PLCB-2289 7/05 I APPLICATION FOR SUNDAY SALES PERMIT (WHOLESALE LICENSES) COMMONWEALTH OF PENNSYLVANIA PENNSYLVANIA LIQUOR CONTROL BOARD BUREAU OF LICENSING The undersigned hereby applies for a Sunday Sales Permit for the license expiring . 1. NAME OF LICENSEE LICENSE NO. 2. TRADE NAME (IF ANY) LID NO. 3. ADDRESS OF PREMISES 4. (STREET, RURAL ROUTE, P.O. BOX NO.) (POST OFFICE) (STATE) (ZIP) RESOLUTION (CORPORATIONS AND LIMITED LIABILITY COMPANIES 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 and 47 P.S. §4-436(j), that the foregoing answers and statements provided herein are true and complete to the best of my knowledge, information, and belief. SIGNATURE TITLE NAME OF ATTORNEY REPRESENTING YOU IN THIS MATTER, IF ANY HOME ADDRESS PHONE ADDRESS SIGNATURE TITLE HOME ADDRESS PHONE ( ) PHONE ( ( ) DATE SIGNED ) INSTRUCTIONS This form is to be submitted by manufacturers, distributors and importing distributors to apply for a Sunday Sales Permit. All questions must be answered. A filing fee of $100.00 is required. Remittance made payable to "PLCB" or "Commonwealth of Pennsylvania." IF YOU REQUIRE ASSISTANCE IN COMPLETING THE APPLICATION, CALL THE LICENSING INFORMATION CENTER AT (717) 783-8250, OPTION #7. SEND COMPLETED APPLICATION WITH FILING FEE TO: PENNSYLVANIA LIQUOR CONTROL BOARD, BUREAU OF LICENSING, P.O. BOX 8940, HARRISBURG, PA 17105-8940. American LegalNet, Inc. www.FormsWorkflow.com