Application For Alcoholic Beverage Control Manufacturer License(S) - Stateof New York Liquor Authority Page 12

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OFFICE USE ONLY
14
Original
Amended
Date
Print YOUR Name
_________________________________________________________
3. RESIDENCE HISTORY
List your residence history for the past FIVE (5) years to the PRESENT DATE.
Address
From (mm/yyyy) To (mm/yyyy)
Address
From (mm/yyyy) To (mm/yyyy)
From (mm/yyyy) To (mm/yyyy)
Address
From (mm/yyyy) To (mm/yyyy)
Address
________________________________________________________________________
4. EMPLOYMENT HISTORY
List your employment history for the past FIVE (5) years to PRESENT DATE.
Also, list any employment history that shows experience in the alcohol industry.
Add additional sheets if necessary.
Employer
From (mm/yyyy) To (mm/yyyy)
Position
Employer Address
Type of Business
Employer
From (mm/yyyy) To (mm/yyyy)
Position
Employer Address
Type of Business
Employer
From (mm/yyyy) To (mm/yyyy)
Position
Employer Address
Type of Business
________________________________________________________________________
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