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H P FUEL, 'INC.
MYERS CORNERS. ROAD
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2785 WEST MAIN STREET
WAPFINGERS FALLS
fblllil inll OwnC!r'~Slr~.t Mil",..:
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PRESIDENT
IJ.1I4aD11D'11
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License fee:
, Filing fee:
lotal fee due:
STATE OF NEW YORK - LIQUOR AUTHORITY
Renewal Application (Directions for Completion enclosed)
594.00 SPECIAL MAILING REQUEST: Complete If you wanl
30.00 your license mailed to an address otller than the
624.00 licensed premises address:
New effective date:
New expiration date:
06/01/2010
05/31/2013
[PJ~CG~~~~[Q)
H & P FUEL INC
H & P FUEL
233 MYERS CORNERS ROAD
WAPPINGERS FALLS, NY 12590
APR 3 0 2010
TOWN OF WAPPINGER
TOWN CLERK
NEW SERIAL#: 2109814 OLD SERJAL#: 102DUTCAX2109814122
233 MYERS CORNERS ROAD -W APPINGERS r ALLS,NY 12590
(Premise address)
Make sure all names and address inlormation is correct, if not make the necessary
changes on the reverse side.
APPROVED METHOD OF OPERATION
METHOD OF OPERATION:'
DAYS/HOURS OF OPERATION:
ADDITIONAL INFORMATION:
ANY CHANGE TO THE APPROVED METHOD OF OPERATION MUST BE APPROVED BY THE AUTHORITY PRIOR TO IMEPLEMTING
SUCH CHANGE. CONTACT YOUR ZONE OFFICE TO OBTAIN THE APPROPRIATE FORM TO MAKE ANY CHANGES.
ALL QUESTIONS MUST BE ANSWERED.
Any laise answer or statement made by the applicant constitutes perjury and will subject any license hereunder to revocation.
1.
If any changes in tacts have occurred since the signing of the application for your currently held license
which have not been reported to and acknowledged by the State Liquor Authority check "YES" and set forth
details of changes in facts in the appropriate schedules A and/or B on the rev~e side. If no changes .
in facts have occurred, check -NO..
1.
YES
o
NO
~
2.
Stale whether said licensed business presently is regularly kept open and operated by the licensee.
If no, submit statement with explanallon.
2.
iii
o
3. If your premises are closed, state whether your license certificate is deposited in safekeeping with the
appropriale zone office of the NVS Liquor Authority. .
APPLICANT UNDERSTANDS THAT ANY CHANGE IN ANY OF THE FACTS REPORTED HEREIN WHICH OCCURS BETWEEN THE SIGNING OF THIS APPLICATION AND
THE COMMENCEMENT OF THE NEW LICENSE PERIOD MUST BE REPORTED TO THE AUTHORITY IN WRITING BY CERTIFIED OR REGiSTERED MAIL WITHIN 48 HOURS. ANY
CHANGE OF FACTS OCCURRING AFTER THE COMMENCEMENT OF THE NEW LICENSE PERIOD MUST BE REPORTED WITHIN 10 DAYS. THE FAILURE TO COMPLY WITH THE
FOREGOING is A GROUND FOR THE REVOCATION, CANCELLATION OR SUSPENSION OF THE'L1CENSE.
3.
o
o
Not Applicable
IKI
THIS CERTIFICATION MUST BE SIGNED and DATED by INDIVIDUAL APPLICANT and EACH MEMBER of A PARTNERSHIP
INDIVIDUAL APPLICANTS AND EACH MEMBER OF APARTNE'RSHIP COMPLETE THIS SECTION.
The undersigned, each for himself. certifies that he is the epplicant above named: that he knows the contents of the ebove application and the statements contained
therein, that the same are true of his own knowledge, that he has complied and will continue to comply with all conditions upon which the original license was issued:
that no physical changes have been made to the licensed premises since the issuance of the original license, excepllhose authorized by the Slate Liquor Authority: and
represents that all slatements made in the original application lor this license end in any and all applicetions for renewalthereot are true end correcl, except as modified
in subsequent renewal applications or as otherwise reported to and acknowledged or approved by the Authority.
