Application For A Combined Craft Manufacturing License For Existing Licensed Craft Manufacturers - New York State Liquor Authority Page 2

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___________________________________________________________________________________________________________________
APPLICANT STATEMENT
________________________________________________________________________________________________
I, [print name]
(the
sole proprietor,
partner,
corporate principal or,
LLC/LLP member)
understand that the State Liquor Authority will rely on each and every answer in the application and
accompanying documents in reaching its determination and state, under penalty of perjury, that all
statements and representations therein are true to the best of my knowledge and belief; and
I state that the location and description of the premises to be licensed does not violate any
requirement of the ABC law or other state or local ordinances; and
I understand that if any change occurs in the information provided to the Authority in the
application, the licensee must notify the Authority by certified mail within 48 hours and if any change
occurs after receipt of the license, the licensee must notify the Authority by certified mail within 10 days. I
understand that failure to give such notice may result in disapproval of the application or revocation or
non-renewal of any license for which this application is submitted; and
I understand that the licensee will be bound by the statements and representations made in the
application, including, but not limited to the licensee's method of operation and the identity of persons
with an ownership or financial interest in the licensed premises; and that all statements and
representations made become conditions of the license; and
I understand that any physical alterations to, or changes to the size of the area used for the sale
and consumption of alcoholic beverages, must be reported to the Authority and may require the
approval of the Authority; and
I understand that the licensee must keep the Authority advised of any change in the mailing
addresses of the licensee, the licensee's principals, and the licensee's landlord.
I understand that the licensee's failure to operate the licensed premises in accordance with the
statements and representations made in the application may result in revocation of any license for which
the application was submitted; and
I understand that any false statement or misrepresentation will constitute cause for disapproval of
the application or revocation or non-renewal of any license for which this application is submitted.
________________________________________________
____________________________________
Signature
Date
Page 2 of 3

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