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Joey's Italian-American Restaurant A 8 rd - 5T ATE OF NEW YORK EXECUTIVE DEPARTMENT ON OF ALCOHOLIC BEVERAGE CONTROL STATE LIQUOR AUTHORITY licatiol~ inal copy of this Notice was Mailed to the Local Municipality or Community Board: TiES 30-DA Y ADV ANCE NOTICE IS BEING MAILED TO THE CLERK OF THE FOLLOWING LOCAL MUNICIPALITY OR COMMUNITY BOARD 2. Name of the Local Municipality or Community Board: 3. Street Address of Local Municipality or Community Board: 4. City, Town, or Village: WAPPINGER FALLS 5, Telephone Number of Clerk of Local Municipality or Community Board: REPRESENTATIVE REPRESENTING THE APPLICANT IN CONNECTION WITH THE APPLICANT'S ORIGIN AL (FIRST) ON_PREMISES ALCOHOLIC BEVERAGE LlC,NSE A"UCA TION "OR TIlE EST ABUSHMW' IDENTIFIED IN THIS NOTIce 6. Representatives Full Name is: GLEN F KUBIST A & ASSOCIATES 7. Representative's Street Address: 242 BROADWAY PO BOX 670 8. City, Town, or Village: PORT EWEN 9. Business Telephone Number of Attorney- THE ",UCAN< WILL FILE AN O'IGlNAL (,,,sn WLlCAnON FO' ^" ON-P""'SES ALCOHOUC BEVERAGE LICENSE IN O,OER TO CONDUCT _ WITHIN THE \DENTIF"D EST ABLlSH""N' . THF TVPE OF BU"NESS DESC'IBEO BELOW 6I;~_I 10 Type(s) of Alcohol to be sold under the License ("IV ~-\ oBeer o Wine and Beer Only ~ Liquor, Wine, and Beer Only - Extent of ~ RestaUrant (Sale of Food o Tavern_Restaurant (A mixed-u," establishment that o Tavern I Cocktail Lounge! Ad"" I 11- Food Service: Primarily; Full Food Menu; has both a sit-down dining area and a "stand-up" bar Bar (Alcohol sales primarily' 111,','l ,..,.al ('x"QIlIl.) Kitchen run by Chef where patrons may receive direc\ deliveries of alcohol) minimum food availability fI;.~q\llll'lll\:li\', I o Hote\ ...---- 12- Type of OLive o Disk OJOke o Patron Dancing 0 Cabaret. Night Club, Discotheque Dcap,,,,,, !,IIO Establishment' Music Jockey Box (Small Scakl (Large Scale Dance Club) or ill,'I<,' I',ll\ liS ("x" all c=O o Club (e.g. Golfl o Bed & 0 Catering D Stage o Topless ~ Other RESTAURAN I that apply) FraternaIOrg.) Breakfast Facility Show~ Entertalnment (specify): & PIZZERIA i Proposed ~ None o RooftoP '1 13. o PatiO o Freestanding o Garden I D Other OUldoor Area(s): or Deck Covered Structure Grounds (Specify): 14 Willlhe proposed License Holder or a Manager be physically present within the establishment during All Hours of Operation? ('X- ~ \ ~ YESl ON~ 15- Application Serial Number: \ T \6. The Applicant's Full Name as it will appear in the application \J --r- "".. 00-",,",,", ~oohol. __ Li_." J.T .0. ENTERPRISES 0 F DUTCHESS coUNTY, LLC 17. The FU~nNa~e ofthe Applicant s proposed licensed Establishment (the Trade Name --+- d. 7''''.' F"Foe' L"'"'' E..,'ohm'" will .",,,1 ,,,',,"1" JOEY'S IT AllAN-AMERICAN RESTAURANT ~ 18. The Apphcant s proposed Licensed Establishment is localed \: 19- wlthm the bUlldmg whtch has the following Slreet Address- 235-237 MYERS CORNERS ROAD Ctty, Town, or Village: \W APPINGER FALLS 20. The proposed Licensed Establishment will be located on the followmg floor(s) oflhe bulldmg al Ihe above address II NY Zip Code 12590 --+- 2L , Wlthm the bUlldmg at the abo dd h ve a ress, I e proposed Licensed Eslablishment will be 10C,llcd wlthm Ihe room(s) numbered as fonows: \ 9 ~ 22 BUSll1ess Telephone Number of Ihe Applicant: 8 4 5 2 9 . -..