PERMIT NEW YORK STATE LIQUOR AUTHORITY APPLICATIONS for ALCOHOLIC BEVERAGE CONTROL MISCELLANEOUS II PERMITS CONTENTS • Instructions for completing forms • Application Forms • Fee Chart DIRECTIONS FOR COMPLETING THE PERMIT APPLICATIONS • Must be TYPED or PRINTED. (In blue or black ink) • Complete applicable forms FULLY. • Follow instructions carefully. Completed applications and any supporting information should be mailed to: NEW YORK STATE LIQUOR AUTHORITY PO BOX 3796 NEW YORK, NY 10008-3796 Agency Website address: www.abc.state.ny.us SLA FORM: 1014 (3/25/11) American LegalNet, Inc. www.FormsWorkFlow.com AIRCRAFT/STEAMSHIP- FEE- $ 788.00 (3 years)\$ 36.00 (One time) This application must be filed with the State Liquor Authority Office that supports the county where you will establish your business. See Attached schedule. A permit may be issued for any of the following types of activities. Please read the description of the permits and their conditions carefully. Complete questions 1 through 10 plus 14, 15, 16. Also complete the signature sheet and indicate what type of permit you are applying for. This application is to be used for the purpose of obtaining an annual permit under §99-b of the Alcoholic Beverage Control Law, to purchase alcoholic beverages from a duly licensed manufacturers or wholesaler, for ship's stores for consumption outside the territorial jurisdiction of this State. The applicant hereby represents that if a permit is issued for the purpose above mentioned, the following conditions will be complied with: 1. The alcoholic beverages will be used only for ship's stores for consumption outside the territorial jurisdiction of this state. 2. The alcoholic beverages will not be offered for sale or sold in this state. 3. The duplicate permit or a photostat copy thereof will be delivered to each manufacturer or wholesaler from whom purchases are made. 4. The alcoholic beverages will be delivered directly to the aircraft/steamship of the permittee or to a warehouse for which a warehouse permit has been issued by the Liquor Authority. 5. Only alcoholic beverages in the original sealed containers which comply with the provisions of law with respect to labels and sizes of containers will be purchased. ALCOHOL PERMIT- FEE - $38.00 (3 years) Complete questions 1 through 5 and 7, 8, 9, 11, 12, 13, 16, 16A and signature sheet. Indicate what type of permit you are applying for. This application is to be used for an alcohol permit for the purchase and use of alcohol by the superintendent, or duly authorized officer, of a hospital, museum laboratory, art, charitable, educational, or similar public institution, or by drug store, a licensed physician, dentist, veterinarian, optometrist and chiropodist, or by a manufacturing establishment using alcohol in its processes of manufacture. May not be purchased from distributor except in sealed containers not larger than 5 gallons. Maintain book and records, amount purchased, size of containers, name and address and permit number from who it was purchased. American LegalNet, Inc. www.FormsWorkFlow.com ANNUAL BEER FUNCTION PERMIT- FEE - $ 74.00 Complete questions 1 through 10 plus 20. Complete signature sheet and indicate what type of permit you are applying for. This application is to be used by a Brewer or Beer Wholesaler for the issuance of an Annual Beer Function Permit, pursuant to §97.2 of the Alcoholic Beverage Control Law, to authorize the sale of beer for consumption only and not for resale, at outdoor or indoor gatherings, functions, occasions or events to which the general public will not be admitted and to which admission is not made contingent upon the payment or an admission fee, donation or contribution. Person who purchase beer for use at gathering must execute and file with the permittee a statement that the beer will not be sold or offered for sale. BREWER'S OUTDOOR PERMIT Just a letter is issued. DISTRIBUTOR'S ALCOHOL PERMIT (A,B,C,D) Complete questions 1 through 10 plus 15, and 16 and 18. Complete signature sheet and indicate what type of permit you are applying for. A class "A" permit, Fee-$4,820.00 (3 years) shall authorize the holder thereof to sell and distribute to licensed rectifiers alcohol which is to be used for beverage purposes and to all holders of permits issued pursuant to this section or sections ninety-one and ninety-two of this chapter. A class "B" permit, Fee - $2,420.00 (3 years) shall authorize the holder thereof to sell and distribute alcohol to holders of a class "C" alcohol distributor's permit or to holders of permits issued pursuant to section ninety-one and ninety-two of this chapter. A class "C" permit, Fee-$500.00 (3 years) shall authorize the holder thereof to sell and distribute alcohol to holders of permits issued pursuant to section ninety-two of this chapter and to use alcohol in the preparation by him of