Idaho State Police Alcohol Beverage Control 700 S. Stratford Dr. Ste 115 Meridian, ID 83642 (208) 884-7060 SUPPLEMENTAL APPLICATION FOR BREWER'S PUB OR RETAIL LICENSE Year _____ I hereby certify that my brewery produces fewer than thirty thousand barrels (930,000 gallons) of beer annually. Brewery Licensee/Owner Therefore, I qualify and hereby apply for a Brewer's Retail Beer License (This license allows you to sell only the products of your brewery at your licensed brewery or one remote location or both.) OR Brewer's Pub License (This license allows you to sell the products of any brewery by the bottle, can or glass at your brewery location, or one remote location, or both. This license is subject to city and county fees, therefore, a city and county license must be purchased prior to operation.) Subscribed and sworn to before me this ___ day of , 20____. (seal) Notary Public Residing at My Commission Expires EH 10.02-05 Supplemental App for Brewers 9/2009 American LegalNet, Inc. www.FormsWorkFlow.com