PLCB-2318 3/12 COMMONWEALTH OF PENNSYLVANIA PENNSYLVANIA LIQUOR CONTROL BOARD LIMITED WINERY EXPOSITION PERMIT (SEE INSTRUCTIONS ON REVERSE) BUREAU OF LICENSING 13 B Mo./Date/Year Mo./Date/Year The undersigned hereby applies for a permit to participate in Alcoholic Ciders, Wine and Food exhibitions for 1. a. Nonconsecutive dates of: Mo./Date/Year Mo./Date/Year Mo./Date/Year Mo./Date/Year Mo./Date/Year Mo./Date/Year Mo./Date/Year Mo./Date/Year Mo./Date/Year Mo./Date/Year Mo./Date/Year Mo./Date/Year Mo./Date/Year Mo./Date/Year Mo./Date/Year Mo./Date/Year Mo./Date/Year Mo./Date/Year b. Consecutive dates from: 2. EVENT TITLE to CONTACT PERSON DAYTIME PHONE NO. DESCRIPTION OF EXPOSITION (SEE INSTRUCTIONS FOR DEFINITION OF EXPOSITION) 3. NAME OF LICENSEE TRADE NAME (IF ANY) ADDRESS OF PREMISES (STREET, RURAL ROUTE, P.O. BOX NO.) (POST OFFICE) (STATE) LK LIC. NO. LID NO. (ZIP) 4. NAME AND ADDRESS TO WHICH PERMIT SHOULD BE MAILED, IF DIFFERENT FROM ABOVE APPLICANT 5. LIST LOCATION OF PREMISES OR AREA TO BE LICENSED STREET, RURAL ROUTE, P.O. BOX NO. CITY, BOROUGH, TOWNSHIP, INC. TOWN COUNTY LIST DESCRIPTION OF PREMISES OR AREA TO BE LICENSED INSIDE AREA WIDTH LENGTH OUTSIDE AREA 6. ARE PUBLIC STREETS, ROADS OR THOROUGHFARES BEING CLOSED FOR THIS EVENT? If `yes', attach written approval from municipal authority. YES YES NO NO 7. HAS A SPECIAL PERMIT EVER BEEN GRANTED TO THIS LICENSEE? If `yes', give date (Months/Year) Give NUMBER OF PERMITS this calendar year 8. IS EVENT TO BE HELD ON PREMISES LICENSED BY A PLCB LICENSEE OTHER THAN THE APPLICANT LIMITED WINERY? YES NO If `yes', list LID and property owner's/lessor's NAME DO NOT WRITE bELOW ThIS LINE 9. RESOLuTION (cORPORaTIONS OR LIMITED LIabILITY cOMPaNIES ONLY) At a regular or special meeting held on ________________________________ , 20 _________ by the applicant, it was resolved that said application be filed with the Pennsylvania Liquor Control Board, and that _______________________________________ and/or_____________________________________ is/are hereby (NAME OF OFFICER/TITLE) (NAME OF OFFICER/TITLE) authorized to execute said application, and any other papers required by the Board. I swear or affirm, subject to the penalties provided by 18 Pa. C.S. §4904 and 47 P.S. §5-504(b), that the foregoing answers and statements provided herein are true and complete to the best of my knowledge and belief. SIGNATURE TITLE NAME OF ATTORNEY REPRESENTING YOU IN THIS MATTER, IF ANY HOME ADDRESS PHONE ADDRESS SIGNATURE TITLE HOME ADDRESS PHONE DATE SIGNED PHONE EMAIL ADDRESS INSTRucTIONS 1. This form is to be used by Limited Winery licensees to apply for a Special Permit to participate in Alcoholic Cider, Wine and Food Expositions OFF the licensed premises. A fee made payable to "PLCB" or "Commonwealth of PA" in the amount of $30.00 per day must accompany this form. 2. A site plan reproduced on paper on an 8½" x 11" format must accompany the application. It must depict the location of the limited winery at the event in conjunction with other vendors. The plan must be clear and readable. 3. The application, fee, and site plan MUST be submitted at least 30 days prior to the exposition. 4. This form is not for use at a Farmer's Market. See PLCB-2404, Application For Limited Winery Farmer's Market Permit. INfORMaTION The permit may be issued to a licensed, limited winery for expositions not to exceed 30 consecutive days. The total number of days may not exceed 100 days in any calendar year. The holder of the permit may engage in the sale of alcoholic ciders and wine products by the glass, bottle or in case lots by the permittee under the authority of a Limited Winery license AND may provide tasting samples of alcoholic cider and wines in individual portions not to exceed one fluid ounce, which may be sold or offered free of charge. Sale of wine or liquor scented candles acquired or produced by the limited winery are also permitted. If holding the exposition at the premises of another retail licensee, the special permittee is liable for any violations of the Liquor Code and the Board's regulations occurring at the location used by the permittee. The area under the control of the permittee must be marked by visible signs or temporary barriers, clearly delineating the area covered by the special permit. Permits are not transferable and cannot be renewed. NO alternate rain dates may be considered. Expositions of wine and food, are "affairs held indoors or outdoors with the intent of promoting PA products by educating those in attendance of the availability, nature and quality of Pennsylvania-produced alcoholic ciders and wines in conjunction with suitable food displays, demonstrations and sales," and may include other activities such as arts and crafts, musical activities, cultural and agricultural exhibits, and similar activities [47 P.S. §5.505.2(4)]. IF YOU REQUIRE ASSISTANCE IN COMPLETING THE APPLICATION PACKET, CALL THE LICENSING INFORMATION CENTER AT (717) 783-8250. SEND THE APPLICATION PACKET TO: PENNSYLVANIA LIQUOR CONTROL BOARD, BUREAU OF LICENSING, P.O. BOX 8940, HARRISBURG, PA 17105-8940.