Application For Alcoholic Beverage Control Manufacturer License(S) - Nys Liquor Authority Page 7
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18manu-rev120817
OFFICE USE ONLY
Date ________________
Original
Amended
28
FINANCIAL DISCLOSURE
Applicants must demonstrate the costs and the sources of funding for this venture. All investors must be disclosed.
Personal Questionnaires must be submitted for all investors, joint account holders, donors, or lenders (excluding banking institutions).
The Total Investment (Total Cash plus the Total Borrowed) must equal or exceed the Total Expenses.
1. EXPENSES (Actual or Estimated)
1a. Real Property (if purchased within the past year by the applicant or
any of its principals):
1b. Purchase/Contract Price of Business (submit copy of contract):
1c. Renovations/Improvement Costs (i.e.: furnishings, fixtures, etc.) :
1d. Miscellaneous (any other expense related to this venture):
TOTAL EXPENSES
0
Total of lines 1a through 1d.
2. CASH*
*Cash includes funds on hand that do not need to be repaid. For example, checking or savings account or gifted funds.
Attach copies of bank statements or other financial documentation for EACH source of cash.
Dollar Amount
2a. Source of Funds
Personal Questionnaire attached
2b. Source of Funds
Personal Questionnaire attached
Dollar Amount
2c. Source of Funds
Personal Questionnaire attached
Dollar Amount
TOTAL CASH
0
Total of All Cash Expended
3. BORROWED*
*Borrowed funds include funds that must be repaid. For example, loans, mortgages, lines of credit and promissory notes.
Attach copies of agreements or other financial documentation for EACH source of borrowed monies.
3a. Source of Funds
Personal Questionnaire attached
Dollar Amount
3b. Source of Funds
Personal Questionnaire attached
Dollar Amount
3c. Source of Funds
Personal Questionnaire attached
Dollar Amount
TOTAL BORROWED
0
Total of All Borrowed Funds
4. Have all investors been disclosed in this application?
TOTAL INVESTMENT
0
Yes
No
Total Cash plus Total Borrowed
The following person(s) MAY NOT invest in a manufacturing license to traffic in alcoholic beverages: convicted felons, persons
under the age of twenty-one (21), police officers, and anyone with an interest in a retail license.
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