Ethyl Alcohol Permit Application (Over 151 Proof)

This form is REQUIRED and must be filed annually with the Idaho State Liquor Division (ISLD) for all ethyl alcohol permits in Idaho. This form must be completed in its entirety, signed and submitted before December 1 for the next license year. All licenses expire the 31st of December in the year the license is issued. New applicants may submit at any time during the year, however, will be required to resubmit during the renewal period mentioned above.

Instructions: This form is an application for permission to acquire commercial sized quantities of alcoholic liquor in the manufacture of medicines for scientific purposes. Be specific in describing the use of alcohol and any end products or services. Incomplete applications with insufficient information will be denied. Permits may not be transferred or shared. If more than one person needs to place orders for alcohol, each must obtain a permit in their own name.

Ethyl Alcohol Permits are issued by the Idaho State Liquor Division in accordance with the Idaho Liquor Act, Idaho Administrative Procedures Act and applicable codes outlined in section 8 of this application.

New applications shall be submitted for renewals annually.

1. Application Date
Date*
2. Type of Application
Application*
- New
- Renewal
3. State Sales/Use Tax Permit #
Number*
4. Idaho License
Number (For renewal applications only)
5. Business Name
Name*
Employer ID Number (EIN)*
Vendor
Physical Address*
Street Address City State ZIP Code
Shipping Address (if different)
Street Address City State ZIP Code
Telephone/Cell Number(s)*
Email Address*
Business Entity is Registered with the Secretary of State’s Office*
- Yes
- No
Click here for details on filing with the Secretary of State’s Office
6. Contact Person
Name
Telephone/Cell Number(s)
Email Address
7. Business Profile Overview
Specific Description of Business*
Specific Description of Use of Alcohol*
Specific Use of End Product or Service*
Estimated Gallons of Alcohol to be Used Per Year*
One must reapply for a new permit if they exceed their estimated gallons per year.
8. Idaho Codes and Rules
It is recommended that you be familiarized with Idaho liquor codes and rules:
- Idaho Code: 23-203 Idaho State Liquor Division - Powers & Duties
- Idaho Code: 23-512 Permits & Licenses – Sales for Medical or Scientific Purposes
- Idaho Code: 23-513 Permits & Licenses – Term of Permits or Licenses
- Idaho Code: 23-514 Permits & Licenses – Nature of Permit
- Idaho Code: 23-602 Penal Provisions – Unlawful Manufacture, Traffic In, Transportation, and Possession of Alcohol Beverage
- Idaho Statues: Idaho Legislature - Title 23 Alcoholic Beverages
- IDAPA Rules: 15.10.01 - Rules of the Idaho State Liquor Division
9. Signature
I do hereby attest that I have the authority to sign legally binding contracts on behalf of the business entity named herein. I have read, understand and acknowledge the Idaho liquor laws and IDAPA rules, have not been convicted of or pleaded guilty to a felony or a crime of moral turpitude, have a reputation of “probity, temperance and integrity”, will comply with federal, state, county and local laws, regulations, and Idaho State Liquor Division rules and policies and acknowledge that the issued Ethyl Alcohol Permit is at the sole discretion of the Director or his appointed representatives. I certify that all information provided in the application and all required documents are accurate to the best of my knowledge.

By submitting this application, you are acknowledging that the electronic signature below, is intended to have the same force and effect as your manual signature.

In case of any conflict between the terms or statements herein and any federal and state regulations, laws, codes, State or Division policies, the regulations, laws, codes or policies prevail.
Signature*
Name Business Name Date
Signature page must accompany application. If alternate arrangements are needed for submitting this application or any of the required documents, contact Ethyl Alcohol Permits, for permission and instructions.
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Ethyl Alcohol Permit Application (Over 151 Proof)

1. Application Date

2. Type of Application

3. State Sales/Use Tax Permit #

4. Idaho License

5. Business Name

6. Contact Person

7. Business Profile Overview

8. Idaho Codes and Rules

9. Signature

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