-+- - 8 - 5 7 'i X 23. Business Fax Number of the Applicant: . ... f . 24. . Business E-Mail Address of the Applicant: 25. IF YOU KNOW - Was .theredever an alcoholic beverage license in effect for the space where \ \ '. you mten to operate your hcensed establishmenl? IZI 0 1 0 Yes No I Don'l i., 1\"\\ . OWNER OF TH' B",LOONG IN WHICH THE PROPOSED LICENSED EST "\-I'HMENT WILL BE LOCATED 26. Does the Apilhcant own the building in If'YES", SKIP ilems No. 27,28,29, & 30 . which the proposed Licensed Yes 0 If"NO', ANSWER items No , .1;.) "',&301 Estabhshment will be located? ("X" ~ Go dllectly 10 Item No- 3 1 NOIZI Then continue to lkll\ and complele Ihe fon~. ' i 27. Building Owner's Fun Name is: and complete thl: lll: III E.G.S ENTERPRISES, INC. --_._-~ 28. Building Owner's Streel Address: 19 CADY LANE - 29. City, Town, or Village:\W APPINGER FALLS INY Zip Code: 30. Business Telephone Number of Building Owner: 18 \ I 25l)() 4 5 1 2 I 9 r I 5 To -\0 -'10 T - 7 - .,.11.2009 p.ll02) ST ATE OF NEW YORK EXECUTIVE DEPARTMENT 'DIVISION OF ALCOHOLIC BEVERAGE CONTROL ST ATE LIQUOR AUTHORITY SlandardizedORIGlNAL APPLICATION NOTICE FORMfar Providlllg" 30-Dav Advance Notice 10 a Local Municipality or Community Board In conlleellllll wllh the submissIOn 10 the Slole Liquor AUlhorily oflhe Applicant's Origi.nal (First) On-Premises Alcoholic Beverage License Aoplicatl<lll for the Establishment Identified in this Notice (Page 2 oj:') IN ORDER TO MAKE SURE THAT PAGES I AND 2 OF YOUR NOTICE ARE NOT SEPARATED OR MISPLACED \1 PLEASE RE-ENTER IMMEDlATEL Y BELOW THE INFORMATION REGARDING YOUR APPLICATION SERIAL NUMBER, NAME AND TRADE NAME II YOUR COURTESIES ARE APPRECIA TED IS. Application Serial Number: I 16. The Applicant's Full Name as it will appear in the application I, for the On-Premises Alcoholic Beverage License, is. J.T.D. ENTERPRISES OF DUTCHESS COUNTY, LLC 17, The Full Name of the Applicant's proposed licensed Establishment (the Trade Name I, under which the proposed Licensed Establishment will conduct business) is: JOEY'S IT AllAN-AMERICAN RESTAURANT .- INFORMATION REGARDING ANY BUSINESS LICENSED TO SELL ALCOHOLIC BEVERAGES THAT IS CURRENTLY BEING OPERATED IN THE SPACE WHERE THE APPLICANT INTENDS TO OPERATE HIS/HER/ITS PROPOSED LICENSED ESTABLISHMENT 31. IF YOU KNOW. Is a business that IS licensed to sell alcoholic beverages currenlly being cnnducled Yes ~ NoD I Don't Knl" m the space where you intend to operate your licensed establishment? Are you buying any asset(s) owned by the operator of the licensed business currently being conducted 32. in the space where you intend to operate your licensed establishment? Yes 0 No~ (For example: good will, equipment, furniture, cookware, dishware, etc.) vO IF YOU ANSWERED ~TO ITEM 31 OR 32 SKIP ITEMS NO. 33 AND 34. GO DIRECTL Y TO ITEMS NO. 35, 36, 37, 38 AND 39. IF YOU ANSWERED ~TO ITEMS 31 AND 32, PLEASE PROVIDE THE INFORMATION REQUESTED BY ITEMS NO 33 AND 34 IF A BUSINESS LICENSED TO SELL ALCOHOLIC BEVERAGES IS NOT CURRENTL Y BEING OPERATED IN THIS SPACE WHERE THE APPLICANT INTENDS TO OPERATE HIS / HER / ITS PROPOSED LICENSED ESTABLISHMENT, PLEASE PROVIDE INFORMATION REGARDING ANY BUSINESS LICENSED TO SELL ALCOHOLIC BEVERAGES THAT WAS MOST RECENTLY OPERATED UN THIS SPACE., 33. IF YOU KNOW -I Was a busJness that was licensed to sell alcoholic heverages previously