NEW YORK STATE LIQUOR AUTHORITY APPLICATION for ALCOHOLIC BEVERAGE CONTROL WINERY RETAIL ON-PREMISES LICENSE CONTENTS • Instructions for completing form • Application Form DIRECTIONS FOR COMPLETING THIS LICENSE APPLICATION • Must be TYPED or PRINTED in ink. • Complete applicable forms FULLY. • Follow instructions carefully. S.L.A. ZONE OFFICES: ZONE 1 State Liquor Authority 317 Lenox Ave. New York, New York 10027 Telephone: 212-961-8385 ZONE 2 State Liquor Authority Alfred E. Smith Building 80 So. Swan Street Suite 900 Albany, New York 12210-8002 Telephone: 518-474-7604 ZONE 3 State Liquor Authority Iskalo Electric Tower Bldg. 535 Washington St. Suite 303 Buffalo, New York 14203 Telephone: 716-847-3035 SYRACUSE DISTRICT OFFICE State Office Building 333 E. Washington Street Room 205 Syracuse, NY 13202 Telephone: 315-428-4198 www.abc.state.ny.us SLA FORM: 353 (05/29/07) American LegalNet, Inc. www.FormsWorkflow.com WHERE DO I FILE MY APPLICATION? This application must be filed with the State Liquor Authority office (addresses on front cover) that supports the county where you will establish your business. ZONE 1 Bronx Kings Nassau New York Queens Richmond Suffolk Westchester ZONE 2 Albany Clinton Columbia Dutchess Essex Franklin Fulton Greene Hamilton Montgomery Orange Putnam Rensselaer Rockland Saratoga Schenectady Schoharie Sullivan Ulster Washington Warren SYRACUSE DISTRICT Broome Cayuga Chenango Cortland Delaware Herkimer Jefferson Lewis Madison Oneida Onondaga Oswego Otsego St. Lawrence ZONE 3 Allegany Cattaraugus Chautauqua Chemung Erie Genesee Livingston Monroe Niagara Ontario Orleans Schuyler Seneca Steuben Tioga Tompkins Wayne Wyoming Yates This application must be accompanied by the appropriate fee in check or money order form ONLY. Cash will not be accepted. Check must be made payable to the New York State Liquor Authority. CODE ANNUAL FEE BY LOCATION (in cities having a population of 100,000 or more) WW-353 (elsewhere - cities with a population of less than 100,000) $480.00 $240.00 FILING FEE $100.00 American LegalNet, Inc. www.FormsWorkflow.com INSTRUCTIONS This application is to be used by a licensed winery to apply to the Liquor Authority for a license to sell wine at retail for consumption on the premises (Section 76, Subdivision 3 of the ABC Law). This license also includes authorization for the on-premises sale of beer, wine product and cider. The annual duration of this license shall be co-extensive with the term of the winery license. 1. To synchronize the expiration of the license, the annual fee will be pro-rated at a monthly rate of: (a) In cities having a population of 100,000 or more $40.00 (b) elsewhere $20.00 For computational purposes, please utilize the following fee payment worksheet: X A = + $100 Filing Fee = B C A. Count the number of months from the anticipated date you will submit this application to the expiration date of your winery license. Subtract 1 month from this number. Enter this amount in section A. B. In section B, place the monthly pro-rated fee from the above schedule. C. Section C is the total fee due after the calculation is performed. 2. Winery licensee must provide a Penal Bond in the sum of $1,000 issued by the authorized surety company. 3. Diagram(s) on 8 ½” x 11” paper must be submitted which illustrate the interior arrangement of the proposed premises where the permitted beverages will be consumed, and which show the spatial relationship to the licensed winery. Included in the sketch should be the measurements and location of any bar, bathroom(s), tables, chairs, entrances and exits, display windows, counters, closets, shelving and storage. 4. A “Notice” must be published in the newspaper, and proof of publication shall be submitted to the Authority in the manner described in the accompanying “Notice to On-Premises Applicants”. 5. Accompanying “Affidavit” must be completed. 6. Section G – Establishment Questionnaire must be completed (attached). 7. Section H – Method of Operation must be completed (attached). American LegalNet, Inc. www.FormsWorkflow.com APPLICATION FOR RETAIL WINE LICENSE FOR ON-PREMISES CONSUMPTION BY A WINERY It is not necessary to employ any person, agency or organization to assist you in filing this application. Beware of persons claiming to be able to assist you in securing action on your application. The payment of money or other thing of value for the use of influence, or promise of influence in obtaining a license is a violation of law and offenders will be prosecuted. 