Form 70-Ab-022511 - Additional Bar Application 2011 (Page 2 of 2) in pdf

Form 70-Ab-022511 - Additional Bar Application 2011 Page 2

Page 2

APPLICATION FOR

ADDITIONAL BAR

The applicant hereby agrees that any application filed under the Alcoholic Beverage Control Law by any person having any interest,

direct or indirect, either in the premises or in the business to be licensed, for any license or permit, shall be deemed and made a part

hereof and considered by the State Liquor Authority in acting upon this application.

THIS CERTIFICATION TO BE SIGNED AND DATED

____________________________________________, certifies that he/she is_____________________________________________

(Title)

of the above named applicant corporation; that he/she knows the contents of the above application and the statements and answers

therein; that the same are true of his/her own knowledge; that he/she has been authorized, by order of the Board of Directors of said

applicant corporation to make the statements and answers in this application in behalf of said applicant corporation with the same

force and effect as if said corporation made such statements and answers itself.

Dated_________________________________________

_________________________________________________

(Signature of authorized officer)

CONTACT/ATTORNEY/REPRESENTATIVE NAME:

______________________________________________________________

ADDRESS: ___________________________________________________

TELEPHONE: _________________________________________________

E-MAIL ADDRESS: ____________________________________________

ACTION BY LIQUOR AUTHORITY

APPROVED

DISAPPROVED

By _______________________ Date __________________

Mail Application to:

New York State Liquor Authority Licensing

Church Street Station

PO Box 3817

New York, NY 10008-3817

Additional bar form 70-AB (revised 02/25/11)

Form 70-Ab-022511 - Additional Bar Application 2011 Page 2