The 4065 Club Inc.
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TOWN OF WAPPINGER
TOWN CLERK
CHRIS MASTERSON
SUPERVISOR
CHRISTOPHER J, COLSEY
TOWN CLERK'S OFFICE
20 MIDDLEBUSH ROAD
WAPPINGERS FALLS, NY 12590
(845) 297-5771
FAX: (845) 298-1478
TOWN COUNCIL
WILLIAM H, BEALE
VINCENT BETTINA
MAUREEN McCARTHY
JOSEPH P. PAOLONI
July 13, 2009
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 has been notified by
The 4065 Club Inc. 339 Route 82, Hopewell Jet., 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,
hn C. Masterson
Town Clerk
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Standardized RENEWAL APPLICATION NOTICE FORM for P,widing a
30-Dav Advance Notice /0 a Local Municipalitv or Communitv Board
ill connection with the submission /0 the Slale Liquor Aulhori~y ola
Renewal Apulication for an On-Premises Alcoholic Beverae:e License
STATE OF NEW YORK
EXECUTIVE DEPARTMENT
DIVISION OF ALCOHOLIC BEVERAGE CONTROL
STATE LIQUOR AUTHORITY
I. Date the Original copy of this Notice was Mailed to the Local Municipality or Community Board:
THIS 30-DA Y ADVANCE'NO'rlCEISIliiINQ'~AlLE])1'OTHECLl!lRK.Ol"'Tr-W',110u.oWIN:G;~p~,~1UNICWAttrYOR .COMMUNITY BOARD
2. Name of the Local Municipality or Community Board: I.s
3.
4. City, Town, or Village:
5. Telephone Number
, , ' ''>'''':::i'_,'' ,:c(:-:. <,,_, '->'::- >_r,":',.." ,-,:,::,:;,/,::,''1 "":"-i':<,:'>. -; ,,",','>'<< '
ATTORNEY FOR THE;LIOElNSEHOt,DER'StJl:lMi'rnNG TfI~:RENiil:wAi. !'ppUOATION.
6. Attorney's Full Name is:
7. Attorney's Street Address:
B. City, Town, or Village:
9. Business Telephone Number of Attorney:
CURRENT LlqENSE HOLDER WliO/THi\T'WlLL SUBMIT THE-RENI!)WAL"API'LICA:rrO.NTOTHE:Sl'ATE,LlQt,19RA.UTHORITY
10.
D Beer Only D Wine and Beer Only
@Liquor, Wine, and Beer
Type(s) of Alcohol sold under the License ("X"~:
11.
Extent of
Food Service:
("X"~
o
IVt Tavern-Restaurant (A mixed-use establishment that
~ has both a sit-down dining area and a "stand-up" bar
where patrons may receive direct deliveries of aicohol)
Tavern / Cocktail Lounge / Adult Venue /
Bar IAlcohol sales primarily - meets legal
minimum food availability requirements)
D
Restaurant (Sale of Food
Primarily; Full Food Menu;
Kitchen run by Chef)
12.
Type of
Establishment:
o Hotel
D Capacity for 600
or more patrons
D Live
Music
D Disk
Jockey
D Juke
Box
D Patron Dancing D Cabaret, Night Club, Discotheque
(Small Scale) (Large Scale Dance Club)
("X" all
tbat apply)
e:tP
Catering
Facility
1\71 Club le.g. Golf /
~ Fraternal Org.)
D
D
D Stage
Shows
D Topleas
Entertamment
D Other
(Specify):
D Other
(Specify):
Bed&
Breakfaat
13.
Licensed
Outdoor Area:
~ None.
Freestanding
Covered Structure
D Garden /
Grounds
D D Patio
Rooftop or Deck
~.d
: AM PM
TO
": Pi PM
D
Days and Hours
of Operation
(Complete all;
circle AM or PMI
Wedneadav
.....b;Q,o AM@
TO
~A~
14.
Frldav
-6.lOO AM fij)
TO
~AM6i>
Sunday
3 :00 AM6j)
TO
~Ar.@>
JR]
PM
15.
Will the License Holder or a Manager be physically present within the establishment during All Hours of Operation?
16.
License Serial Number:
lB.
19.
20.
2 J. City, Town, or Village:
22. The Licensed Establishment is located on the following Ooor(s) of the building at the above address:
23. Within the building at the above address, the Licensed Establishment is located within the room(s} numbered as follows:
24. Business Telephone Number of Current License Holder:
25.
Does the License Holder own the
buliding in which the Licensed
Establishment is located? I "X" ~
No 0
If "NO", ANSWER items No. 26-29,
and complete the 3 entries
at Item No. 30,
If "YES", SKIP items No. 26-29.
Complete the 3 entries
at Item No. 30.
Yes ~
OWNER OF THE BUILDING IN WHIOH THE'LICENSED::Il:BtABU(lHMENTiS LoCATED'
:t I\lC .
26.
Building Owner's Full Name is:
27.
2B. City, Town, or Village:
29. Business Telephone Number of Building Owner:
I hold the License or am.a Principal of the Legal Entity that holds the License. Representations in.thls form are In conformity with representations made in submitted
documents relied upon by the Authorl\)' when granting theexiating license. I understand that representations made in thl" form will also be relied upon, and that false
30. representations may resllIt in revocation of the license. By my signature, I affirm ~ under Pena111 ofperjw;y - that the representations made in thls form are true.
Printed Name
(0 ~
Il.1HlIl
Title
A, St-ko/ L
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