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Application For Additional Consumer Bar(s) Form. This is a Connecticut form and can be use in Department Of Consumer Protection Statewide.
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Tags: Application For Additional Consumer Bar(s), CPLP-03, Connecticut Statewide, Department Of Consumer Protection
FOR OFFICIAL USE ONLY
DCPLC-ACB Rev 11/09
STATE OF CONNECTICUT
DEPARTMENT OF CONSUMER PROTECTION
LIQUOR CONTROL DIVISION
Telephone: (860) 713-6210
Email: liquor.control@ct.gov
Website: www.ct.gov/dcp
APPLICATION FOR ADDITIONAL CONSUMER BAR(S)
Instructions:
Complete this application and submit with a check or money order made payable to “Treasurer, State of
Connecticut” for the total number of additional consumers bar(s) for which you are requesting approval at $190.00
each.
Return the completed application and appropriate fee to:
License Services Division
Department of Consumer Protection
165 Capitol Avenue
Hartford, CT 06106
Permittee Name (First Name, Middle Initial, Last Name)
Liquor Permit Number
Name of Business
Business Street Address (Location of Business)
City
State
Zip code
Business Telephone Number (with area code)
Business Fax Number (with area code)
Backer’s Name (LLC, INC, SOLE PROP.)
Number of additional consumer bar(s) requested @ $190.00 each
NOTE:
This application must be accompanied by an 8.5 x 11 inch sketch of the entire premises, showing the
location(s) of the additional consumer bar(s) for which you are requesting approval. You must also
submit a photograph(s) of these proposed location(s).
I have attached a sketch and photograph(s), as described above, related to the additional consumer bar(s) for which I
am requesting approval
Yes
No
Signature of duly authorized representative
Date
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