Tacocina
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S1'ATEOFNEW
EXECUTIVE DEPAR
DIVISION OF ALCOHOLIC BE
STATE LIQUOR A
%ed NOTICE FORM for ProViding a
/0 a Local MunieiDlllity or CommuDity Board
~ A ""l(' Il.
fQj;
'"" ...,~"fI
in lX11IMCIion
for aD On-Premises Alcoholit Beve.-..e Lkense
THIS 3O-DAY ADVANCE NOTICE IS BEING PROVIDED TO THE CLERK OF THE FOLLOWING LOCAL MUNICiPALITY OR COMMUNITY BOARD
"
1.
Date the original copy of this Notice was mailed to the Local Municipality or Community Board:
2,
Name of the Local Municlpality or Community Board:
!w:
e.r
"R Raw Al'PUCAJITlI. PROVID& DaICRJPI'IOJIIII:LOW OIIDJG ALLIIO'OIUIATlOR DOWII TO DAD
"R AL1UATlO8' APPLICAlfTII. ATTAClI COIIPI.IIT& DllllCalPTlOIf dD DIAGRAII 0,. I'ROPOIIIID ALTBRATI08'(81
lOR C1JJUtUT U----. IlBT"RTB API'ROVSD IISTIIOD OP OPII:RATIOR OIILT
DO RO'I' usa 1'11I8 )'()IUI TO CB.UIGB TOUR IIBTIIOD 0,. OPII:RATlOIf
Type{s) of alcohol sold or to be sold under the license D 0 IV1
( 'X" 2iW: Beer Only Wine and Beer Only ~ Liquor, Wine, and Beer
3,
4,
Extent of
food service:
("X"mW
[gI Restaurant (Sale of food primarily; Full food menu;
Kitchen run by chell
o Tavern / CocktaIl Lounge j Adult Venue j Bar (Alcohol sales primarily _
meets legal minimum food availability reqUirements)
TYPe or
establishment:
D
o
Club (e,g. Goff j D Bed & D Catering
Fraternal 01'8,) Breakfast Facility
D Karaoke 0 Stage 0 Topless 0 Recreational Facility
Bar Shows Entertainment (Sports Facility jVessell
5,
H tel 0 Live.
o MUSlC
O Dillk
Jockey
D~ke
O Patron Dancing 0 Cabaret, Night Club, Discotheque
(Small Scale} (Large Scale Dance Club)
D Capacity for 600
or more patrons
("X" all
that apply)
7, Will the license holder or a manager be physically present within the establishment during all hours of operation? ("X"~:
City, Town, or Village:
o
6.
Ucensed
outdoor area:
[] None 0 Rooftop
O Patio
or Deck
O Freestanding
Covered Structure
O Garden j
Grounds
D Sidewalk
Cafe
8. Ucense serial number:
10.
II.
12.
13.
14.
15.
16. Business telephone number or applicant/licensee:
17. Business fax number of applicant/licensee:
i8. Business e-mail address of applicant/licensee:
19.
Does the applicant or license holder
own the building in which the
establishment is located? ( "X" 2iW
Yes 0
If"YES", SKIP items No. 20-23.
Complete the 3 entries
at [tern No. 24.
No~
If"NO", ANSWER items No. 20-23,
and complete the 3 entries
at Item No. 24.
OWNER OF THE BUILDING IN WHICH THE LICENSED ESTABLISHMENT IS LOCATED
20. Building owner's full name is:
21.
22. City, Town, or Village;
23.
I am the applicant or hold the license or am a principal of the 1egaI 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. I understand that representations made In this form will also be
re1ied upon, and that false representations may result In disapproval or the application or revocation of the license.
By my signature, I affirm - under Peualty al'Peo;IuF - that the representations made In this form are true.
24.
Revised 10/12111
.
TOWN CLERK
TOWN OF WAPPINGER
20 MIDDLEBUSH ROAD
W APPINGERS 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
Isinay Czarniecki
Joseph P. Paoloni
Office of the Town Clerk
December 12, 2011
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
Tacocina Restaurant Inc, located at 1289 Corporate Park, Route 9, Suite 1, 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 December 12,2012.
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,
~~~
C istme Fulton
Town Clerk
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