Application For Alcoholic Beverage Control Retail License (On Premises)

opla-rev 01/22/16 Original OFFICE USE ONLY Amended Date LICENSE 102 APPLICATION FOR ALCOHOLIC BEVERAGE CONTROL RETAIL LICENSE (ON PREMISES) FILING CHECKLIST APPLICANTS SHOULD KEEP A COPY OF THIS APPLICATION AND THE SUPPORTING DOCUMENTS FOR THEIR RECORDS. This checklist has been created to better assist you with the application process. All items on the checklist must be complete and accurate. If all items in the checklist are not submitted, the application may be disapproved for Failure to Comply. Section 100(7) of the Alcoholic Beverage Control Law requires that Notice be posted in a conspicuous place at the entrance of the premises within 10 days of filing a new application to sell liquor at retail. This Notice does not apply to a premises that is currently licensed to sell liquor at retail. This Notice Form can be found on our website under "Notice to be Posted at Proposed Premises". Section110-b of the ABC Law requires ALL on-premises applicants (whether applying for beer, wine, or liquor licenses)to notify the local Municipality or Community Board at least 30 days prior to filing an application with the Liquor Authority THE COMPLETED STANDARDIZED NOTICE FORM AND PROOF OF DELIVERY MUST BE SUBMITTED WITH THIS APPLICATION. All Applicants MUST include the following Sections of the Retail License Application at the time of submission: Application (Pages 4-5) Right to Premises Landlord Identification Financial Disclosure 500 Foot Law Statement Statement of Area Plan Establishment Questionnaire Community Board/Municipality Notification and Proof of Mailing or Delivery (using the Standardized Form, see above for more information) Method of Operation Personal Questionnaire (for each Principal, Lender, Donor, Joint Account Holder, etc.) Notice of Appearance (if represented by someone other than the applicant) Applicant's Statement All Applicants MUST submit the following Supporting Documents when filing the application: Bond, Form L-9 (signed by the applicant and expiring at the end of the initial licensing term) Completed copy of the Standardized Form for providing 30 days advance notice to the municipality with proof of delivery Detailed Diagrams of the premise to be license (See Diagram instructions and Examples at the end of this application. ) 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 restroom rule (if only 1 restroom) Menu Photo Identification for all applicant Principals (copies only) Photos of applicant Principals Photos of the proposed premises (exterior and interior-including kitchen area) Proof of Citizenship for all applicant principals NOT currently licensed with the NYS Liquor Authority (see instructions) Submission of the all fees associated with this application (see instructions and online retail fee chart) All Applicants MUST submit the following Supporting Documents before a license can be issued (Conditions of Approval): Assumed Name Filing Receipt (if DBA is used) Certificate of Authority to Collect Sales Tax Certificate of Occupancy Maximum Occupancy Certificate (if requesting the restroom waiver) NYS Department of State Corporate Filing Receipt or Business Certificate from County Clerk if Sole Proprietor or Partnership Newspaper Affidavit 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 Page 1 American LegalNet, Inc. www.FormsWorkFlow.com opla-rev 01/22/16 Original OFFICE USE ONLY Amended Date 49 Standardized NOTICE FORM for Providing 30-Day Advanced Notice to a Local Municipality or Community Board (Page 1 of 2 of Form) 1. Date Notice Was Sent: 1a. Delivered by: 2. Select the type of Application that will be filed with the Authority for an On-Premises Alcoholic Beverage License New Application Renewal Alteration Corporate Change Removal Class Change For New applicants, answer each question below using all information known to date. For Renewal applicants, set forth your approved Method of Operation only. For Alteration applicants, attach a complete written description and diagrams depicting the proposed alteration(s). For Corporate Change applicants, attach a list of the current and proposed corporate principals. For Removal applicants, attach a statement of your current and proposed addresses with the reason(s) for the relocation. For Class Change applicants, attach a statement detailing your current license type and your proposed license type. This 30-Day Advance Notice is Being Provided to the Clerk of the following Local Municipality or Community Board 3. Name of Municipality or Community Board: Applicant/Licensee Information 4. License Serial Number, if Applicable: 5. Applicant or Licensee Name: 6. Trade Name (if any): 7. Street Address of Establishment: 8. City, Town or Village: 9. Business Telephone Number of Applicant/Licensee: 10. Business Fax Number of Applicant/Licensee: 11. Business E-mail of Applicant/Licensee: 12. Type(s) of Alcohol sold or to be sold: 13. Extent of Food Service: 14. Type of Establishment: 15. Method of Operation: (Check all that apply) Seasonal Establishment Patron Dancing Video/Arcade Games Other (specify): 16. Licensed Outdoor Area: (Check all that apply) None Patio or Deck Rooftop Garden/Grounds Freestanding Covered Structure Juke Box Disc Jockey Recorded Music Karaoke Beer & Cider Wine, Beer & Cider Liquor, Wine, Beer & Cider Expiration Date, if Applicable: ,NY Zip Code : Full food menu; Full Kitchen run by a chef or cook Menu meets legal minimum food availability requirements; Food prep area at minimum Live Music (Give details: i.e. rock bands, acoustic, jazz, etc.): Employee Dancing Exotic Dancing Topless Entertainment Security Personnel Third Party Promoters Sidewalk Cafe Other (specify): Page 2 American LegalNet, Inc. www.FormsWorkFlow.com opla-rev 01/22/16 Original OFFICE USE ONLY Amended Date 49 Standardized NOTICE FORM for Providing 30-Day Advanced Notice to a Local Municipality or Community Board (Page 2 of 2 of Form) 17. List the floor(s) of the building that the establishment is located on: 18. List the room number(s) the establishment is located in within the building, if appropriate: 19. Is the premises located within 500 feet of three or more on-