plcb-2313 2/12 I commonwealth of pennsylvania pennsylvania liquor control board application by hotel licensee for exemption from bedroom requirements bureau of licensing pursuant to section 461(c)(9) the undersigned hereby applies to be exempt from the requirement to maintain bedrooms for public accommodation. 11. name of licensee license no. 12. trade name (if any) lid no. 13. address of premises (street, rural route, p.o. box no.) (post office) (state) (zip) 14. will all or some of the areas currently designated as bedrooms be licensed for serving or storage of liquor or malt or brewed beverages consistent with the liquor code and board regulations? if "yes," list those areas intended to be converted to serving or storage areas: location (floor) yes no size (width x length) 15. will any of the areas currently designated as bedroom areas be used for any purpose other than licensed serving or storage (see no. 4)? if "yes," is it all or some of the bedroom areas? submit plans and fully explain what the new use will be: all some yes no 16. 1 will another business be conducted in the existing bedrooms? yes no a. what type of business will be conducted? b. by whom? do not write below this line American LegalNet, Inc. www.FormsWorkFlow.com 7. resolution (corporations, limited liability companies and limited partnerships only) at a regular or special meeting held on __________________________________________ , 20 ______by the applicant it was resolved that said application be filed with the pennsylvania liquor control board, and that _________________________________________ and/or _______________________________________ is/are hereby (name/title) (name/title) authorized to execute said application, and any other papers required by the board. I swear or affirm, subject to the penalties provided by 18 Pa. C.S. §4904, 47 P.S. §4-403(h) and/or §4-436(j), that the foregoing answers and statements provided herein are true and complete to the best of my knowledge and belief. signature title name of attorney representing you in this matter, if any home address phone address signature title phone home address phone date signed e-mail address instructions this form is to be submitted by licensees holding either hotel liquor or hotel malt beverage licenses granted prior to January 1,1965 in municipalities having a popoulation of less than ten thousand (10,000) persons druing the 2000 Federal Decennial census and hotel licensees that were granted prior to september 1, 1949, which lapsed not more than once, provided that a new Hotel License was granted prior to January 1, 1971. if the application is not approved, the establishment must maintain the minimum number of bedrooms required by law. all questions must be answered. 1. A filing fee is not required. 2. an investigation may be required. those areas currently designated as "bedrooms" may be used as licensed serving or storage areas. complete question #4 if you intend to use all or some of the areas for licensed service or storage . 3. complete question #5 if you intend to use any of the area(s) formerly designated as bedroom areas for any other purposes; i.e., permanent rental units, etc. 4. complete question #6 if another business will be conducted in the area(s) formerly designated as bedroom areas. interior connections to another business will require board approval. 5. Plans are required showing the proposed changes listed in response to Questions 4, 5 or 6. Plans must be on 8½" x 11" paper and must be clear and readable. they do not have to be professionally drawn but must show room dimensions, interior connections, passageways and hallways and all entrances and exits to the building. this application must be approved by the pennsylvania liquor control board before physical alterations or new construction is begun. information if you require assistance in completing the application, call the licensing information center AT (717) 783-8250, OPTION #7. send completed application with floor plans to: pennsylvania liquor control board, bureau OF LICENSING, P.O. BOX 8940, HARRISBURG, PA 17105-8940. American LegalNet, Inc. www.FormsWorkFlow.com