Date
(Print name of licensee(s)
(Signature of Iicensee(s)
(Home Address)
(Home Telephone )
THIS CERTIFICATION TO BE SIGNED AND DATED BY A CORPORATION OR A CLUB
CORPORATE OFFICER OR CLUB ALCOHOLIC BEVERAGE CONTROL (ABC) OFFICER COMPLETE THIS SECTION
PI YU S H MO D I certifies that he is PR ES I DENT
(Prinl Name 01 Corporate Ollie.,) (Print Title 01 Corporale OHcer)
of the above named applicanl corporation: that he knows the contents otthe above application and the stalements and enswers therein, that the same are true 01 his
own knowledge: that he has been authorized by order of the Boerd of Directors of said applica~t corporation to make the statemerts and answers in this applicetion in
behalf of said applicant corporation with the same force and effect as If said corporation made such statements end enswers Itsell; that II has complied and will continue
10 comply wllh all conditions upon which the original license was issued: that no physical chenges have been made to the licensed premises since the issuance of the
original license, except those authorized by the Slale Liquor Authorily: and represents that all statements made in the original application for this license and in any and
all epplications for renewallhereof are true and correct, except as modified in subsequent renewal applications or as otherwise reported to end acknowledged or
approved by the Authority.
~~ture of authorized officer)
Date
.; l-\ -2,v- \...
15 AMERICAN WAY
WAPPINGERS FALLS, NY 12590
,PRESIDENT
(Home Address and Home Telephone)
rcrmll'1016
SLA tRevlsed 02109>
STATE OF NEW YORK - L1aUOR AUTHORITY
(Renewal Application)
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~~~
..
ADDRESS CHANGES OR CORRECTIONS: Note if physical address of premises was changed by Post Office, City, Town, Village, 911
Emergency Systems, or 911 address reassignment, please submit notice of authorization from appropriate agency.
Street address of premises to be licensed Post oHlce address of premises (If different)
City, town or viliage . Zip Code Telephone Number City, town or village - Zip Code (If different)
(845)298-326
Landl,ord Name lendlord Address
BOTTtNI STATION HOLDINGS,LLC 2785 WEST MAIN STREET
WAPPINGERS FALLS, NEW YORK 12590
1a, If you answered yes to Question 1, on the reverse, complete the appropriate schedule "A" or "B",
Use this schedule" A" to set forth details of arrests, summonses andlor convictions which have occurred since the signing
of the epplication for the currently held license and have not been reported to the Authority or having been reported have not
b
een acknowledaed bv the Authoritv. Submit copy of Certificate of DisDosition or Police ReDort.
Name of Defendant Connection with Business Crime or Date Disposition In
(licensee, employee, patron or other) O"ense . Each case
(submit copy)
NONE NONE NONE
1 b. Use this schedule, "B" to set forth details of any outstanding loans andlor such "changes" (ather than arrests, or address
changes) which have not been reported to the Authority or having been reported, have not been acknowledged by the Authority.
(See instruction forms. If more soace is needed, ettach rider!.
Nature of Change Date Details
'.
r
NONE
NOTICE TO MUNICIPALITY/COMMUNITY BOARD
(ON-PREMISES LICENSEES ONLY)
On Premises Licensees are required by the Alcoholic Beverage Control Law, Section 64, Subdivision 2a, upon receipt of
a renewal application for a license to sell alcoholic beverages at retail for consumption on the .premises, to promptly
notify, in writing, the clerk of the Village, Town or City wherein the premises are locatecj, of your application to the State
Liquor Authority not less than thirty days prior to the submission of your application to .the Authority, In the City of New
York, such notification is to be sent to the community board with jurisdiction over the area in which the premises is
located. Notification pursuant to this Section is to be sent by certified mail, return receipt requested,
YOU MUST SUBMIT THE NOTICE PROVIDED WITH THIS RENEWAL PACKET TO THE COMMUNITY BOARD OR
MUNICIPALITY AND SUBMIT SAME TO THIS OFFICE ALONG WITH THE ORIGINAL OR A COPY OF THE CERTIFIED
MAIL CARD OR RECEIPT
Form 11016 SlA (A8111Sed02109l
TOWN CLERK
Chris Masterson
TOWN OF WAPPINGER
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
WWW.TOWNOFWAPPINGER.US
(845)297-4158 - Main
(845) 297-577] - Direct
(845) 298-]478 - Fax
TOWN SUPERVISOR
Christopher J. Colsey
TOWN BOARD
William H. Beale
Vincent Bettina
lsmay Czamiecki
Joseph P. Paoloni
Office of the Town Clerk
April 30, 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 ofthe Town of Wappinger has been notified by H
& P Fuel, Inc, located at 233 Myers Corners Rd, Wappingers Falls, New York, of
intention to file an application with the New York State Liquor Authority.
As this location is within the Town of Wappinger, the Town Board has received and
directed that this application be placed on file with no comment.
Sincerely,
JCMlcf