New York > Statewide > Division Of Alcoholic Beverage Control
Application For Alcoholic Beverage Control Retail License (On Premises) - New York
| Application For Alcoholic Beverage Control Retail License (On Premises) Form. This is a New York form and can be used in Division Of Alcoholic Beverage Control Statewide . |
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opla-rev 04/18/2013 OFFICE USE ONLY Original Amended Date LICENSE 29 APPLICATION FOR ALCOHOLIC BEVERAGE CONTROL RETAIL LICENSE (ON PREMISES) FILING CHECKLIST This checklist has been created to better assist you with the application process. All items on the checklist must be complete and accurate to the best of your ability. If all items in the checklist are not submitted, the application may be disapproved for Failure to Comply. Please note that per Section 110(b) of the ABC Law all on-premises applicants (whether applying for beer; beer & wine; or beer, wine & liquor) are required to notify the Municipality or Community Board at least 30 days prior to filing the application with the New York State Liquor Authority. THE COMMUNITY BOARD/MUNICIPALITY NOTICE FORM AND PROOF OF MAILING MUST BE SUBMITTED WITH THIS APPLICATION. All Applicants MUST submit the following Sections of the Retail License Application upon filing of the application: Application (Pages 1-2) Right to Premises Landlord Identification List of Expenses 500 Foot Rule Statement Statement of Area Plan Establishment Questionnaire Method of Operation Proof of Citizenship Affirmation (non US born principals) Applicant's Statement Personal Questionnaire (for each Principal, Manager, Lender, Donor, etc.) Notice of Appearance (if represented by someone other than the applicant) All Applicants MUST submit the following Supporting Documents upon filing of the application: Bond, Form L-9 (signed by the applicant and expiring at the end of the initial licensing term) Community Board/Municipality Notification (using the Standardized Form, see above for more information) Detailed Diagrams which include Interior and Block Plot (aerial view of the building showing nearby businesses/residences) Investment Records showing the source and availability of the funds to be used for the venture Lease/Deed/Contracts (any applicable for this venture) You must provide proof that you have full control over the premises to be licensed. Letter of request to waive the 2 bathroom rule (if only 1 bathroom) Maximum Occupancy Certificate (if requesting the Bathroom Waiver) Menu Photo Identification for all applicant Principals and Managers (copies only) Photos of applicant Principals and Managers (Must be in color) Photos of the proposed premises (exterior and interior-including kitchen area) (Must be in color) Proof of Citizenship for all applicant principals NOT currently licensed with the NYS Liquor Authority (copy of Birth Certificate, Passport) All Applicants MUST submit the following Supporting Documents before a license can be issued: Certificate of Assumed Name (if DBA is used) Certificate of Authority to Collect Sales Tax Certificate of Occupancy Department of State Filing Receipt Newspaper Affidavit Page 1 American LegalNet, Inc. www.FormsWorkFlow.com Photos of the premises showing ready to open and operate Worker's Compensation & Disability Insurance Policy numbers AND carrier names OR a Certificate of Attestation of Exemption from coverage opla-rev 04/18/2013 OFFICE USE ONLY Original Amended Date LICENSE 29 APPLICATION FOR ALCOHOLIC BEVERAGE CONTROL RETAIL LICENSE (ON PREMISES) It is not necessary to employ any person, agency or organization to assist you in filing this application. Beware of persons claiming to be able to assist you in securing action on your application. The payment of money or other thing of value for the use of influence, or promise of influence in obtaining a license is a violation of law and offenders will be prosecuted. 1. APPLICANT Name of Applicant: Trade Name(DBA): (see instructions) ** must be provided if premises will be called by any name other than as listed in the "Name of Applicant" Premises Street Address: City: County: Mailing Address (if different than above): City: E-mail address (if available): State: Zip Code: , NY Zip Code: Telephone Number of Premises (include area code): 2. CONTACT (if other than applicant) Name of Contact: Office Address: City: State: Zip Code: Attorney Representative Contact Person Telephone Number of Office (include area code): E-mail address (if available): Is this application filed under the Self Certification Program? YES NO 3. For SEASONAL licenses only - beginning and ending months: 4. LICENSE TYPE: (see schedule of fees) CODE: 5. Number of ADDITIONAL BARS (if any): (see instructions) 6. TOTAL PAYMENT DUE: 7. Federal Tax ID #: 7a. Certificate of Authority Permit#: YES NO DO NOT KNOW 8. Are there any local option restrictions in this area (DRY, PARTIALLY DRY)? If YES, explain: THE COMMUNITY BOARD/MUNICIPALITY NOTICE FORM AND PROOF OF MAILING MUST BE SUBMITTED WITH THIS APPLICATION. [OFFICE USE ONLY] continued on next page DATE FILED: SERIAL #: Page 2 American LegalNet, Inc. www.FormsWorkFlow.com opla-rev 04/18/2013 OFFICE USE ONLY Original Amended Date 29 9. TO BE FILLED IN ONLY BY SOLE PROPRIETOR OR PARTNERS (attach additional sheets if necessary) Name of Individual / Partner Residence Social Security #: Date of Birth Name of Individual / Partner Residence Social Security #: Date of Birth Name of Individual / Partner Residence Social Security #: Date of Birth Name of Individual / Partner Residence Social Security #: Date of Birth 9a. TO BE FILLED IN ONLY IF YOU WILL EMPLOY A MANAGER Name of Manager Residence Social Security #: Date of Birth Name of Manager Residence Social Security #: Date of Birth 10. TO BE FILLED IN ONLY BY CORPORATION OR LLC/LLP APPLICANTS (attach additional sheets if necessary) List the names and address or Principals (Stockholders, Officers, Directors, LLC Members/Managers, LLP Partners) Name of Principal Residence Social Security #: Title No. of Shares if Corporation or % of ownership if LLC or Partnership Date of Birth Name of Principal Residence Social Security #: Title No. of Shares if Corporation or % of ownership if LLC or Partnership Date of Birth Name of Principal Residence Social Security #: Title No. of Shares if Corporation or % of ownership if LLC or Partnership Date of Birth Name of Principal Residence Social Security #: Title No. of Shares if Corporation or % of ownership if LLC or Partnership Date of Birth 10a. TO BE FILLED IN ONLY IF YOU WILL EMPLOY A MANAGER Name of Manager Residence Social Security #: Date of Birth Name of Manager Residence Social Security #: Date of Birth continued on next page Page 3 American LegalNet, Inc. www.FormsWorkFlow.com opla-rev 04/18/2013 OFFICE USE ONLY Original Amended Date 174 RIGHT TO PREMISES 1.
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