Date Rec’d                  /           / 
                                                           Chartered                          Amount Rec’d          $ 
                                              Transportation                                  Cash         Recpt #: 
                                                                                              Check             Ck #: 
                                              Liquor License    
                                                                                              Processed by:                   
                                                           Application                        Payment  Processed:            /        / 
                                                                                              Control Number:                  
  6601 Campstool Road 
  Cheyenne, Wyoming 82002-0110 

                                              LICENSING TERM:  
                                                                  
                                _____________ to _____________ 

                                           License #:____________ 
                                                                  
 Type of Business:             Railroad       Bus               Limousine        ___________________(Other) 
    
 Type of License Applied for:              Railroad:              Annual (Fee $250.00)                   24Hr (Fee $25.00) 
                                           Charter (Bus/Limo): Annual (Fee $250.00)                      24Hr (Fee $25.00) 
    
 Applicant:    
                                                                 
 Business Name (DBA):   
                                                                 
 Contact Person:                                                Phone #:     
  
 Email Address:     
  
 Company Location:                                              City:                         State:                 Zip:    
  
 Mailing Address:                                               City:                         State:                 Zip:    
                                                                 
 Vehicle License Plate:  
                                                                 
                       Is the above information correct?            Yes         No     If No, Please update. 
 
FILING AS (CHOOSE ONLY ONE) 
 
   INDIVIDUAL            PARTNERSHIP                        CORPORATION        LLC                          LLP 
 
NOTE: Individual and Partnership filers must be domiciled residents of Wyoming for at least one year and not 
claimed residence in any other state in the last twelve months, and provide personal information in table below. 
 
 Applicants Legal Name  Date of DO NOT LIST PO BOXES        Residence Phone   Have you been a            Have you       Have you been 
                        Birth    Residence Address, Street,     Number      DOMICILED resident for        been          Convicted of a 
                                         City, State & Zip                    at least 1 year and not    Convicted of a Violation Relating 
                                                                            claimed residence in any      Felony        to Alcoholic Liquor 
                                                                            other statein the last year? Violation?     or Malt Beverages? 
                                                                               YES                       YES            YES     
                                                                               NO                        NO             NO      
                                                                               YES                       YES            YES     
                                                                               NO                        NO             NO      
 (If more information is required, complete in identical form, on a separate piece of paper and attach to this 
                                                            application.) 
 

If a corporation, LLC or LLP list the full names and residence address of all the officers and directors and of 
all shareholders owning jointly or severally ten percent (10%) or more of the stock of the corporation, LLC 
or LLP. Use back of form if additional space is needed. 
 
 Applicants Legal Name  Date of DO NOT LIST PO BOXES        Residence Phone For corp or    For corp or Have you       Have you been 
                        Birth    Residence Address, Street,   Number        LLC. No of     LLC.        been           Convicted of a 
                                  City, State & Zip                         years in corp  % of Stock  Convicted of a Violation Relating 
                                                                             or LLC        Held        Felony         to Alcoholic Liquor 
                                                                                                       Violation?     or Malt Beverages? 
                                                                                                       YES            YES     
                                                                                                       NO             NO      
                                                                                                       YES            YES     
                                                                                                       NO             NO      
 (If more information is required, complete in identical form, on a separate piece of paper and attach to this 
                                                            application.) 
 
By filing this application, I agree to operate in Wyoming under the requirements of                    W.S.12-2-202 and all other 
applicable Wyoming laws and rules, and to file required sales tax reporting documents and taxes. 
 
By signing this application, I acknowledge for __________________________________________(Business Name) 
that all of the information provided is true and correct, and that I agree to meet the Wyoming operating conditions 
specified above.  This application must be signed by an owner, partner, corporate office or LLC/LLP member. 
 
                                  VERIFICATION OF APPLICATION 
 
(Requires signatures by ALL Individuals, ALL Partners, ONE (1) LLC Member, TWO (2) Corporate Officers or 
Directors, except that if all the stock of the corporation is owned by ONE (1) individual then that individual may 
sign and verify the application upon his oath, or TWO (2) Club Officers.) W.S.12-4-102(b) 
 
Under penalty of perjury, and the possible revocation or cancellation of the license, I swear the above stated facts, 
are true and accurate. 
 
Dated this ______ day of_________________, 20____.            ____________________________________________ 
                                                              Applicant 
 
                                                              ____________________________________________ 
                                                              Applicant