SEP1011-rev081512 PERMIT NEW YORK STATE LIQUOR AUTHORITY ALCOHOLIC BEVERAGE CONTROL SPECIAL EVENT PERMIT APPLICATION This application must be accompanied by the appropriate fee in check or money order ONLY, made payable to the New York State Liquor Authority. Cash will NOT be accepted. APPLICATIONS SUBMITTED WITHOUT THE PROPER FEE AND/OR WITHOUT THE PROPER ATTACHMENTS WILL BE DISAPPROVED. TYPE OF SPECIAL EVENT PERMITS AND ASSOCIATED FEES Type of Permit Fee All Night Permit (New Years Eve) Caterers (one time) Non-Refundable Filing Fee $51.00 $38.00 Total Fee per Point of Sale per date $10.00 $61.00 $48.00 Charitable (one time) $20.00 alcohol may not be served for consumption None $20.00 Wine/ Liquor Auction ***Temporary Beer & Wine (one time) None $3,200.00 $36.00 $3,200.00 $26.00 $10.00 $10.00 *** The Alcoholic Beverage Control Law limits the number of Temporary Beer & Wine permits that can be issued for a location to four (4) permits during a 12 month period. Total Fee Due: A separate fee is required for all points of sale and for all dates of an event. (ie..for a Temporary Beer & Wine Permit - 2 points of sale x two days = $144/ For a Caterer's Permit - 2 points of sale x two days = $192) Completed applications and any supporting information should be mailed to: NEW YORK STATE LIQUOR AUTHORITY PO BOX 3796 NEW YORK, NY 10008-3796 Page 1 of 9 American LegalNet, Inc. www.FormsWorkFlow.com SEP1011-rev081512 PERMIT SPECIAL EVENT PERMIT 1. Type of Event Caterer Permit ($48 for each point of sale for each date) Charitable Permit ($20 per event date) All Night Permit Temporary Beer and Wine Permit ($36 for each point of sale for each date) Wine/Liquor Auction Permit Will the event be open to the public? YES YES Has this event been advertised? NO NO Please attach a copy of the advertisement or provide a description of how the event was advertised. 2. Applicant Information Has the applicant ever applied for a temporary beer & wine permit? YES Is the applicant currently licensed by the New York State Liquor Authority? YES NO NO If YES, provide date last applied: If YES, provide License Serial Number THIS SECTION MUST BE COMPLETED BY ALL APPLICANTS Name of Applicant, Organization or Group: Trade Name (if applicable): Business or mailing address of applicant: City: State: County: Telephone No. (include area code): FEIN or Social Security Number: Zip Code: Applicant Fax Number: Applicant E-Mail Address: Has the applicant or (if partnership) any of the partners, or (if a corporation) any of the officers, directors, stockholders, or any agent or employee of the applicant, ever been CONVICTED (including pleas of guilty or suspended sentences) of any felony or of any other crime or offense of any kind except traffic violations? YES NO Previously Reported If YES, submit a Certificate of Disposition or a Certificate of Conviction by the Court Clerk for each case. Page 2 of 9 American LegalNet, Inc. www.FormsWorkFlow.com SEP1011-rev081512 PERMIT 3. Event Information If the event is a street fair or block party, the applicant is required to obtain a letter from the local municipality lifting the open container law. If the event will be held for a beer tasting or brewfest, a signed Brewfest Requirement Form (found on the website under Special Event Permits) must be included with the application. If the event is for sports fighting, a signed Contact Sport Questionnaire (found on the website under Special Event Permits) must be included with the application. If games of chance will be held, a copy of the Racing and Wagering Permit must be included with the application. Select the type of event that best describes your function: * If event type is "Other" please provide a brief description below. Event Schedule Date(s) of event: Start Time End Time (indicate AM or PM): (indicate AM or PM): 1. 2. 3. 4. Where will the event be held: INSIDE OUTSIDE INSIDE AND OUTSIDE TENTED A. Diagram of Event Area Attach a diagram of the area to be licensed indicating restricted area for the sale and consumption of alcoholic beverages, the location of all points of sale, restrooms and all entrances/exits. This must be included or the application will not be accepted. Number of bars or stands serving alcoholic beverages: (Each bar is considered a point of sale and is required to have a permit.) Number of restrooms available: Number of entrances/exits to restricted area: Applicants may not share the proceeds from the sale of alcoholic beverages. If the event is a fundraiser, provide the name of the beneficiary and describe how monies will be raised: Name of beneficiary: Description of