Form SFN 60428 Application for a Brewer Taproom Special Events Permit - North Dakota

Form SFN60428 is a North Dakota Office of State Tax Commissioner form also known as the "Application For A Brewer Taproom Special Events Permit". The latest edition of the form was released in July 1, 2013 and is available for digital filing.

Download a PDF version of the Form SFN60428 down below or find it on North Dakota Office of State Tax Commissioner Forms website.

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APPLICATION FOR A BREWER TAPROOM
SPECIAL EVENTS PERMIT
OFFICE OF NORTH DAKOTA STATE TAX COMMISSIONER
SFN 60428 (7-13)
ND License Number
Federal Employee Identification Number
Legal Name
Federal Brewer's Notice
DBA (if applicable)
Physical Address
City
State
ZIP Code
Mailing Address
State
ZIP Code
City
Fax Number
Telephone Number
Email Address
Contact Person
There is no fee for this permit
Name of special event
Type of event (for example, trade show, convention, festival)
Number of dates requested
Dates brewer taproom plans to participate
Location of the special event (Name of facility)
Address
City
State
ZIP Code
I declare under the penalties of North Dakota Century Code § 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
For Tax
Bismarck, ND 58505-0599
Department
Phone: (701) 328-2702
Use Only
APPLICATION FOR A BREWER TAPROOM
SPECIAL EVENTS PERMIT
OFFICE OF NORTH DAKOTA STATE TAX COMMISSIONER
SFN 60428 (7-13)
ND License Number
Federal Employee Identification Number
Legal Name
Federal Brewer's Notice
DBA (if applicable)
Physical Address
City
State
ZIP Code
Mailing Address
State
ZIP Code
City
Fax Number
Telephone Number
Email Address
Contact Person
There is no fee for this permit
Name of special event
Type of event (for example, trade show, convention, festival)
Number of dates requested
Dates brewer taproom plans to participate
Location of the special event (Name of facility)
Address
City
State
ZIP Code
I declare under the penalties of North Dakota Century Code § 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
For Tax
Bismarck, ND 58505-0599
Department
Phone: (701) 328-2702
Use Only

Download Form SFN 60428 Application for a Brewer Taproom Special Events Permit - North Dakota

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