N.D. Admin. Code § 10-08-02-02
10-08-02-02. Keg registration form.
A retail licensee selling beer in kegs shall fill out a keg registration form which is signed by the purchaser. The form must be in the following format:
KEG REGISTRATION FORM VALID ID MUST BE SHOWN
Instructions (Please Print):
NAME: ________ ADDRESS: ________ PHONE: _______ TYPE OF ID SHOWN AND NUMBER: ___ KEG NUMBER (To Be Filled In By Retail Licensee): ____
SIGNATURE OF PURCHASER: ____ DATE: ____________
History: Effective September 1, 1983.
General Authority: NDCC 5-02-09.1
Law Implemented: NDCC 5-02-07.2
TO: Attorney General's Licensing Division
State Capitol Building
Bismarck, North Dakota 58505
STATE OF NORTH DAKOTA)
COUNTY OF
1. Your Name:
2. Other names now or previously used:
3. Present Address:
4. Name of licensed premises:
5. Country of Citizenship: Date of Birth: Place of Birth: Name of Spouse:
6. List all places of residence during past ten years:
FROM-TO (Years) STREET ADDRESS CITY STATE
7. State your employment (including part-time) for the past ten years:
FROM-TO (Years) EMPLOYER BUSINESS ADDRESS REASON FOR LEAVING
8. Have you ever operated, had a financial interest in, or been employed with an alcoholic beverage establishment? ____ If so, list:
FROM-TO NAME OF ESTABLISHMENT ADDRESS YOUR INVOLVEMENT (Years)
9. Have you been convicted of a crime (felony or misdemeanor) other than a minor traffic offense within the last five years? ____ If so, list all criminal convictions and the disposition:
DATE OFFENSE CITY STATE DISPOSITION FELONY OR MISDEMEANOR
10. Have you or any entity with which you have been or are associated had any license denied or revoked? ____ If yes, give full details:
11. If business is being taken over or purchased from another person, partnership, or corporation, have all outstanding debts owed to beer and liquor distributors and other providers of supplies and inventory for the licensed premises been paid? ____ If not, explain:
The undersigned swears that the information on this form is true and correct to the best of the undersigned's knowledge, information, and
belief, and acknowledges that false or misleading information is sufficient grounds for denial or revocation of license or authorization.
Signature
Subscribed and sworn to before me this _ day of _, 19__.
Notary Public
(SEAL)
My Commission Expires