CONDITIONS FOR TEMPORARY RETAIL PERMIT This application must be preceded or accompanied by: (i) a complete application for a retail liquor license and (ii) one set of recent photographs of the premise, no smaller than 4” x 6” in size. The current license, if any, must be surrendered to, placed in safekeeping with, or otherwise deemed abandoned by the State Liquor Authority. You will need to specify: • PURCHASE OF AN EXISTING BUSINESS: If the applicant is the purchaser of the existing business, the subject premises must have operated under a retail license within thirty days of the filing of the application for this permit. In that case, the holder of a temporary permit may traffic in alcoholic beverages only as would be permitted under the privileges of the current license which it replaces. A contract of sale or conveyance must be included with the application for the liquor license; or • APPLICATION FOR A NEW BUSINESS: If the applicant is not purchasing the existing business, a temporary permit may be issued provided the premises is not a wine or liquor store, is not subject to the 500’ Rule, and is not located in New York City (Kings, Queens, Bronx, New York, Staten Island). The issuance of a temporary permit is NOT a guarantee of approval of the application for the liquor license. The Authority is held harmless from any hardship created by the subsequent DISAPPROVAL of the license application for both the purchaser and the seller. The permit holder may purchase alcoholic beverages only by currency, money order, or certified check on or before delivery of beverages to the premises, unless the permit holder already holds another retail license and is not in violation of Alcoholic Beverage Control Law 101-a. If the permit holder is purchasing the alcoholic beverages from the current licensee an Application for Liquidator’s Permit, with fee of $36, is required upon submission of the Temporary Retail Permit application. If the permit holder is not purchasing the alcoholic beverages from the current licensee an Affidavit stating that there is no transfer of alcoholic stock is required upon submission of the Temporary Retail Permit application. If you are applying for additional bars in the permanent application, you will need a Temporary Retail Permit for each bar. This will require the filing of a separate application and fee for each intended bar. The temporary permit is granted at the discretion of the State Liquor Authority for a period of ninety days, and may similarly be renewed for an additional thirty days. YOU MUST FILE FOR A RENEWAL OF THE TEMPORARY RETAIL PERMIT PRIOR TO THE EXPIRATION OF THE EXISTING PERMIT. RENEWAL APPLICATIONS RECEIVED AFTER THE EXPIRATION DATE OF THE EXISTING PERMIT MAY BE DISAPPROVED. The temporary permit may be summarily cancelled or suspended at any time, if the NYS Liquor Authority determines that good cause exists for such suspension or cancellation. FEES Fee is payable upon filing, and must be a personal check, certified check or money order, payable to the NYS Liquor Authority. The fee is not refundable. INITIAL FEE (90 Days) Retail beer, Grocery or Drug Store permit…$ 128.00 Any other retail permit… $ 640.00 (x # of bars) 30 DAYS EXTENSION FEE Retail beer, Grocery or Drug Store permit …$ 64.00 Any other retail permit… $ 96.00 (x # of bars) APPLICATIONS FOR THE INITIAL TEMPORARY RETAIL PERMIT MUST BE MAILED TO: New York State Liquor Authority Licensing Church Street Station P.O. Box 3817 APPLICATIONS TO RENEW A TEMPORARY RETAIL PERMIT ARE TO BE MAILED TO THE ZONE OFFICE PROCESSING THE PERMANENT LICENSE APPLICATION. New York, New York 10008-3817 American LegalNet, Inc. www.FormsWorkFlow.com NEW YORK STATE LIQUOR AUTHORITY APPLICATION FOR TEMPORARY RETAIL PERMIT [See Reverse Side for Conditions of Issuance] FOR OFFICIAL USE ONLY-DO NOT WRITE IN THIS BOX Expiration/Surrender/Safekeeping Date:__________ Pending Disciplinary-Location ___YES ___NO (Seller) Original or Renewal (circle one) Pending Disciplinary-Principals ___YES ___NO (Seller) Pending Disciplinary-Principals ___YES ___NO (Buyer) (1) NAME OF APPLICANT___________________________________________ Date Filed ______/____/______ (2) SELECT ONE OF THE FOLLOWING: Purchase of an Existing Business: ___ Transfer or Sale of a business in a premises that is currently LICENSED* for alcoholic beverage sales. Submit a Contract of Sale or Conveyance. Application for a New Business: ___ A new or existing business in a proposed premise that is currently UNLICENSED for alcoholic beverage sales, is not a wine or liquor store, is not subject to the 500’ Rule and is not located in New York City (Kings, Queens, Bronx, New York, Staten Island). ___ A new business in a premise that is currently LICENSED for alcoholic beverage sales, where a Transfer or Sale of the previous business is NOT taking place, is not a wine or liquor store, is not subject to the 500’ Rule and is not located in New York City (Kings, Queens, Bronx, New York, Staten Island). *The subject premises must have been operating under a retail license within thirty days of the filing of the application for this permit. (3) NAME OF CURRENT LICENSEE (if any) _______________________________________ Serial Number __________ (4) ADDRESS OF PREMISES ________________________________________________Telephone #__________________ As an authorized signatory of the current applicant, I certify that I have read and understand the foregoing conditions for temporary retail permit and represent that I am eligible for such permit. _______________________ TITLE _______________________________________ APPLICANT’S SIGNATURE ________________ DATE The above party agrees that any false statement in the above certifications will constitute grounds for disapproval of the permit and the license applications. FOR OFFICIAL SLA USE ONLY - DO NOT WRITE IN THIS BOX Serial Number ___________________ Date of Issuance ____________ SLA Action: Effective From: __________ To: __________ Fee Amount: _________ Approved Disapproved By: ________________ Date: ___________ SLA form 180-058 (revised 11/11) American LegalNet, Inc. www.FormsWorkFlow.com