New York > Statewide > Division Of Alcoholic Beverage Control
Application For Temporary Retail Permit 180-058 - New York
| Application For Temporary Retail Permit Form. This is a New York form and can be used in Division Of Alcoholic Beverage Control Statewide . |
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-35 New York State Liquor Authority (1) Name of Applicant (2) Select ONE of the following: Purchase of an Existing Business: Transfer or Sale of a business in a premises that is currently LICENSED* for alcoholic beverage sales. Submit a Contract of Sale or Conveyance. Application for a New Business: A new or existing business in a proposed premises that is currently UNLICENSED for alcoholic beverage sales, is not a wine or liquor store, is not subject to the 500' Rule and is not located in New York City (Kings, Queens Bronx, New York, Staten Island). A new business in a premises that is currently LICENSED for alcoholic beverage sales, where a Transfer or Sale of the previous business is NOT taking place, is not a wine or liquor store, is not subject to the 500' Rule and is not located in New York City (Kings, Queens, Bronx, New York, Staten Island). *The subject premises must have been operating under a retail license within thirty days of the filing of the application for this permit. APPLICATION FOR TEMPORARY RETAIL (ST) PERMIT See Reverse Side for Conditions of Issuance SLA Form 180-058, 04/30/13 (3) Name of Current Licensee, if any: (4) Address of premises Serial Number: Phone Number As an authorized signatory of the current applicant, I certify that I have read and understand the foregoing conditions for a Temporary Retail Permit and represent that I am eligible for such permit. TITLE DATE APPLICANT's SIGNATURE The above party agrees that any false statement in the above certificates will constitute grounds for disapproval of the permit and the license application(s). FOR OFFICIAL SLA USE ONLY-DO NOT WRITE IN THIS BOX Expiration/Surrender/Safekeeping Date: Original or Renewal (Circle One) New/Transfer/NLIE (Circle One) Permit Serial Number: _________________________ Fee Amount: ________________ SLA ACTION: Approved Disapproved Yes Yes Yes Yes No No No No Pending Disciplinary-Location (Seller) Yes Yes Yes No No No Pending Disciplinary-Principals (Seller) Pending Disciplinary-Principals (Buyer) Date of Issuance: _____________ Effective From: ______________To: _____________ By: _________________________ Conditions: Date: ____________ Photos show Ready to Operate? Contract of Sale (NYC)? 500' Hearing Needed? Premises within 200' of any school, church or place of worship? Surrender or Safekeeping of License Liquidator's Application/Affidavit Inventory, (Liquidator's submitted) Other: See Reverse Side for Conditions of Issuance American LegalNet, Inc. www.FormsWorkFlow.com CONDITIONS FOR TEMPORARY RETAIL PERMIT This application must be preceded or accompanied by: (i) a complete application for a retail liquor license and (ii) one set of recent photographs of the premise, no smaller than 4" x 6" in size. The current license, if any, must be surrendered to, placed in safekeeping with, or otherwise deemed abandoned by the State Liquor Authority. You will need to specify: · PURCHASE OF AN EXISTING BUSINESS: If the applicant is the purchaser of the existing business, the subject premises must have operated under a retail license within thirty days of the filing of the application for this permit. In that case, the holder of a temporary permit may traffic in alcoholic beverages only as would be permitted under the privileges of the current license which it replaces. A contract of sale or conveyance must be included with the application for the liquor license; or · APPLICATION FOR A NEW BUSINESS: If the applicant is not purchasing the existing business, a temporary permit may be issued provided the premises is not a wine or liquor store, is not subject to the 500' Rule, and is not located in New York City (Kings, Queens, Bronx, New York, Staten Island). The issuance of a temporary permit is NOT a guarantee of approval of the application for the liquor license. The Authority is held harmless from any hardship created by the subsequent DISAPPROVAL of the license application for both the purchaser and the seller. The permit holder may purchase alcoholic beverages only by currency, money order, or certified check on or before delivery of beverages to the premises, unless the permit holder already holds another retail license and is not in violation of Alcoholic Beverage Control Law 101-a. If the permit holder is purchasing the alcoholic beverages from the current licensee an Application for Liquidator's Permit, with fee of $36, is required upon submission of the Temporary Retail Permit application. If the permit holder is not purchasing the alcoholic beverages from the current licensee an Affidavit stating that there is no transfer of alcoholic stock is required upon submission of the Temporary Retail Permit application. Such Affidavit must be signed by the Seller. If you are applying for additional bars in the permanent application, you will need a Temporary Retail Permit for each bar. This will require the filing of a separate application and fee for each intended bar. The temporary permit is granted at the discretion of the State Liquor Authority for a period of ninety days, and may similarly be renewed for an additional thirty days. YOU MUST FILE FOR A RENEWAL OF THE TEMPORARY RETAIL PERMIT PRIOR TO THE EXPIRATION OF THE EXISTING PERMIT. RENEWAL APPLICATIONS RECEIVED AFTER THE EXPIRATION DATE OF THE EXISTING PERMIT MAY BE DISAPPROVED. The temporary permit may be summarily cancelled or suspended at any time, if the NYS Liquor Authority determines that good cause exists for such suspension or cancellation. Should the permanent application be disapproved while operating under a Temporary Permit, you must cease and desist alcohol sales and surrender the permit to the Liquor Authority immediately. FEES Fee is payable upon filing, and must be a personal check, certified check or money order, payable to the NYS Liquor Authority. The fee is not refundable. INITIAL FEE (90 Days) 30 DAYS EXTENSION FEE Retail on-premises beer, Grocery or Retail on-premises beer, Grocery or Drug Store permit ... $128.00 Drug Store permit ...$ 64.00 Any other retail permit... $ 640.00 (x # of bars) Any other retail permit... $ 96.00 (x # of bars) APPLICATIONS FOR THE INITIAL TEMPORARY RETAIL PERMIT MUST BE MAILED TO: New York State Liquor Authority Licensing Church Street Station P.O. Box 3817 APPLICATIONS TO RENEW A TEMPORARY RETAIL PERMIT ARE TO BE MAILED TO THE ZONE OFFICE PROCESSING THE PERMANENT LICENSE SLA Form 180-058, 04/30/13 American LegalNet, Inc. www.FormsWorkFlow.com New York, New York 10008-3817
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