Fillable State of New Hampshire Liquor Commission Division of (State of New Hampshire)

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State of New Hampshire Liquor Commission Division of (State of New Hampshire)

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State of New Hampshire
Liquor Commission
Division of Enforcement & Licensing
DISCLOSURE OF ALCOHOL FOR IMPORT INTO NEW HAMPSHIRE
Name and Address:
(
Note
–
enter New Ham
p
shire address where
y
ou do/will reside
)
PRODUCT NAME SIZE
NUMBER OF
BOTTLES
IMPORTING FROM
COUNTRY/PROVIDENCE/STATE
ETC.
USE ADDITIONAL DISCLOSURE OF ALCOHOL FOR IMPORT FORMS AS NEEDED FOR ADDITIONAL PRODUCT
(This Section) New Hampshire Commission Use Only
Enf&Lic Recommended
By signing this document, I am attesting that the above reference product(s)
is/are being brought into New Hampshire for my personal use only and will not
be re-sold.
Yes No
Chief or Designee
Date
Commission Approved
Yes No
Signature Date
Chairman or Designee Date
L-077 (created 11/27/12)
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State of New Hampshire Liquor Commission Division of (State of New Hampshire)

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Completed 21 July 2020

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