Application For A Domestic Distillery Special Events Permit
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Application For A Domestic Distillery Special Events Permit Form. This is a North Dakota form and can be use in Office Of State Tax Commissioner Statewide.
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Tags: Application For A Domestic Distillery Special Events Permit, 22927, North Dakota Statewide, Office Of State Tax Commissioner
North Dakota Office of State Tax Commissioner
Application For A Domestic Distillery
Special Events Permit
ND License Number
Legal Name
FEIN
DBA (if applicable)
Federal Basic Permit Number
Physical Address
City
State
Zip Code
Mailing Address
City
State
Zip Code
Telephone Number
FAX Number
Contact Person
Email Address
There is no fee for this permit.
1. Name of special event:
2. Type of event (for example, trade show, convention, festival):
3. Number of dates requested:
4. Dates domestic distillery plans to participate:
5. Location of the special event:
Name of facility
Address
City
State
Zip Code
I declare under the penalties of North Dakota Century Code ยง 12.1-11-02, which provides for a Class A misdemeanor for
making a false statement in a governmental matter, that this application has been examined by me and to the best of my
knowledge and belief is complete, correct, and true.
Name of Owner or Authorized Officer (print or type)
Signature of Owner or Authorized Officer
Title
Date
Please send application to:
Office of State Tax Commissioner
Alcohol Tax Section
600 E. Boulevard Ave. Dept. 127
Bismarck, ND 58505-0599
Phone: (701) 328-2702
22927
Rev. 10/10
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