Application For Special Permit to Sell Beer/Table Wine MONTANA SpecPerm Rev. 4-03 Return to: Montana Department of Revenue Registration and Licensing P.O. Box 1712 Helena, MT 59604-1712 Check type of organization: Fee: 501(c)(3) organization (limit up to 3 per year) * 501(c)(3) intercollegiate athletic fund-raising organization (limit up to 12 per year) * 501(c)(4) civic league or organization (limit up to 12 per year)* 501(c)(6) chamber of commerce or business league (limit up to 12 per year)* (Must provide proof of liquor liability insurance) Accredited Montana post secondary school (limit up to 3 per year) An organization operated to raise funds for a needy person Licensed veterans or fraternal organization (limit up to 3 per year) Professional sports organization (seasonal) Junior hockey team (seasonal) $10 per day $10 per day $10 per day $10 per day $10 per day $10 per day $10 per day $1,000 per season $1,000 per season *A copy of your IRS tax exempt certificate must be attached or on file with the department Section 1: Applicant Information Applicant_____________________________________________________________________________________________ Address______________________________________________________________________________________________ Street City State Zip Purpose for event ________________________________________________________________________________ Date(s) for which special permit is desired ____________________________________________________________ Exact location where beer/table wine will be sold and consumed___________________________________________ Section 2: Local Law Enforcement To be completed by a local law enforcement official: I approve of the described event ___________________________________________________________________ Print name and title Signature and date _____________________________________________________________________________ I disapprove of the described event_______________________________________________________________ Print name and title Signature and date _____________________________________________________________________________ Section 3: Applicant Acknowledgment Beer/table wine will be sold and consumed within the enclosure where the event is to be held and only on the abovedesignated date(s). The location of the event is not within 600 feet and on the same street as a school or church. The application, applicable fee, and approval of local law enforcement must be received by the Department of Revenue, Registration and Licensing, three days in advance of the earliest date for which the permit is desired. If granted a permit, the applicant, any agent, or employee will abide by all the laws, rules and ordinances, relating to the sale of beer and table wine. The applicant understands that violation of any department rule, state, or any local ordinance relating to the sale of beer or table wine by the applicant, any agent, or employees, shall be sufficient grounds to revoke the permit. Any authorized employee of the Department of Revenue, or its duly appointed representative and/or any peace officer of this State shall have the right to examine the permittee’s premises at any time. __________________________________________________________________________________________________________________ Print name and title of authorized official of applicant _______________________________________________________ ___________________________________ Signature of authorized official of applicant (_____)______________________ Contact Phone Number Federal ID Number for Applicant (______)______________________ Fax Number 501 American LegalNet, Inc. www.FormsWorkflow.com Samples of Qualified Organizations An organization or institution that has a tax-exempt designation under section 501(c)(3) of the Internal Revenue Code An organization or institution that is organized and operated to raise funds for a needy person An accredited Montana postsecondary school A civic league or organization that has a tax-exempt designation under section 501(c)(4) of the Internal Revenue Code An organization authorized by an accredited Montana Postsecondary school to engage in fund-raising activities for intercollegiate athletics that has a tax-exempt designation under the provisions of section 501(c)(3) of the Internal Revenue Code (Only one organization for each Montana postsecondary school may be authorized under this section) An association or corporation engaged in professional sporting contest or junior hockey contests A chamber of commerce or business league that has a tax-exempt designation under section 501(c)(6) of the Internal Revenue Code (The chamber of commerce or business league receiving a special permit must obtain liquor liability insurance for any event conducted) American LegalNet, Inc. www.FormsWorkflow.com