conducted Yes~ NoD in the space where you intend to operate your licensed establishment? I Don't KIll. Are you buying any asset(s) owned by the operator of the licensed business that was most recently conducted 34. in the space where you intend to operate your licensed establishment" Yes 0 No~ (For eXllTl1'le: good will, equipment, fiuniture, cookware, dishware, etc. ) " [] IF YOU ANSWERED 'YES' TO ITEM NO.3 I OR 32 OR 34, THEN PLEASE ANSWER ITEMS NO. 35 and 36 and 37 and 38 and 39 1\ OF THY.r LICENSED BUSINESS WHERE THE APPLICANT INTENDS TO OPERATE HIS I HER / ITS LICENSED ESTABLISHMENT. PLEA IF YOU KNOW- The Full Name of the Operator of the licensed business 35. now being conducted (or that was most recently conducted) in the space where you intend to operate your licensed establishment IF YOU KNOW - The Full Name of the licensed Establishment (the Trade Name) 36. now being operated (or that was most recently operated) in the space where you intend to operate your licensed establishment: IF YOU KNOW- The alcoholic beverage license serial number of the business 37. now being conducted (or that was most recently conducted) in the space where you intend to operate your licensed establ ishment: IF YOU KNOW. The Type of Alcoholic Beverage License held by the current (or most recent) licensed operator: F & S RISTORANTE INC I Don't KIl<>1I [] CALABRIA I Don't Kill '" 0 2104110 I Don't KIl<l" [J I Don't KIl()\\ 0 I Don't KIl' [gJ 38. 39. IF YOU KNOW - Telephone Number of the current licensed operator or the most recent licensed operator: 41 If the Original Application is approved, I am the Person who will hold the license or] am a Principal or the Legal Entity that will hold the l,iCL"lhL Representations in this form are in full conformity with representations made in documents that have been subm II.kd (or documents that will be submitted) to the State Liquor Authority, and relied upon by the Authorll\ I understand that representations made in this fonn will also be relied upon by the Authority, and that false representations in any dOCIlIII"11I sub m i t t e d tot h e Aut h 0 r i t Y may res u I tin rev 0 c a I ion 0 fan y I ice n set hat m y b e i s S 11 l' .1 By my signature, I affirm - under Penalty of Perjury - that the representations made in this form are till<' Printed Name Tille .<iigllalllre JOSEPH M. MASSA MBER / MANAGER ~ /L.tJ.-CA- TOWN CLERK Chris Masterson TOWN SUPERVISOI{ Christopher J. COIsCI 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NY 12590 WWW.TOWNOFWAPPINGER.US (845) 297-4158 - Main (845) 297-5771 - Direct (845) 298-1478 - Fax TOWN BOARD William H. Beale Vincent Bettina Ismay Czarni<:c"i Joseph P. Pao\OI11 Office of the Town Clerk August 13t\ 2010 New York State Liquor Authority 80 South Swan Street Suite 900 Albany, New York 12210 Attn: Renewals Dear Sirs: Please be advised that the Town Board of the Town of Wappinger had been previously notified by J.T.D. Enterprises of Dutchess County, LLC, Joey's Italian-American Restaurant, 235-237 Myers Comers Road, Wappingers Falls, New York, of intention to file an application with the New York State Liquor Authority. This was approved at our Town Board Meeting on August 16,2010 In this instance the Town of Wappinger, hereby waives its right to the 30 day hold on processing the above application and consents to the