1. Applicant Name Trade Name (D/B/A) Winery License (serial) Number: 2. Premises Address City, Town or Village ZIP County Telephone No. Between what streets Has premises been know by any other address? If YES, please specify_________________________ _________________________________________________________________________________ E-mail address (if available) : _______________________________________________________ Premises Post Office Address (if different from above) 3. Attorney/Representative Name Office Address ZIP City/Town/Village Telephone No. E-mail address (if available): ________________________________________________________ $ 4. Total Payment Due: [OFFICE USE ONLY] Date filed: STATE LIQUOR AUTHORITY action: Approval Disapproval SERIAL NUMBER: Assigned To: NEW TRANSFER American LegalNet, Inc. www.FormsWorkflow.com NOTICE TO ON-PREMISES APPLICANTS Effective August 22, 1999, all applicants for licenses for on-premises consumption must publish a NOTICE in a newspaper, designated by the County Clerk, once a week for two successive weeks as hereinafter provided. → If the proposed premises are located in any county other than New York, Kings, Queens, or Bronx, the NOTICE shall be published in a daily or weekly newspaper in the city, town or village in which the premises are located and if there be none in a daily or weekly newspaper in the county where the premises are located. → If the proposed premises are located in the counties of New York, Kings, Queens or Bronx, the NOTICE shall be published in one daily and one weekly newspaper published in the county where the premises are located. The NOTICE shall be printed in English in substantially the following form: Notice is hereby given that a license, number (fill in license number *) for (fill in beer, liquor and/or wine, as the case may be) has been applied for by the undersigned to sell (fill in beer, liquor and/or wine, as the case may be) at retail in a (hotel, club, restaurant, vessel, car, or other type of establishment, as the case may be) under the Alcoholic Beverage Control Law at (fill in street address, city, town or village and county in which the premises are located) for on-premises consumption. (fill in name of applicant) (fill in address of applicant) The first publication shall be made within 10 days of the filing of the application. Applicant shall obtain two original copies of proof of publication. One original copy must be submitted to the Authority within 15 days of receipt. The second original shall be retained by applicant. Except for good cause shown, the Authority shall not issue the license unless proof of publication is submitted within such 15 day period. The form of proof of publication shall be as follows: STATE OF NEW YORK COUNTY OF of being duly sworn, says that (s)he is of the publishers of the , a (daily) or (weekly) newspaper (printed and) published in the (city, town, or village and county) , and that the notice of which the annexed is a true copy, has been published in said newspaper for two successive weeks commencing on the day of . Sworn to before me this * day of IF KNOWN American LegalNet, Inc. www.FormsWorkflow.com APPLICANTS STATEMENT Any answer or statement, which is false, made by the applicant may constitute perjury and may subject any permit or license issued hereunder to revocation or cancellation. I, ________________________________________________________________________________________ , the applicant, (sole proprietor, partner, corporate principal or LLC member) for an Alcoholic Beverage Control Retail License understand that the New York State Liquor Authority will rely on each and every answer in the application and accompanying papers in reaching their determination and state, under penalty of perjury, that all statements therein are true to the best of my knowledge and belief. I further state that the location and layout of the premises to be licensed does not violate any requirement of the ABC Law. I verify if any change occurs prior to the receipt of the license, I will notify the Authority by registered or certified mail within 48 hours or if change occurs after receipt of the license, I will notify the Authority similarly within 10 days. I understand that failure to give the required notice will violate the Alcoholic Beverage Control Law and may result in revocation of the license. Signature Date Revised 05/29/07 American LegalNet, Inc. www.FormsWorkflow.com