“LIVE CARD TABLE APPLICATION”
DEPARTMENT OF JUSTICE GAMBLING CONTROL DIVISION 2550 PROSPECT AVENUE P.O. BOX 201424 HELENA, MT 59620-1424 PHONE:(406)444-1971 FAX: (406)444-9157
OFFICE USE ONLY
CHECK NO. ___________
CHECK AMOUNT _________ REFUND ____________
SELECTED ADMINISTRATIVE RULE EXCERPT
(To obtain a complete copy of the rules and statutes, send $10.00 by check only, made out to “Gambling Control Division”, to the address shown on this form.)
Mont. Code Ann. §23-5-306 (1) (a) A person who has been granted an operator’s license under 23-5-177 and a license to sell alcoholic beverages for consumption on the premises may be granted an annual permit for the placement of live card game tables. Mont. Admin. R. 23.16.1201 (7) “Card table” or “live card game table” means a table licensed by the department on which no more than one authorized card game is played at a time.
AN IMPROPERLY OR INCOMPLETE APPLICATION WILL BE RETURNED “Type or Print Legibly using Ink”
OPERATOR NUMBER
LIQUOR LICENSE NUMBER (12 Digits)
ESTABLISHMENT PHONE NUMBER
PROVIDE MAILING ADDRESS: Check if changed ESTABLISHMENT NAME
OPERATOR: HOLDER OF OPERATOR LICENSE HOW MANY CARD TABLES DO YOU WISH TO LICENSE?
Federal Tax I. D. No.
CHECK CARD GAMES TO BE PLAYED
Poker 1 Table ($250.00)
st
Whist Solo Pitch
Panguingue Cribbage Rummy
Bridge Hearts
Additional Table(s) ($500.00 each)
Pinochle
STAPLE PAYMENT HERE
I CERTIFY THAT THIS INFORMATION IS TRUE AND CORRECT
SIGNATURE OF LICENSEE/ OFFICER
PRINT NAME OF PERSON SIGNING
DATE
FORM 29 REV 4/97