Authority's Approval of said application. Sincerely, d C. Masterson own Clerk JCMlcf SAMPLE WAIVER Kerry O'Brien - Director of Licensing New York State Liquor Authority 80 South Swan Street Suite 900 Albany, New York 12210 RE J.T.D. ENTERPRISES OF DUTCHESS COUNTY, LLC. JOEY'S ITALIAN-AMERICAN RESTAURANT 235-237 MYERS CORNERS ROAD WAPPINGER FALLS NY 12590 Dear Ms. O'Brien The Town ofWappingers Falls acknowledges that an On Premises Liquor License Application is being filed by the above captioned licensee for the location so specified. In this instance the Town ofWappingers Falls waives its rights to the 30 day hold on processing the above application and consents to the Authority's Approval of said application. Please feel free to contact this office should you have any questions regarding this letter. This letter should be typed, on your letterhead, to the Liquor Authority, and sent to my office by mail or by fax 338-6057 ... (jfen ~ ~u6ista & .9lssociates 242 BROADWAY' PO Box 670 PORT EWEN, NEW YORK 12466 PHONE: (845) 338-8062 FAX: (845) 338-60:-,;' kubista@aol.com www.gkubista.com July 28, 2 ~~CG~~~~[j) Clerk, Town ofWappingers 20 Middle Bush Road Wappingers Falls, NY 12590 JUC 28 2010 TOWN OF WAPPINGER TOWN CLERK RE: J.T.D. ENTERPRISES OF DUTCHESS COUNTY, LLC. JOEY'S IT ALlAN-AMERICAN RESTAURANT 235-237 MYERS CORNERS ROAD WAPPINGER FALLS NY 12590 Dear Sir/Madam This office represents the above captioned licensee and on their behalf we are contacting your municipality as required by Section 64 Subdivision 2A of the ABC Law. At this time an Application is being filed with the State Liquor Authority for an On Premises Liquor License. This application cannot be processed for 30 days unless your municipality waives your rights to a 30 day hold and consents to the approval of the instant application. If a waiver is an option in this instance, kindly forward your letter of waiver and consent to the undersigned at the address listed above. CERTIFIED MAIL RETURN RECEIPT 7009 0960 0000 8618 6172 q (en!J. XJ,tbista & .9lssociates 242 BROADWAY' PO Box 670 PORT EWEN, NEW YORK 12466 FAX: (845) 338-6U, , PHONE: (845) 338-8062 kubista@aol.com www.gkubista.com July 28, 2010 Clcik, Town ofWappingers 20 Middle Bush Road Wappingers Falls, NY 12590 RE: J.T.D. ENTERPRISES OF DUTCHESS COUNTY, LLC. JOEY'S ITALIAN-AMERICAN RESTAURANT 235-237 MYERS CORNERS ROAD WAPPINGER FALLS NY 12590 Dear Sir/Madam This office represents the above captioned licensee and on their behalf we are contacting your municipality as required by Section 64 Subdivision 2A of the ABC Law. At this time an Application is being filed with the State Liquor Authority for an On Premises Liquor License. This application cannot be processed for 30 days unless your municipality waives your rights to a 30 day hold and consents to the approval of the instant application. If a waiver is an option in this instance, kindly forward your letter of waiver and consent to the undersigned at the address listed above. Thank you for your anticipated assistance i t~is instance. I s, fPa~(C~u Q) JUL' 29 2U1 TOWN OF WAPPINGER TOWN CLERK CERTIFIED MAIL RETURN RECEIPT 7009 0960 0000 8618 6172 SAMPLE WAIVER Kerry O'Brien - Director of Licensing New York State Liquor Authority 80 South Swan Street Suite 900 Albany, New York 12210 RE J.T.D. ENTERPRISES OF DUTCHESS