ABC Reporting

NONPROFIT PERMIT APPLICATION

MUST BE RECEIVED BY ABC NO LESS THAN 14 DAYS PRIOR TO YOUR EVENT

Check all that apply (at least one is required):
Beer Permit ($20) Wine Permit ($20) Liquor ($0)

Applicant Name

Federal Tax ID#

Mailing Address - Street

City

State

Zip

Start Date

End Date

Start Time

End Time

Event Address - Street

City

County

Zip

Name of Event

Number of attendees expected to attend your event

Is the location of the event inside city limits? Yes No

Purpose

Proceeds will be donated to

Beverage Type	Received From	Donated/Purchased

THE FOLLOWING IDAHO RETAIL/WINERY/BREWERY LICENSEE(S) WILL BE ASSISTING WITH THE SERVICE, SALE, OR DISTRIBUTION OF ALCOHOLIC PRODUCT DURING THIS EVENT. IF NOT IDENTIFIED BELOW, I UNDERSTAND THAT NO ADDITIONAL RETAILER MAY ASSIST WITH THIS EVENT AND ANY PRODUCT PROVIDED BY THEM MUST BE SERVED BY A REPRESENTATIVE OF THE NON-PROFIT ORGANIZATION.

Retailer	Premises #/License #	Phone Number	Email

I HEREBY CERTIFY THAT THE APPLICANT LISTED ABOVE IS NOT OTHERWISE LICENSED IN THE STATE OF IDAHO TO SELL ALCOHOLIC BEVERAGES AND THE PROCEEDS FROM THIS EVENT WILL BE DONATED FOR BENEVOLENT, CHARITABLE, OR PUBLIC PURPOSES. I ALSO ACKNOWLEDGE THAT ALL DONATED, UNUSED PRODUCT MUST BE RETURNED TO THE DONATING RETAILER/DISTRIBUTOR/WHOLESALER/INDIVIDUAL FOLLOWING THIS EVENT.

Enter your name below to sign this form:

Name

Title

Phone Number

Add any required documents here (Example – IRS letters for first time applicants)

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