-30 STATE OF NEW YORK PERMIT APPLICATION FOR LIQUOR AUTHORITY BREWER TASTING PERMIT Section 51, subdivision 8 (a) of the A.B.C. Law provides that a licensee or his/her employee, or a brewer or manufacturer as defined in Section 3 of this chapter, or an importer having a basic permit as required by Section 1.20 of Title 27 of the Code of Federal Regulations, may obtain a permit to serve small samples of beer or malt beverages he/she produces or imports at establishments licensed under Section 54 or 54 (a) of this article. A permit may also be issued for serving small samples of beer or malt beverages produced or imported by such licensee, brewer, manufacturer or importer at annual fairs sponsored by agricultural and horticultural societies as defined in Section 1409 of the not-for-profit corporation law, and for sampling at the licensed premises of the holder of a wholesaler’s license under Section 53 of this article issued or renewed prior to July 1, 1960 and thereafter renewed or transferred, which authorizes the holder thereof to sell beer at retail to a person for consumption at his/her home. Pursuant to that Section, this application is submitted by a licensee, brewer, manufacturer or importer for a permit to conduct beer tasting functions. A beer tasting is a presentation of samples of one or more beers for the purpose of acquainting the tasters with the characteristics of the beer or beers tasted. If applying for a permit not to exceed a maximum of three (3) days, this application must be properly executed by the applicant and filed with the Office of the State Liquor Authority at the appropriate zone office and must be accompanied by a certified check, bank officer’s check or draft, personal check or money order in the amount of $30.00 ($20.00 + $10.00 filing fee) to the order of the State Liquor Authority. If you are applying for an annual brewer tasting permit, this application must be properly executed by the applicant and filed with the Office of the State Liquor Authority at the appropriate zone office and must be accompanied by a certified check, bank officer’s check or draft, personal check or money order in the amount of $1,010.00 ($1,000.00 + $10.00 filing fee) to the order of the State Liquor Authority ALL ANSWERS BELOW MUST BE TYPEWRITTEN OR PRINTED IN DARK INK. (IF MORE SPACE IS NEEDED, ATTACH RIDER) ANY FALSE ANSWER OR STATEMENT MADE BY THE APPLICANT/LICENSEE MAY SUBJECT THE LICENSEE TO DISCIPLINARY PROCEEDINGS SECTION A Give full name of Applicant/Licensee NYS Serial # NYS Certificate # County Telephone Number Street address of licensed premises City, Town or Village – Zip Code SECTION B 1. Please check the appropriate permit you are applying for: _____________ Annual Brewer Tasting Permit ______________Temporary Brewer Tasting Permit (3 day maximum) If applying for the Temporary Brewer Tasting Permit, state date(s), day(s) of the week and time(s) of the day when beer tasting function will be held (3 day maximum): Date (s)___________________________________________________________________________________________ Day(s) of Week __________________________________________ Time(s) ___________________________________ 2. State the estimated number persons attending such function: Number of Persons______________________ 3(a). State name, address and Serial # of licensed premises where function is to be held or name and location of annual fair where function is to be held: Licensee Name__________________________________________________________Serial #___________________ Street address____________________________________________________________________________________ City, Town or Village-Zip Code __________________________________________County _____________________ American LegalNet, Inc. www.FormsWorkFlow.com The applicant/licensee hereby represents that if a permit is issued for the purpose above mentioned, the following conditions will be complied with: 1. 2. 3. 4. 5. Permittee shall comply with Federal and State Tax requirements. All beer or other malt beverages served pursuant to a permit issued under this subdivision shall have been purchased by the retail licensee upon whose premises the serving of samples is taking place. No liquor or wine is permitted at the beer tasting. The permit (or a copy thereof) shall be displayed on the premises where the beer tasting shall be held. The permittee shall obtain the consent of the retailer to hold the tasting on the licensed premises. THE APPLICANT HEREBY AGREES THAT ALL PAPERS FILED IN SUPPORT OF THIS APPLICATION AND ANY APPLICATION FILED UNDER THE ALCOHOLIC BEVERAGE CONTROL LAW BY ANY PERSON HAVING ANY INTEREST, DIRECT OR INDIRECT, EITHER IN THE PREMISES OR IN THE BUSINESS TO BE LICENSED, FOR ANY LICENSE OR PERMIT, SHALL BE DEEMED AND MADE A PART HEREOF AND CONSIDERED BY THE STATE LIQUOR AUTHORITY IN ACTING UPON THIS APPLICATION. SECTION C THE FOLLOWING CERTIFICATION MUST BE SIGNED AND DATED BY INDIVIDUAL APPLICANT AND EACH MEMBER OF PARTNERSHIP The undersigned, each for themselves, certifies that he/she is the applicant above named; that he/she knows the contents of the above application and the statements contained therein and the same are true of his/her own knowledge. Dated__________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ (Signature of applicant or of each partner) THIS CERTIFICATION TO BE SIGNED AND DATED WHEN AN APPLICANT IS A CORPORATION ___________________________________________________, certifies that he/she is____________________________________________ (Title) of the above named applicant corporation; that he/she knows the contents of the above application and the statements and answers therein; that the same are true of his/her own knowledge; that he/she has been authorized, by order of the Board of Directors of said applicant corporation to make the statements and answers in this application in behalf of said applicant corporation with the same force and effect as if said corporation made such statements and answers itself. Dated __________________________________________ ________________________________________________________ ( Signature of authorized officer) Completed applications and any supporting information should be mailed to: NEW YORK STATE LIQUOR AUTHORITY PO BOX 3796 NEW YORK, NY 10008-3796 Brewer Tasting (revised 3/25/11) American LegalNet, Inc. www.FormsWorkFlow.com