New Jersey > Statewide > Division Of Alcoholic Beverage Control
Petiton For Temporary Permit To Operate Pending Action By Municipal Issuing Authority - New Jersey
| Petiton For Temporary Permit To Operate Pending Action By Municipal Issuing Authority Form. This is a New Jersey form and can be used in Division Of Alcoholic Beverage Control Statewide . |
|
||||||
 Get this form for FREE as a print-only pdf |
|||||||
|
STATE OF NEW JERSEY OFFICE OF THE ATTORNEY GENERAL DEPARTMENT OF LAW AND PUBLIC SAFETY DIVISION OF ALCOHOLIC BEVERAGE CONTROL P.O. BOX 087, 140 EAST FRONT STREET TRENTON, NJ 08625-0087 PETITION FOR TEMPORARY PERMIT TO OPERATE PENDING ACTION BY MUNICIPAL ISSUING AUTHORITY UPON PETITIONER=S APPLICATION FOR LICENSE RENEWAL [AI] This application must be filed with the State Division of Alcoholic Beverage Control. It is necessary to be filed with appropriate fee when application for renewal of license and renewal fees have been filed with the municipality, but the municipal governing body has not renewed the license by July 1st, and the licensee wishes to conduct business. The fee is $75.00 plus the daily fee of $5.00 per day, payable by cash, check or money order payable to the Division of Alcoholic Beverage Control. The application must be completed in full, signed by the applicant, and endorsed by the municipality. The application can be mailed or hand-delivered to the Division of A.B.C. at the above-captioned address. 1. Name of licensee as it appears on the license certificate: ______________________________________________________________ 2. Address of licensed business as it appears on the license certificate:__________________________________________________ ______________________________________________________________ 3. New Jersey 12-digit license number_______-____-______-________ 4. Requested effective dates for Ad Interim Permit: From____________________ to ____________________ inclusive. Day/Month/Year Day/Month/Year Name/Title of Authorized Signator________________________________ [Please Print] [Signator=s name must appear on 12-page license application: President, Vice President, Sole Proprietor or Partner.] as Signature_________________________________ Date_____/_____/______ [OTHER SIDE TO BE COMPLETED BY MUNICIPAL CLERK OR A.B.C. BOARD SECRETARY] OVER American LegalNet, Inc. www.FormsWorkflow.com TO BE COMPLETED BY MUNICIPAL AUTHORITIES 1. Date renewal application was filed and renewal fees paid: _____/_____/_____. 2. 3. Date Municipal Council or A.B.C. Board will meet to act on renewal of this license: _____/_____/_____. Please state reason why the license was not renewed by resolution prior to July 1st.:________________________________ ______________________________________________________________ ______________________________________________________________ 4. Does the municipality object to the issuance of an Ad Interim Permit by the State Division of Alcoholic Beverage Control? _____Yes _____No Municipal Clerk or A.B.C. Board Secretary: ______________________________________________ [Please Print] Signature:____________________________________ THE FOLLOWING FORMULA PERTAINS TO ALL RETAIL LICENSEES: $5.00 PER DAY X [No. of Days] ___________ = __________[AI Fee] [AI Fee]___________ + $75.00 = $__________________ [Total Fee] ----------------------------------------------------------------If an additional permit is needed, the following formula applies: $5.00 [Per Day] X ______ [No. of Days] = $_________________ [Total Fee] DO NOT SEND CASH THROUGH THE MAIL 07/03 American LegalNet, Inc. www.FormsWorkflow.com
|
|||||||
