-29 NEW YORK STATE LIQUOR AUTHORITY Application for Retail Liquor, Wine and Beer License by a U.S. Certificated Airline This application is to be used by a UNITED STATES CERTIFICATED AIRLINE company to apply for a license to sell liquor, wine, cider and beer for on-premises consumption, to passengers while in actual transit. The original of this application must be properly executed and signed and filed with the New York State Liquor Authority, Church Street Station, PO Box 3817, New York, NY 10008-3817. The application must be accompanied by the following: 1) Check or money order payable to the New York State Liquor Authority for the required fee. The fee for a two (2) year license to sell liquor upon an aircraft being operated on REGULARLY SCHEDULED FLIGHTS by a United States Certificated Airline in this state shall be $3,840.00 for an airline company operating up to and including twenty such aircraft and $5,120.00 for such an airline operating more than twenty such aircraft. In addition to the foregoing fee, a FILING FEE of $200.00 must also be submitted with each initial application. 2) BOND in the penal sum of $1,000.00 issued by a surety company, authorized to execute such bonds in the State of New York with the applicant name, principal terminal address and correct expiration date. 3) Air Carrier Certificate 4) List of Officers on Official Airline Letterhead The applicant hereby applies for a license to sell liquor, wine, cider and beer at retail, for consumption on aircraft operated on Regularly Scheduled Flights by applicant airline. 1. Name of Applicant Airline 2. Address of Principal Place of Business 4. Principal Terminal In New York State with complete address 5. Under the Laws of what State was applicant organized? Date of Organization: 6. Has applicant been approved as a United States Certificated airline in New York State? If “yes”, state date of issuance and number thereof Circle one Yes or No 7. Does the applicant operate 21 or more such aircraft on regularly scheduled flights in New York State? 8. Will alcoholic beverage be stored on a premises other than upon such aircraft? If you answered “Yes”, please submit a Warehouse Application. Circle One Circle One Yes or No Yes or No The applicant hereby agrees that 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. Applicant:_______________________________________________________ Date:______________________________________ By:_____________________________________________________________ ______________________________________________________________certifies that he is_______________________________ (Title) of the herein named applicant corporation; that he knows the contents of the above application and the statements and answers therein; that the same are true of his own knowledge; that he 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. _______________________________________________________ __________________________________________________ Signature of Authorized Officer Residence Address Dated:__________________________________________________ Form 260 (02/25/11) American LegalNet, Inc. www.FormsWorkFlow.com