any of the products enumerated in section ninety-one of the chapter. Such a permit may be applied for by and shall be issued only to a wholesale druggist. A class "D" permit, Fee- $ 1,172.00 (3 years) shall authorize the holder thereof to sell and distribute alcohol to the holder of winery licenses. Such permit shall be issued only to a person holding a winery license under this chapter. Such permits shall be issued in such form as may be prescribed by the liquor authority, and the privileges granted thereby shall be exercised in accordance with the terms and conditions thereof and the rules of the liquor authority. American LegalNet, Inc. www.FormsWorkFlow.com DRUG STORE PERMIT-FEE $173.00 (3 YEARS) Complete questions 1 through 10, plus 12, 15, 16 and 22. Complete signature sheet and indicate what type of permit you are applying for. This permit shall authorize the permittee to sell liquor or wine in the original sealed package for off-premises consumption only upon a written prescription by a regularly licensed physician and in quantity not exceeding one pint of liquor and one quart of wine. The following information must be submitted with your application: 1. A copy of your New York State Pharmacy License. HOSPITAL PERMIT-FEE $ 98.00 (3 YEARS) Complete questions 1 through 10 plus 12. Complete signature sheet and indicate what type of permit you are applying for and present permit number. This application is to be used by a hospital for a permit to purchase liquor, wine or beer for medicinal use only in the treatment of bona fide patients of such hospital. Such permit does not authorize the purchase or use of alcohol. The following information must be submitted with your application: 1. A copy of your New York State Hospital License. The applicant hereby represents that if a permit is issued for the purpose above mentioned, the following conditions will be complied with: 1. The liquor, wine or beer will be used only for medicinal purposes in the treatment of bona fide patients of the hospital. 2. The duplicate permit of a photostat copy thereof will be delivered to each manufacturer or wholesaler from whom purchases are made. 3. Only liquor, wine or beer in the original sealed containers which comply with the provisions of law with respect to labels and sizes of containers will be purchased. INDUSTRIAL ALCOHOL PERMIT-FEE $ 212.00 (3 YEARS) Complete questions 1, 2, 3, 4, 5, 7, 8, 9, 10, 18, 19, and 20. Complete signature sheet and indicate what type of permit you are applying for. This permit shall entitle the permittee to purchase alcohol intended for use in the manufacture and sale of any of the following when they are unfit for beverage purposes, namely: a. b. c. d. Denatured alcohol purchased and used pursuant to acts of Congress and regulations promulgated thereunder. Patent, proprietary, medicinal, pharmaceutical, antiseptic and toilet preparations. Flavoring extracts, syrups and food products. Scientific, chemical, mechanical and industrial products. American LegalNet, Inc. www.FormsWorkFlow.com INDUSTRIAL ALCOHOL MANUFACTURER-FEE $ 2,420.00 Complete questions 1 through 10, 13,16, 18, 19 and 20. Complete signature sheet and indicate what type of permit you are applying for. Section 91-A- An industrial alcohol manufacturer's permit may be issued by the liquor authority entitling the applicant to manufacture alcohol intended for use and/or used for the following purposes. a. b. c. d. e. f. For scientific, chemical, mechanical, industrial, medicinal and culinary purposes. For use by those authorized to procure alcohol tax-free, as provided by the acts of congress and regulations promulgated thereunder. in the manufacture of denatured alcohol as provided by the acts of congress and regulations promulgated thereunder. In the manufacture of patented, patent, proprietary, medicinal, pharmaceutical, antiseptic, toilet, scientific, chemical, mechanical and industrial preparations or products, unfit for beverage purposes. In the manufacture of flavoring extracts and syrups, unfit for beverage purposes. In the manufacture of ethanol from biomass feedstock for use as fuel (including but not limited to motor fuel, heating fuel, or fuel for process heat.) Such permit shall be in such form as prescribed by the rules of the liquor authority and shall permit the manufacturer to manufacture and distribute said alcohol to holders of industrial alcohol permits, alcohol permits, distributors' alcohol permits class A, distributors' alcohol permits class B and distributors' class C but nothing contained herein shall authorize the manufacturing an distribution of said alcohol for beverage purposes. The following is required and must accompany the application: Photographs (in duplicate) of exterior of premises at least 5 x 7 inches in size. Personal Questionnaire (in duplicate) of Form Q-12 for each person listed as