Whenever a permit shall be lost, defaced, or destroyed, a duplicate permit in lieu thereof will be issued by the Director of the Alcoholic Beverage Control Division upon payment of a fee of fifty dollars ($50.00) and the filing of an application for a duplicate permit which shall be properly verified as provided in this part and shall set forth:

1. (1) The date which the permit was lost, defaced, or destroyed; and
2. (2) The circumstances under which the permit was lost, defaced, or destroyed.