Form 24152 Application for a Domestic Distillery Special Events Permit - North Dakota

Form 24152 or the "Application For A Domestic Distillery Special Events Permit" is a form issued by the North Dakota Office of State Tax Commissioner.

The form was last revised in October 1, 2010 and is available for digital filing. Download an up-to-date Form 24152 in PDF-format down below or look it up on the North Dakota Office of State Tax Commissioner Forms website.

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North Dakota Office of State Tax Commissioner
Application For A Domestic Distillery
Special Events Permit
ND License Number
FEIN
Legal Name
Federal Basic Permit Number
DBA (if applicable)
Physical Address
City
State
Zip Code
City
Mailing Address
State
Zip Code
FAX Number
Telephone 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 § 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: 701.328.3158
24152
Rev. 10/10
North Dakota Office of State Tax Commissioner
Application For A Domestic Distillery
Special Events Permit
ND License Number
FEIN
Legal Name
Federal Basic Permit Number
DBA (if applicable)
Physical Address
City
State
Zip Code
City
Mailing Address
State
Zip Code
FAX Number
Telephone 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 § 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: 701.328.3158
24152
Rev. 10/10

Download Form 24152 Application for a Domestic Distillery Special Events Permit - North Dakota

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