Change Of Floor Plan-Expansion Of Liquor Licensed Premise Application

New Mexico Regulation and Licensing Department PO Box 25101 Santa Fe, NM 87504-5101 (505) 476-4875 Fax (505) 476-4595 ALCOHOL AND GAMING DIVISION CHANGE OF FLOOR PLAN / EXPANSION OF LIQUOR LICENSED PREMISES APPLICATION NMAC 15.10.32.13 ­ $75.00 Fee, all fees are non-refundable Application to Change or Expand the licensed premises shall be submitted with the Application Fee and the following Required Documentation: 1) a copy of your existing Approved Floor Plan and 2) a Proposed Detailed Floor Plan, on an 8 ½ x 11" sheet, that includes the existing approved premises and any proposed change or expansion ­ Label all areas and include all entrances, exits, walls or enclosures as well as dimensions for any expansion. For Expansions Only, also include Proof of Tenancy and Photos of expansion. A Licensee may not change or expand the licensed premises without prior written approval of the Director. If the change or expansion of the licensed premises is twenty-five (25%) or more of the total existing square footage of the licensed premises, the Director may require the licensee to file an application for a Transfer of Location. The Licensee cannot make any changes or expand the premises until approval has been granted for this request. A before and after site inspection may be scheduled. Liquor License No.:________________ Phone No.: ____________________________ Fax No.: _____________________________ Business Name (DBA) _______________________________________Owner Name:_________________________________________ License Location: _______________________________________________________________________________________________ Mailing Address: _______________________________________________________________________________________________ Licensee Email: ________________________________________________________________________________________________ Square Footage: Current ____________________ Adding/Changing:___________________ Total: (add both) ___________________ Reason for Request: _____________________________________________________________________________________________ Will the Proposed Expansion bring the licensed premises within 300 feet of a church or school? _________________________________ Has there been any change in the Ownership or Operation of the Licensee? _________________________________________________ If so, explain:__________________________________________________________________________________________________ I (print name) ____________________________________, Licensee for Liquor License No. _______________ hereby attest that the requested change meets the definition of "licensed premises" in NMSA 1978 §60-3A-3 (O), which states in part " `licensed premises' means the contiguous areas or areas connected by indoor passageways of a structure and the outside dining, recreation and lounge areas of the structure... that are under the direct control of the licensee..." Must sign in the presence of a Notary Public: Submitted by: (print name) _____________________________________________________________________________________ Signature: _______________________________________________Title: ____________________________Date: _______________ ________________________________________________________________________________________________ NOTARY PUBLIC USE ONLY: (State of ___________________________, County of ________________________________) SUBSCRIBED AND SWORN TO before me this ______________ day of ______________________________, 20______ By:____________________________________________ Notary Public: _______________________________________ My Commission Expires:_______________________________ SEAL REQUIRED FOR EXPANSIONS ONLY | LOCAL OPTION DISTRICT REVIEW Local Governing Body of: _____________________________________Village, County, City Check one: Approved Disapproved Signature and Title of Village/County/City Official:_______________________________________________________________ AGD USE ONLY: Payment| Application Fee $__________________ Received on: _______________ Receipt No. ___________________ Processed by: _____________________________________________________ Approved Disapproved, _______________ Decision by Director, if required: Approved Disapproved, __________________________________________________ Revised: 5/20/16 American LegalNet, Inc. www.FormsWorkFlow.com Signed by Director: ______________________________________________________________ Date: _____________________