COUNTY, LLC. JOEY'S IT ALlAN-AMERICAN RESTAURANT 235-237 MYERS CORNERS ROAD WAPPINGER FALLS NY 12590 Dear Ms. O'Brien The Town ofWappingers Falls acknowledges that an On Premises Liquor License Application is being filed by the above captioned licensee for the location so specified. In this instance the Town ofWappingers Falls waives its rights to the 30 day hold on processing the above application and consents to the Authority's Approval of said application. Please feel free to contact this office should you have any questions regarding this letter. This letter should be typed, on your letterhead, to the Liquor Authority, and sent to my office by mail or by fax 338-6057 STATE OF NEW YORK EXECUTIVE DEPARTMENT DIVISION OF ALCOHOLIC BEVERAGE CONTROL STATE LIQUOR AUTHORITY Standardized ORIGINAL APPLICATION NOTICE FORM.!or PrrJVIJIII,c ' 30-Dav Advance Notice to a Local Municinalitv or Communitv Board in connecllOn with the submission 10 the State Liquor AuthoT/ly of the Aoolicant's Oril!inal (First) On-Premises Alcoholic 8everal!e License Aoolicat;o" for the Establishment Identified in this Notice (Page I 01 " Date the Original copy of this Notice was Mailed to the Local Municipality or Community Board: TIES 30-DA Y ADVANCE NOTICE IS BEING MAILED TO THE CLERK OF THE FOLLOWING LOCAL MUNICIPALITY OR COMMUNITY BOARD 2. Name of the Local Municipality or Community Board: TOWN OF WAPPINGER 3. Street Address of Local Municipality or Community Board: 20 MIDDLEBUSH ROAD REPRESENTATIVE REPRESENTING THE APPLICANT IN CONNECTION WITH THE APPLICANT'S ORIGINAL (FIRST) ON-PREMISES ALCOHOLIC BEVERAGE LICENSE APPLICATION FOR THE ESTABLISHMENT IDENTIFIED IN THIS NOTICE 4. City, Town, or Village WAPPINGER FALLS 5, Telephone Number of Clerk of Local Municipality or Community Board: 6. Representatives Full Name is GLEN F KUBIST A & ASSOCIATES 7. Representative's Street Address 242 BROADWAY PO BOX 670 8. City, Town, or Village PORT EWEN 10. Type(s) of Alcohol to be sold under the License ("IV w.ti.1 o Beer D Wine and Beer Only ~ Liquor, Wine, and Beer Only i Extent of ~ Restaurant (Sale of Food D Tavern-Restaurant (A mixed-use establishment that D Tavern / Cocktail Lounge / Adult \ 11- Food Service: PrimaTily~ Full Food Menu~ has both a sit-down dining area and a "stand-up" bar Bar (Alcohol sales primarily - mevl , eX" QM.) Kitchen run by Chef where patrons may receive direct deliveries of alcohol) minimum food availability requirl.'lll' 1]1- I D 1 Type of OLive o Disk o Joke o Patron Dancing 0 Cabaret, Night Club, Discotheque o Capaeit) I.., i 12- Hotel I Establishment: Music Jockey Box (Small Scale) (Large Scale Dance Club) or more P;III <;i i D Club (e.g. Golf/ o Bed & 0 Catering I:8J Other RESTAURANl i ("x" all c::::::> o Stage o Topless i that apply) Fraternal Org.) Breakfast Facility Shows Entertainment (SpecifY) & PIZZERIA 13. Proposed ~ None D Rooftop o Patio D Freestanding o Garden / o Other Outdoor Area(s): or Deck Grounds (Specify): 1 Covered Structure I 14. Will the proposed License Holder or a Manager be physically present wilhin the establishment during All Hours of Operation? ("X- one): I ~ YES I [J A pplication Serial N um ber: I -... 