Idaho State Police Alcohol Beverage Control 700 S. Stratford Drive Ste 115 Meridian, ID 83642 (208) 8847060 RECEIPT FOR SALE OF BEER IN KEGS TO UNLICENSED GROUP OR INDIVIDUAL Date of Sale: __________________________________________________________________________ Keg Identification Number(s): ____________________________________________________________ Brand: __________________________ Keg Capacity: ________________ No. of Kegs: ______________ Name of Purchaser: ____________________________________ Date of Birth: ____________________ Address: _____________________________________________________________________________ Location, Time and Date where beverages will be consumed: ___________________________________ _____________________________________________________________________________________ Valid Driver's License Number: __________________________ State: _________ Expiration: _________ OR Military Identification Card Number: ______________________________ Expiration: ____________ OR Valid Identification Card Number: ________________________ State: _______ Expiration: ________ Vehicle in which keg(s) will be transported: _________________________________________________ Year Make Color Plate No. I certify that the information given in this receipt is true and correct to the best of my knowledge and belief that I am of or over the legal age to purchase, possess and consume beer, that the beer will not be resold, nor will I allow consumption by beer by any person who is not of legal age, nor will I remove the numbered label. ___________________________ Signature of Purchaser Identify of Seller: _______________________________________________________________________ Licensee/Salesman Trade (Business) Name Address of Licensed Premises: ____________________________________________________________ WARNING It is unlawful for anyone under the age of 21 to purchase beer, or for a person to five or otherwise make available any beer to anyone who has not attained the age of 21 years (Idaho Code Sections 231013 and 23 1023). Possession of a keg containing beer, except by licensees, which is not identified by the numbered label, is prohibited by law. The numbered label must not be removed, altered or obliterated. Any purchaser who provides false information on this receipt shall be guilty of a misdemeanor (Idaho Code Section 231018). GIVE YELLOW COPY TO PURCHASER ­ LICENSEE RETAIN ORIGINAL FOR SIX MONTHS American LegalNet, Inc. www.FormsWorkFlow.com