour (Fee $25.00/direction)
Applied for:
 Charter:
Annual (Fee $250.00)
24 Hour (Fee $25.00)
Date Purchased:
Time Period:
Forward this Copy with Check to:
Wyoming Liquor Division
1520 E 5th Street
Cheyenne, WY 82002-0110

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