fund raising activities: Page 3 of 9 American LegalNet, Inc. www.FormsWorkFlow.com SEP1011-rev081512 PERMIT 4. Venue A. Location Information Name of place where event is to be held: Street address where event is to be held: City: State: Zip Code: Telephone No. (include area code): County: Number of Attendees (Mandatory): B. Landlord Information Name of Landlord/Owner of property where the event will take place: Will the event be held on a licensed premises? YES NO If YES, state license number: Has the premises ever been licensed? YES NO If YES, state license number: I, the landlord/owner of the applied for premises, hereby grant permission for the sale or services of alcoholic beverages by the applicant for consumption on said property. Landlord Signature Title Date Printed Name of Landlord: 5. Security Name of Police Jurisdiction at event site: (for NYC applicants, please specify precinct) Address: City: State: Zip Code: Please provide details as to the security measures in place and include the method for preventing underage alcohol consumption, method for preventing service to intoxicated individuals, containing consumption to the restricted area, the number of personnel and their duties. Off duty police may not provide security. Page 4 of 9 American LegalNet, Inc. www.FormsWorkFlow.com SEP1011-rev081512 PERMIT 6. Caterer Permits Attach a menu for food and alcoholic beverages to be served by the applicant/licensee A. Caterers Permits ONLY Name of the person, organization, group, association, sodality, auxiliary or not for profit that hired the applicant/licensee: Business or mailing address of above: City: County: State: Zip Code: Telephone No. (include area code): B. Caterers Permits for club licensees -- OFF the club premises ONLY I certify that I am an authorized officer of the applicant licensee club; that the event to be held will be exclusively for the use and benefit of the club members only and will be so restricted; that the club has not advertized such an affair as open to the public; alcoholic beverages shall be sold only to members attending such event ; and that the statements contained in this application are true. Authorized Officer Signature Title Date C. Caterers Permits for club licensees -- ON the club premises ONLY The Alcoholic Beverage Control Law provides that a Caterer's Permit may be issued to a licensed club to cater an affair to be held on the club premises if the event meets criteria 1, 2 and 3 or criteria 4: 1. The event is to be held by the sodality, auxiliary or other organization affiliated with the licensed club (state which): 2. A particular charitable or non-profit event is to be held by the organization which is a charitable or non-profit organization and such organization has one or more members who are also members of the club (state names): 3. The event is in conjunction with the use of the primary athletic or sports facilities of the licensed club and is to be held by the non-affiliated organization (state name of primary athletic or sports facilities): 4. The event is being held on the club premises because no other suitable licensed premises authorizes to sell alcoholic beverages to the public is available within a reasonable distance (set forth the facts to establish foregoing): (Use additional sheets if necessary.) I certify that I am an authorized officer of the applicant licensee club; that the club has not solicited the event, nor advertised such event in any manner as open to the public and alcholic beverage shall be sold only to persons invited to and attending such event ; and that the statements contained in this application are true. Authorized Officer Signature Title Page 5 of 9 Date American LegalNet, Inc. www.FormsWorkFlow.com SEP1011-rev081512 PERMIT 7. Authorization This certification must be signed and dated by: the individual applicant OR each member of a partnership OR an officer duly authorized by order of the Board of Directors of the applicant corporation, group or association to make the statements and answers in this application on behalf of said applicant entity, with the same force and effect as if said entity made such statements and answers itself. PROVIDE THE FOLLOWING FOR ALL AUTHORIZED SIGNATURES BELOW (attach additional sheets if necessary): Print Name: Date of Birth: Residence street address: City: State: County: Zip Code: Telephone No. (include area code): Print Name: Date of Birth: Residence street address: City: State: County: Zip Code: Telephone No. (include area code): Print Name: Date of Birth: Residence street address: City: State: County: Zip Code: Telephone