It shall be unlawful to sell wine for sacramental purposes except to a minister, pastor, priest, or officer of a regularly organized church or religious congregation, and before such a sale is made, the person desiring to make such purchase shall sign and deliver to the druggist a written or printed statement giving his name, residence, and the name and location of the church for which the wine is purchased, and shall certify that it is purchased in good faith to be used only for sacramental purposes.