Montana Beer Connoisseurs Semi-Annual Tax Report — Return and Instructions (Form BCT, combo)

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- - Section 1 - Required Fees and License Information Beer $50 Please enclose a copy of one of the documents below for proof of age and mark the appropriate box: Copy of birth certificate Driver' s license Other state-issued identification Section 2 - General Information Applicant Name ____________________________________________________________________________________ Mailing Address ____________________________________________________________________________________ Street Address or PO Box City State Zip Shipping Address ___________________________________________________________________________________ Number and Street City State Zip Note: Beer cannot be shipped to post office boxes. Email Address _____________________________________________________________________________________ Yes, I would prefer to receive an annual reminder email to complete my renewal electronically. Social Security Number - - Telephone Number _________________________________ Section 3 - Questions Do you agree to provide semi-annual (June 30 and December 31) reports to the Department of Revenue showing the quantity of beer you received by direct shipment and pay applicable taxes due? Yes No Do you agree to comply with all Montana laws and all Department of Revenue rules and regulations pertaining to the shipping of products? (Refer to 16-4-901; 16-4-902; 16-4-903; 16-4-910 and 16-6-301, MCA.) Yes No Section 4 - Declaration and Affidavit This application is made for the purpose of licensing the above-mentioned connoisseur. Montana law states "upon proof that any applicant made false statements in any part of the application, the application for license may be denied, and if issued the license may be revoked" (16-4-402, MCA). I declare under penalty of false swearing that I am the applicant or the duly authorized representative of the individual making this application, and that the responses provided, including any accompanying information, are true, correct and complete. Applicant Signature _____________________________________________________Date ________________________ Print Name ____________________________________________________________ Please return this application to: Alcoholic Beverage Control Division PO Box 1712 Helena, MT 59624-1712 *13MM0101* *13MM0101* Beer Connoisseur's License Application LCD 48 V3 1/2022 Questions? Call us at (406) 444-6900, or Montana Relay at 711 for the hearing impaired.