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Standardized NOTICE FORM for Providing 30-Day Advance Notice to a Local Municipality or Community Board

Meetings/Documents/wd::dc_1731_bliss_liquoir_license
Working document2025-01-28

49

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rev-0 1/28/25 me |LiquorLiquor ----- End of picture text -----

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1/28/25 OFFICE USE ONLY me |LiquorLiquor © Originaligi © Amended Datete . Standardized NOTICE FORM for Providing 30-Day Advance Notice to a Local Municipality or Community Board ses r——r———————

  1. Date Notice Sent: 1a. Delivered by: \uw x o\ \ a ----- End of picture text -----

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; 2. Select the type of Application that will be filed with the Authority for an On-Premises Alcoholic Beverage License: For premises outside the City of New York: @ New Application EQ Removal © Class Change For premises in the City of New York: (counties of Kings, New York, Bronx, Queens and Richmond): © New Application © New Application and Temporary Retail Permit © Temporary Retail Permit © Removal © Class Change © Method of Operation © Corporate Change ORenewal © Alteration For New and Temporary Retail Permit applicants, answer each question below using all information known to date For Renewal applicants, answer ail questions For Alteration applicants, attach a complete written description and diagrams depicting the proposed alteration(s) For Corporate Change applicants, attach a fist of the current and proposed corporate principals For Removal applicants, attach a statement of your current and proposed addresses with the reason(s) for the relocation For Class Change applicants, attach a statement detailing your current license type and your proposed license type For Method Method of Operation Change Operation Change Change applicants, although not required, required, if you choose to submit, choose to submit, to submit, submit, attach an explanation an explanation explanation detailing those those Please include all documents as as noted above. above. Failure to do so may result in to do so may result in do so may result in so may result in may result in result in in disapproval of the application. the application. application. This 30-Day Advance 30-Day Advance Advance Notice is Being Provided to the Clerk of the Following Being Provided to the Clerk of the Following Provided to the Clerk of the Following to the Clerk of the Following the Clerk of the Following Clerk of the Following of the Following the Following Following Local Municipality or Community Board: or Community Board: Community Board: Board: Applicant/Licensee Information: 4. Licensee License ID (if applicable):[ Expiration Date (if applicable): [ 7. Street Address of Establishment: Oo Vor SK roe AUD usiness E-mail of Applicant/Licensee Pe @ + A A nN 11. Type(s) of alcohol sold orto be sold: © Beer & cider © Wine, Beer & Cider @ Liquor, Wine, 8eer & Cider ----- End of picture text -----

For Method Method of Operation Change Operation Change Change applicants, although not required, required, if you choose to submit, choose to submit, to submit, submit, attach an explanation an explanation explanation detailing those those changes Please include all documents as as noted above. above. Failure to do so may result in to do so may result in do so may result in so may result in may result in result in in disapproval of the application. the application. application.

This 30-Day Advance 30-Day Advance Advance Notice is Being Provided to the Clerk of the Following Being Provided to the Clerk of the Following Provided to the Clerk of the Following to the Clerk of the Following the Clerk of the Following Clerk of the Following of the Following the Following Following Local Municipality or Community Board: or Community Board: Community Board: Board:

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  1. Extent of Food Service: @ Full Food menu; full kitchen run by a chef/cook © Menu meets legal minimum food requirements; food prep area required 13.Typeoftstablshment: [ Res \auwauk 7 cabima/ AMARA Caters oO Seasonal Establishment a Juke Box Lbisc Jockey OlRecorded Music oO Karaoke 14, Method of Operation: [Patron Dancing =] Employee Dancing —_ [] Exotic Dancing (71 Toptess Entertainment (CI Video/Arcade Games C third Party Promoters LO security Personnel Dlothertspecty: [__
  2. Licensed Outdoor Area: [Hine (J patioor Deck LL) Rooftop (] Garden/Grounds [] Freestanding Covered Structure ----- End of picture text -----

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16, List the floor(s) ofthe building that the establishment is located on: a 17. List the room number(s) the establishment is located in within the building, if appropriate: C_strti(‘t;;TCTCOCOC™C™CTT 18. Is the premises located within 500 feet of three or more on-premises liquor establishments? @yYes € No 19, Will the license holder or a manager be physically present within the establishment during all hours of operation? @ Yes O No

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  1. If this is a transfer application (an existing licensed business is being purchased) provide the name and ID number of the licensee:

Name

License ID Number

  1. Does the applicant or licensee own the building in which the establishmentislocated? § <~ Yes (if YES, SKIP 23-26) @No

Owner of the Building in Which the Licensed Establishment is Located

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23, Building Owner'sstreet address: [— (5 Eaat \ovko\ Saved 24. City, Town or Village: Tie Heol si State: SS ZipCode: | } 2 G2 ----- End of picture text -----

Representative or Attorney Representing the Applicant in Connection with the Application for a License to Traffic in Alcohol at the Establishment Identified in this Notice

1am the applicant or licensee holder or a principal of the legal entity that holds or is applying for the license. Representations in this form are in conformity with representations made in submitted documents relied upon by the Authority when granting the license. | understand that representations made in this form will also be relied upon, and that false representations may result in disapproval of the application or revocation of the license.

By my signature, | affirm - under Penalty of Perjury - that the representations made in this form are true.

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Date: CEE Page 2 of 2 ----- End of picture text -----