15- 16. The Aoolicant's Full Name as it will appear in the application I. 1 for the On-Premises Alcoholic Beverage License, is: J. T.D. ENTERPRISES OF DUTCHESS COUNTY, LLC 17. The Full Name of the Applicant's proposed licensed Establishment (the Trade Name I, under which the proposed Licensed Establishment will conduct business) is: JOEY'S IT ALlAN-AMERICAN RESTAURANT 18. The Applicant's proposed Licensed Establishment is located I: MYERS CORNERS ROAD within the building which has the following Street Address- 235-237 It}- City, Town, or Village Iw APPINGER FALLS NY Zip Code: 12590 1 20. The proposed Licensed Establishment will be located on the following floor(s) of the building at the above address: It Within the building at the above address, the proposed Licensed Establishment will be located within the room(s) numbered as follows: I 9 .. 2L 22 Business Telephone Number of the Applicant: 8 4 5 - 2 9 8 - 5 7 5 X 23. Business Fax Number of the Applicant: - - 24. Business E-Mail Address of the Applicant: I IF YOU KNOW - Was there ever an alcoholic beverage license in effect for the space where I Yes ~ I No 0 I 25. you intend to operate your licensed establishment? I Don't Kll()\\ [] OWNER OF THE BUILDING IN WHICH THE PROPOSED LICENSED ESTABLISHMENT WILL BE LOCATED I No ~ ----~ Does the Applicant own the building in If'YES", SKIP items No. 27,28,29, & 30 If "NO', ANSWER items No 27,28. Iq ,\ 26. which the proposed Licensed Yes 0 Go directly to Item No- 3 1, Then continue to Item No- :; I Establishment will be located? ("X" ~ and complete the form. and complete the form ~~ ._~---_.- 27. Building Owner's Full Name is: E.G.S ENTERPRISES, INC. 28. Building Owner's Street Address: 19 CADY LANE 29. City, Town, or Village: Iw APPINGER FALLS !NY Zip Code: 12590 30. Business Telephone Number of Building Owner: 8 4 5 - 2 9 7 - 5 0 0 (I THE APPLICANT WILL FILE AN ORIGINAL (FIRST) APPLICA TION FOR AN ON-PREMISES ALCOHOLIC BEVERAGE LICENSE IN ORDER TO CONDUCT. WITHIN THE IDENTIFIED EST ABLISHMENT - THE TYPE OF BUSINESS DESCRIBED BELOW 9 Business Telephone Number of Attorney- 'l it STATE OF NEW YORK _''':: ;,;. EXECUTIVE DEPARTMENT ". .. .. }u_~, DIVISION OF ALCOHOLIC BEVERAGE CONTROL . . ST ATE LIQUOR AUTHORITY SlandardizedORIGINAL APPLICATION NOTICE FORMfor Prom/we, 3D-Day Advance Notice 10 a Local MuniciDalitv or Community Board In connectIOn with the submIssIOn to the State LIquor Authority oJthe Applicant's Original (First) On-Premises Alcoholic Beveraee License ApDliqlll\'l\ for the Establishment Identified in this Notice (Page 2 (II. . . 1 I IN ORDER TO MAKE SURE THAT PAGES I AND 2 OF YOUR NOTICE ARE NOT SEPARATED OR MISPLACED ! PLEASE RE-ENTER IMMEDIATEL Y BELOW THE INFORMATION REGARDING YOUR APPLICATION SERIAL NUMBER, NAME AND TRADE NAME i YOUR COURTESIES ARE APPRECIATED 15 Application Serial Number: I 1 16. The Applicant's Full Name. as it will appear in the application IJ I for the On-Premises Alcoholic Beverage License, is. J.T.D. ENTERPRISES OF DUTCHESS COUNTY, LLC 17, The Full Name of the Applicant's proposed licensed Establishment (the Trade Name IJ I under which the proposed Licensed Establishment will conduct business) is: JOEY'S IT ALlAN-AMERICAN RESTAURANT J INFORMATION REGARDING ANY BUSINESS LICENSED TO SELL ALCOHOLIC BEVERAGES THAT IS CURRENTLY BEING OPERATED IN THE SPACE WHERE THE APPLICANT INTENDS TO OPERATE HIS/HERIITS PROPOSED LICENSED ESTABLISHMENT [~y __J 31. IF YOU KNOW. Is a business that is licensed to sell alcoholic beverages