No. (include area code): I certify that I know the contents of this application and the statements contained therein; that the same are true of my own knowledge; and that I am authorized to execute this application and sign this certification. I further certify that I have read the terms and conditions included with this application for the special event permit and agree to comply with the conditions. Authorized Signature Title Date Authorized Signature Title Date Authorized Signature Title Date [OFFICE USE ONLY] Approved Disapproved Amount Rec'd Deposit Date Reason for Disapproval: Audited by Batch Page 6 of 9 Item American LegalNet, Inc. www.FormsWorkFlow.com SEP1011-rev081512 PERMIT 8. Terms and Conditions ALL PERMITS All special event permits are subject to the following terms and conditions: 1. No person shall sell, deliver or give away or cause or permit or procure to be sold, delivered or given away any alcoholic beverages to any person, actually or apparently under the age of twenty-one years. 2. No child, actually or apparently under the age of 16 years will be admitted to the premises at which event is held unless accompanied by their parent or guardian or by an adult person authorized by its parent or guardian, as provided by of §260.20 of the Penal Law. 3. No sale or service of alcoholic beverages shall be made during the hours prohibited by the provisions of §106 (5) of the Alcoholic Beverage Control Law or by rule of the county government having jurisdiction in the county in which the event is held. 4. No alcoholic beverage may be sold, served or consumed in any area where bingo is played. 5. Alcoholic beverages must be purchased from a licensed brewer, winery, or wholesaler ONLY, and not from a retail licensee. 6. A separate permit is required for each point of sale for each date. The permit must be on display at the event. ALL NIGHT PERMITS -Section 99 Applicants must have an active on premise license to apply for an all night permit. An all night permit authorizes licensee to remain open to sell alcoholic beverages between the closing hour prescribed by statute or established county hours on any week day (New Year’s Eve). This permit shall be subject to the following conditions: 1. Applications must be received by the Liquor Authority no later than 45 days prior to the date of the event (November 16th). 2. Notice of the licensee's intent to apply for the permit must be sent to the local police department or, if there is no local police department, to the County Sheriff’s Department. Proof that the notice was mailed must be included with the application. Acceptable proof is either (1) a copy of the notice and a certified mail receipt card or (2) the original, or a copy of the notice stamped and signed by the police department. 3. The permit is valid for the hours between the closing hour prescribed by statute or by the county government having jurisdiction and 8:00 a.m.. 4. The sale of any alcoholic beverage under said permit shall be subject to the same rules, restrictions and conditions as apply to the alcoholic beverages which the said permittee is permitted to sell under their license. 5. PERMIT MUST BE PLAINLY VISIBLE FOR INSPECTION DURING THE TIME IT IS IN EFFECT. 6. All night permits will not be issued for a Sunday. NOTE: In deciding whether to issue the permit, the Authority will consider the licensee’s disciplinary history (including pending charges) and whether, given the nature of the event, the licensee has adequate facilities and security plans in place. The Authority’s Licensing Bureau will make a decision on each application within 10 business days of filing. If the Licensing Bureau denies the application, the licensee can request a review of the decision by a Member of the Authority. Such requests should be sent to the Office of Counsel at the Authority’s Albany office. A Member of the Authority will review the decision and make a final determination within 10 business days of receipt of the request. Page 7 of 9 American LegalNet, Inc. www.FormsWorkFlow.com SEP1011-rev081512 PERMIT CATERERS PERMITS (all) - Section 98 Authorizes an active on-premises retail licensee to furnish alcoholic beverages for use at a specific event located off the licensed premises. Applicant must be hired to furnish provisions (food) and alcoholic beverages at the event. An applicant cannot cater for themselves. Such permit shall be valid for a period not to exceed 24 consecutive hours commencing 8:00 a.m. of the effective date of such permit and shall authorize the permittee to furnish provisions and alcoholic beverages for use at an indoor event. This permit shall be subject to the following conditions: 1. Application must be received by the Liquor Authority a minimum of 15 days prior to the event. 