Application For A Combined Craft Manufacturing License For Existing Licensed Craft Manufacturers - New York State Liquor Authority

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created-120216
OFFICE USE ONLY
29
Original
Amended
Date
LICENSE
___________________________________________________________________________________________________________________
APPLICATION FOR A COMBINED CRAFT MANUFACTURING
LICENSE FOR EXISTING LICENSED CRAFT MANUFACTURERS
___________________________________________________________________________________________________________________
It is not necessary to employ any person, agency or organization to assist you in filing this application. Beware of persons claiming to be able
to assist you in securing action on your application. The payment of money or other thing of value for the use of influence, or promise of
influence in obtaining a license is a violation of law and offenders will be prosecuted.
1. APPLICANT
Licensed Entity:
(As appears in SLA record)
Trade Name (DBA):
Premises Street Address:
City:
, NY
Zip Code:
Telephone # of Premises
:
County:
(include Area Code)
Albany
Mailing Address
(if different from above):
City:
State:
Zip Code:
e-Mail Address:
Business Website:
2. CONTACT (
if different than licensed entity)
Contact Name:
Attorney
Representative
Contact Person
Contact Address:
State:
City:
Zip Code:
Telephone Number of Office
:
(include area code)
e-Mail Address
:
(required)
3. List Craft Manufacturer Serial Numbers Currently Licensed to be Combined
Licensed Serial #:
Licensed Serial #:
Licensed Serial #:
New York State Liquor Authority
Upon receipt of this application the
Please mail this application to:
Licensing Bureau, Craft Manufacturing
Authority will synchronize the license
80 S Swan St. Suite 900
expiration dates and if necessary contact
Albany NY, 12210
you regarding any fees due.
________________________________________________________________________________________________
Office Use Only
Date Filed:
Action Date:
CM(110) Serial #:
Approved
Disapproved
License Board Member:
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