New Mexico Regulation and Licensing Department ALCOHOL AND GAMING DIVISION T o n ey A na ya B uil d i n g ▪ 2 5 5 0 C er r il l o s R oa d ▪ S a nt a F e, N e w M ex i c o 8 7 5 0 5 (5 0 5 ) 4 7 6 -4 8 7 5 ▪ F a x ( 5 0 5) 4 7 6- 4 5 9 5 ▪ ww w.rl d. stat e. n m .u s / AG D _____Fee $75.00 Fees are Non-Refundable CHANGE OF FLOOR PLAN /EXPANSION OF LIQUOR LICENSED PREMISE APPLICATION 15 NMAC 10.3.2 13.1 A Licensee may not change or expand the licensed premises without prior written approval of the Director. Applications to change or expand the licensed premises shall be submitted along with the required documentation and application fee. If the change or expansion of the licensed premises is twenty-five (25%) or more of the total existing square footage of the licensed premises, the Director may require the licensee to file an application for a transfer of location. Proof of tenancy and photographs with a detailed floor are required for the expansion area. Please attach a copy of your existing approved floor plan along with an 8 ½ x 11detailed floor plan that includes the existing approved premises and any proposed change or expansion. Please label all areas and include all entrances, exits, walls or enclosures as well as dimensions for any expansion. The licensee cannot make any changes or expand the premises until approval has been granted for this request. A before and after site inspection may be scheduled. Liquor License Number_____________ Telephone Number __________________________ Fax Number _____________________ Business Name (DBA) _______________________________________Owner Name_________________________________________ Mailing Address ___________________________________________City __________________________State ______ Zip_________ License Location __________________________________________ City___________________________ State______ Zip_________ Current square footage_______________________ Additional square footage you would like to add/change_______________________ Total square footage (add both amounts above) _______________ Reason for request_________________________________________ Will the proposed expansion bring the licensed premises within 300 feet of a church or school? _________________________________ Has there been any change in the ownership or operation of the licensee? ___________________________________________________ If so, explain___________________________________________________________________________________________________ I ____________________________________ (print name) Licensee for Liquor License No. ______ hereby attest that the requested change meets the definition of “licensed premises” in NMSA 1978 60-3A-3 (M), which states in part “ ‘licensed premises’ means the contiguous areas or areas connected by indoor passageways of a structure and the outside dining, recreation and lounge areas of the structure that are under the direct control of the licensee…” You must sign and date this form in the presence of a notary public Submitted by (print name) _____________________________________________________________________________________ Signature _______________________________________________Title ____________________________Date _______________ ___________________________________________________________________________________________ NOTARY PUBLIC USE ONLY SUBSCRIBED AND SWORN TO before me this ___________ Day of ____________________ 20_______By ____________________________________________ Notary Public_______________________________________________________________ My Commission Expires: _______________________________________ ___________________________________________________________________________________________ LOCAL GOVERNING BODY APPROVAL – (Required on expansion requests only) Print Name _______________________________________________________ Title _________________________________________Date ____________________ Signature _________________________________________________________ Phone _______________________________ Fax ____________________________ ___________________________________________________________________________________________ Alcohol and Gaming Use Only: __________Approved __________Disapproved By______________________________________________________________________________________ Date__________________________________________ Revision date: 03/2011 American LegalNet, Inc. www.FormsWorkFlow.com