2. Food must be provided by applicant/licensee, meeting the minimum requirements under §64-a of the Alcoholic Beverage Control Law, for example: salads, soups, sandwiches, finger foods. Pretzels and potato chips do not meet the minimum requirements for food. CATERERS PERMITS FOR CLUB LICENSEES Authorizes a club licensee to furnish alcoholic beverages to MEMBERS for use at events located off the licensed premises. Authorizes a club licensee to furnish alcoholic beverages for events on the licensed premise in accordance with §98(2). Such permit shall be valid for a period not to exceed 24 consecutive hours commencing 8:00a.m. of the effective date of such permit and shall authorize the permittee to furnish provisions and alcoholic beverages for use at an indoor event. This permit shall be subject to the following conditions: 1. Application must be received by the Liquor Authority a minimum of 15 business days prior to the event. 2. Food must be provided, meeting the minimum requirements under §64-a of the Alcoholic Beverage Control Law, for example: salads, soups, sandwiches, finger foods. Pretzels and potato chips do not meet the minimum requirements for food. CHARITABLE PERMITS - Section 99(a) Authorizes a charitable, religious, civic or educational organization to sell alcoholic beverages, at auction or otherwise. Such permit is valid for a 24 hour period commencing at 8 a.m. and only during the hours when such alcoholic beverages may lawfully be sold by retail licensees in the county in which the auction or sale is held. This permit shall be subject to the following conditions: 1. Contributions made by an individual donor to applicant organization are deductible for federal income tax purposes. 2. The funds so raised will be used for non-profit purposes of the organization. 3. All such alcoholic beverages shall be in sealed containers. 4. Not more than eighty (80) cases shall be sold. 5. No alcoholic beverages sold pursuant to such permit shall be consumed on the premises at which they are sold. 6. Applicant must provide a statement as to how alcoholic beverages are to be acquired: purchase, gift or otherwise. Page 8 of 9 American LegalNet, Inc. www.FormsWorkFlow.com SEP1011-rev081512 PERMIT TEMPORARY BEER & WINE PERMITS - Section 97 Authorizes the sale of WINE or BEER at retail for consumption at a gathering for a period not to exceed 24 consecutive hours. Such permit shall be valid for a period not to exceed 24 consecutive hours commencing 8:00 a.m. of the effective date of such permit except that in no event shall the sale of beer be permitted prior to 12:00 Noon on Sunday or during the hours prohibited by the Alcoholic Beverage Control Law or by rule of the county government in which the event is being held. This permit shall be subject to the following conditions: 1. Application must be received by the Liquor Authority a minimum of 15 days prior to the event. 2. No alcoholic beverages except beer or wine may be kept or be permitted to be kept or sold on the premises during the period that any permit issued in accordance with this application is in effect. 3. No beer or wine may be taken from the premises where said event is held except that at the termination of said event, any beer or wine which shall remain on hand will be removed from said premises by brewer, winery or wholesaler from which it was purchased, or by its designated agent. 4. Beer may be sold, served or consumed in rooms or areas in which authorized games of chance are held. Applicants must provide a copy of the Racing and Wagering certificate with the application. 5. The Alcoholic Beverage Control Law limits the number of Temporary Beer & Wine permits that can be issued for a location to four (4) permits during a 12 month period. WINE & LIQUOR AUCTION PERMITS - 99(g) The permit is issued for a calendar year and allows the holder to conduct up to twelve (12) auctions during that period. The permittee may also conduct wine tasting on the premises of any location approved by the Authority for conducting wine/liquor auctions, subject to the following conditions: 1. Only retail off-premises licensees who have been licensed for ten years or more may apply for the permit. 2. The wine/liquor auction permit is in addition to any required local permits. 3. A final list of wineries attending an auction is required to be submitted with the application. Page 9 of 9 American LegalNet, Inc. www.FormsWorkFlow.com