an officer or director. MANUFACTURER OF NON-BEVERAGE PRODUCT PERMIT-FEE $788.00 (3 years), $36.00(ONE TIME) Complete questions 1 through 9 plus 11, 12, 13 and signature sheet. Indicate what type of permit you are applying for. This application is to be used by a manufacturer of non-beverage products to purchase liquor, wine or beer from duly licensed manufacturers or wholesalers for use in the process of manufacture of such products. This application must be accompanied by: 1. A letter of photostat of a letter from the Alcohol Tax Unit of the U.S. Treasury Department stating that the products manufactured by the applicant are classified as exempt from special and commodity taxes, unless such letter or photostat has been previously filed with the Liquor Authority. The applicant hereby represents that if a permit is issued for the purpose above mentioned, the following conditions will be complied with: American LegalNet, Inc. www.FormsWorkFlow.com 1. 2. 3. 4. 5. 6. The liquor, wine or beer will be used only in the process of manufacture of the non-beverage products described herein. The liquor, wine or beer will not be offered for sale nor sold in this state. The duplicate permit or a photostat copy thereof will be delivered to each manufacturer or wholesaler from whom purchases are made. The liquor, wine or beer will be delivered directly to the manufacturing establishment of the permittee and will not be stored elsewhere in the state. Only liquor, wine or beer in the original sealed containers which comply with the provisions of law with respect to labels and sizes of containers may be purchased, unless otherwise specifically authorized by the permit. Records will be kept for two years of all purchases. WINE PRODUCTS PERMIT- (SEE FEE SCHEDULE PAGE) Complete questions 1 through 9 and signature sheet. Indicate what type of permit your are applying for. Permission is granted to the licensee hereafter designated under Sec. 79-a and 79-b of Alcoholic Beverage Control Law, to sell win products containing not more than 6% alcohol by volume. To obtain this permit and/or to exercise the privileges conferred by this permit applicant/permittee shall be subject to the following conditions: 1. The applicant must be currently licensed by a "basic license" to operate either a grocery; drug store; eating place; summer eating place; winter eating place; and the premises licensed must be open and operating; all as a prerequisite to the issuance of the Wine Product Permit. 2. This Wine Product Permit will only remain valid so long as the "basic license" remains in effect. 3. The sale of wine products under the permit shall be subject to the same rules, restrictions and conditions, as apply to the "basic license." 4. The permittee shall exhibit the permit upon demand, to any peace officer or any duly authorized representative of the Liquor Authority or the appropriate Local ABC Board having jurisdiction over the licensed premises. 5. Said permit shall be placed on display at all times next to “basic license” so that it will be plainly visible for inspection. 6. Sale of wine products to anyone under the age of twenty-one is prohibited and may subject the permittee to revocation of his Wine Product Permit and “basic license.” Revised 03-2011 American LegalNet, Inc. www.FormsWorkFlow.com MISCELLANEOUS II PERMITS CODE TYPE OF PERMIT FEE ORIGINAL FILING FEE BOND AY-638 AIRCRAFT COMPANY (3 YEARS) $ 768.00 $ 20.00 NO MA-738 AIRCRAFT (ONE TIME) $ 26.00 $ 10.00 NO AP-632 ALCOHOL PERMIT (3 YEARS) $ 18.00 $ 20.00 NO ANNUAL BEER FUNCTION $ 64.00 $ 10.00 NO BREWERS OUTDOOR (JUST A LETTER NEEDED) NONE NONE NO DA-633 DISTRIBUTORS ALCOHOL "A" (3 YEARS) $4,800.00 $ 20.00 NO DR-634 DISTRIBUTORS ALCOHOL "B" (3 YEARS) $2,400.00 $ 20.00 NO DC-635 DISTRIBUTORS ALCOHOL "C" (3 YEARS) $ 480.00 $ 20.00 NO DD-636 DISTRIBUTORS ALCOHOL "D" (3 YEARS) $1,152.00 $ 20.00 NO DR-644 DRUG STORE (3 YEARS) $ 153.00 $ 20.00 NO MH-640 HOSPITAL (3 YEARS) $ 78.00 $ 20.00 NO IA-630 INDUSTRIAL ALCOHOL (3 YEARS) $ 192.00 $ 20.00 NO IM-631 INDUSTRIAL ALCOHOL MANUFACTURER (3 YEARS) $2,400.00 $ 20.00 NO NONE NONE NO INDUSTRIAL ALCOHOL MANUFACTURER (FUEL ONLY) (3 YEARS) MY-639 MANUFACTURER-NON BEVERAGE PRODUCTS (3 YEARS) $ 768.00 $ 20.00 NO MM-739 MANUFACTURER-NON BEVERAGE PRODUCTS (ONE TIME) $ 26.00 $ 10.00 NO SY-637 STEAMSHIP PERMIT (SHIP STORES) (3 YEARS) $ 768.00 $ 20.00 NO MS-737 STEAMSHIP PERMIT (SHIP STORES) (ONE TIME) $ 26.00 $ 10.00 NO American LegalNet, Inc. www.FormsWorkFlow.com MISCELLANEOUS II PERMITS CODE TYPE OF PERMIT FEE ORIGINAL FILING FEE BOND WINE PRODUCT PERMIT Cities of Albany, Buffalo, Rochester Syracuse, Yonkers, City of New York (including the boroughs of Manhattan, Bronx, Queens, Brooklyn and Staten Island) $ 165.00 NONE NO WINE PRODUCT PERMIT For all other locations $ 83.00 NONE NO Revised 3/25/11 American LegalNet, Inc. www.FormsWorkFlow.com