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CrossCourt STATEOF EWYORK In EXECUTIVE E~l\1~NrI DIVISION OF ALCOHOL BI:WM.Vt~oGELW APPING ER STATE LIQUO AUTH<1f(!)WN CLERK NOV 1 5 2011 Standardized NOTICE FORM for Providing a Advance Notice to a Local MuniciDalitv or Communitv Board nnection with the submission to the State Liquor Authority of a (check one) lication 0 Renewal A licatio~ Alteration Annlication 0 for an On-Premises Alcoholic Bevera2e License ~ ';'A'ff t.. lSt "10 - ,~-::::.,;).~' J [Ri~~~~~le[Q) .f 1. Date the original copy of this Notice was mailed to the Local Municipality or Community Board: THIS 3O-DAY ADVANCE NOTICE IS BEING PROVIDED TO THE CLE.RKOF T1iEFOLLOWING LOCAL MUNICIPALITY OR COMMUNITY BOARD 2. Name of the Local Municipality or Community Board: \ 0 POR DW APPUCMft'S. PROVIDIIDWRJmOII-.otrr...... . . . ft)R lQIOWN TO DAft POR ALTDATlOII API'I.ICAJIT8. ATT4CllCOJII'I,STB~""'''''''''OI' PROI'08BD ALTDATIOIIl8I POR CUIUtBIIT LIeu.... 8&TPORTII.~ IIImI01)OI'OPIIIIATlOII OIlLY DO IIOT V_TIllS poRK TO CHAIIGB YOURMBTIIOD OJ' OI'&RA'I'IOII 3. Type(s) of alcohol sold or to be sold under the license ("X'~: D Beer Only ~ Wine and Beer Only D Liquor, Wine, and Beer 4. Extent of food service: ('X"~ D Restaurant (Sale of food primarily; Full food menu; Kitchen run by chef) IKl Tavern / Cocktail Lounge / Adult Venue / Bar (Alcohol sales primarily- meets legal minimum food availability requirements) 5. Type of establishment: Hotel D LMive. USlC D Disk Jockey D Juke Box D Patron Dancing D Cabaret, Night Club, Discotheque (Small Scale) (Large Scale Dance Club) D Capacity for 600 or more patrons -" (OX" all that applyl , D g] Club (e.g. Golf / D Bed & D Catering Fraternal Org.) Breakfast Facility D Karaoke 0 TIOP- Bar ess Ent. D Restaurant D Recreational Facility (Sports Facility/Vessel) 6. Licensed outdoor area: ~ None D Rooftop D Patio or Deck D Freestanding Covered Structure D Garden / Grounds D Sidewalk Cafe D Other (Specify) : 17. Business fax number of applicant/licensee: City, Town, or Village: \a~ 7. Will the license holder or a manager be physically present within the establishment during all hours of operation? 8. License serial number: 10. 11. 12. 13. 14. 15. 16. Business telephone number of applicant/licensee: 18. Business e-mail address of applicant/licensee: 19. Does the applicant or license holder own the building in which the establishment is located? ( "X" ~ Yes D If "YES', SKIP items No. 20-23. Complete the 3 entries at Item No. 24. No~ If "NO", ANSWER items No. 20-23, and complete the 3 entries at Item No. 24. 22. City, Town, or Village: OWNER OF THE BUILDING IN WHICH THE LICENSED ESTABLISHMENT IS LOCATED 20. Building owner's full name is: 21. 23. I am the applicant or hold the license or am a princ;:ipal of the 1egal entity that bolM oriaapplyingfQr ilielicense'Repreaentationa in thia fonn are in contonn.ity with representations made in submitted documents rejiedupon by the Authority when AJ'81ltingthe license. I undl'll'lltand that repreaentatWnsmade in this form will also be relied upon, and that fa1se representations may result in !fisapproval of the Ilpplication or~tion of the license. By my signature, I aftinn - under PelaaItJ of Per.fu7 - that the representatio in thia fonn are true. ij TOWN CLERK TOWN OF WAPPINGER 20 MIDDLEBUSH ROAD WAPPINGERS FALLS, NY 12590 WWW.TOWNOFWAPPINGER.US (845) 297-4158 - Main (845) 297-5771 - Direct (845) 298-1478 - Fax SUPERVISOR Barbara A. Gutzler TOWN BOARD William H. Beale Vincent Bettina Ismay Czarniecki Joseph P. Paoloni Office of the Town Clerk November 15,2012 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 Cross Court, Inc., located at 204 New Hackensack, 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, (l~~ Christine Fulton Town Clerk fcf