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Petiton For Temporary Permit To Operate Pending Action By Municipal Issuing Authority Form. This is a New Jersey form and can be use in Division Of Alcoholic Beverage Control Statewide.
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Tags: Petiton For Temporary Permit To Operate Pending Action By Municipal Issuing Authority, New Jersey Statewide, Division Of Alcoholic Beverage Control
STATE OF NEW JERSEY
DEPARTMENT OF LAW AND PUBLIC SAFETY
DIVISION OF ALCOHOLIC BEVERAGE CONTROL
P.O. BOX 087, 140 EAST FRONT STREET
TRENTON, NJ 08625-0087
PETITION FOR TEMPORARY PERMIT TO OPERATE PENDING ACTION BY
MUNICIPAL ISSUING AUTHORITY UPON PETITIONER=S
APPLICATION FOR LICENSE RENEWAL [AI]
This application must be filed with the State Division of Alcoholic Beverage Control.
It is necessary to be filed with appropriate fee when application for renewal of
license and renewal fees have been filed with the municipality, but the municipal
governing body has not renewed the license by July 1st, and the licensee wishes to
conduct business. The fee is $75.00 plus the daily fee of $5.00 per day in the form
of a certified check, attorney check or money order payable to the Division of
Alcoholic Beverage Control. No cash, personal checks or business checks will be
accepted. The application must be completed in full, signed by the applicant, and
endorsed by the municipality. The application MUST be hand-delivered to the Division
of A.B.C. at the above-captioned address with a copy of the applicant’s Tax Clearance
Certificate or a copy of the applicant’s Temporary Tax Clearance Certificate issued
by the Division of Taxation. If you have any questions regarding tax clearance,
please contact the Division of Taxation at 609-292-0043. If you have any questions
regarding this permit, please contact the ABC at 609-984-1954.
1. Name of licensee as it appears on the license certificate:
________________________________________________________________________
2. Address of licensed business as it appears on the license
certificate:___________________________________________________________
________________________________________________________________________
3. New Jersey 12-digit license number_________-_______-_________-__________
4. Contact Name____________________________________________________________
5. Contact Phone Number____________________________________________________
6. Requested effective dates for Ad Interim Permit:
From_______________________ to _______________________ inclusive.
Day/Month/Year
Day/Month/Year
Name/Title of Authorized Signator__________________________________________
[Please Print]
Signature_____________________________________ Date_______/_______/________
[Signator=s name must appear on 12-page license application:
Vice President, Sole Proprietor or Partner.]
as President,
[OTHER SIDE TO BE COMPLETED BY MUNICIPAL CLERK
OR A.B.C. BOARD SECRETARY]
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TO BE COMPLETED BY MUNICIPAL AUTHORITIES
1.
Date renewal application was filed and renewal fees paid:
_____/_____/_____.
2.
Date Municipal Council or A.B.C. Board will meet to act on renewal of
this license: _____/_____/_____.
3.
Please state reason why the license was not renewed by resolution prior
to July 1st.:________________________________
______________________________________________________________
______________________________________________________________
4.
Does the municipality object to the issuance of an Ad Interim Permit by
the State Division of Alcoholic Beverage Control?
_____Yes
_____No
Municipal Clerk or A.B.C. Board Secretary:
______________________________________________
[Please Print]
Signature:____________________________________
THE FOLLOWING FORMULA PERTAINS TO ALL RETAIL LICENSEES:
$5.00 PER DAY X [No. of Days] ___________ = __________[AI Fee]
[AI Fee]___________ + $75.00 = $__________________
[Total Fee]
----------------------------------------------------------------If an additional permit is needed, the following formula applies:
$5.00 [Per Day] X ______ [No. of Days] = $_________________
[Total Fee]
APPLICATIONS MUST BE HAND DELIVERED TO THE ABC.
NO OTHER METHOD OF DELIVERY WILL BE ACCEPTED.
MAILED APPLICATIONS WILL BE RETURNED TO SENDER.
03/09
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