currently being conducted Yes~ NoD I Don't Kll< l\\ m the space where you intend to operate your licensed establishment? Are you buying any asset(s) owned by the operator of the licensed business currently being conducted 32. in the space where you intend to operate your licensed establishment? YesD No~ (For example: good will, equipment, furniture, cookware, dishware, etc.) - IF YOU ANSWERED "YES" TO ITEM 31 OR 32 SKIP ITEMS NO. 33 AND 34. GO DlRECTL Y TO ITEMS NO. 35,36,37,38 AND 39. IF YOU ANSWERED "NO" TO ITEMS 31 AND 32, PLEASE PROVIDE THE INFORMATION REQUESTED BY ITEMS NO 33 AND 34 IF A BUSINESS LICENSED TO SELL ALCOHOLIC BEVERAGES IS NOT CURRENTLY BEING OPERATED IN THIS SPACE WHERE THE APPLICANT INTENDS TO OPERATE HIS / HER / ITS PROPOSED LICENSED ESTABLISHMENT, PLEASE PROVIDE INFORMATION REGARDING ANY BUSINESS LICENSED TO SELL ALCOHOLIC BEVERAGES THAT WAS MOST RECENTLY OPERATED UN THIS SPACE.. 33. IF YOU KNOW .\ Was a business that was licensed to sell alcoholic beverages previously conducted Yes~ NoD in the space where you intend to operate your licensed establishment? I Don't Knl> Are you buying any asset(s) owned by the operator of the licensed business that was most recently conducted 34. in the space where you intend to operate your licensed establishment? YesD No~ (For example: good will, equipment, furniture, cookW<lre, dishW<ITe, etc.) II IF YOU ANSWERED 'YES' TO ITEM NO. 31 OR 32 OR 34, THEN PLEASE ANSWER ITEMS NO. 35 and 36 and 37 and 38 and 39] \ OF THY-r LICENSED BUSINESS WHERE THE APPLICANT INTENDS TO OPERATE HIS / HER / ITS LICENSED ESTABLiSHMENT PLEA 36. IF YOU KNOW- The Full Name of the Operator of the licensed business now being conducted (or that was most recently conducted) in the space where you intend to operate your licensed establishment F & S RISTORANTE INC IF YOU KNOW - The Full Name of the licensed Establishment (the Trade Name) now being operated (or that was most recently operated) in the space where you intend to operate your licensed establishment: CALABRIA IF YOU KNOW- The alcoholic beverage license serial number of the business now being conducted (or that was most recently conducted) in the space where you intend to operate your licensed establishment: 2104110 I Don't Kn,)\\ 35. I Don't K I Don't 1'.11' ,\\ [J 37. IF YOU KNOW - The Type of Alcoholic Beverage License held by the current (or most recent) licensed operator: I Don't K",' [] 38. 39. IF YOU KNOW - Telephone Number of the current licensed operator or the most recent licensed operator: I Don't K'I"\\ !:s.;J 41 If the Original Application is approved, I am the Person who will hold the license or I am a Principal or the Legal Entity that will hold the I .i'l'l ,,' Representations in this form are in full conformity with representations made in documents that have been subl1lli \e 01 (or docum ents that w ill be subm itted) to the State Liquor A uthority, and relied upon by the Au th (1111: I understand that representations made in this form will also be relied upon by the Authority, and that false representations in any dOCIIIIL'1l1 subm itted to the Authority may result in revocation of any license that m y be iSSII: By my signature, I affirm _ under Penalty of Perjury - that the representations made in this form an: IIIIl Printed Name Title signature JOSEPH M. MASSA EMBER / MANAGER 4#-~-