Liquor Application Details

Application Details

Registration Number[[registration_number]]Status: [[status]]

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License Type

Is this application for a new license or renewal?=IF([[is_a_pre_existing_license_YN]]==1,'Renewal','New License')

Select Application Service Fee[[select_application_service_fee]]

Which pre-existing license do you want to renew?[[selected_pre_existing_license]]

Registration & Contact Information

Registrant Contact:[[registrant_contact]]

Registrant Name:[[registrant_name]]

Registrant Phone:[[registrant_phone]]

Registrant Email:[[registrant_email]]

General Information

Is the applicant (including any partnerships; members, managers, officers, stockholders or directors) or managers under the age of twenty-one years?=IF([[Q_General7]]==1,'Yes','No')

Is the applicant (including any partnerships; members, managers, officers, stockholders or directors) or managers been denied an alcohol beverage license?=IF([[Q_General8a]]==1,'Yes','No')

Document Details

Master File Form:

Diagram of Premises:

Background Information(DR8404-I):

Proof of Property Possession(One Year Needed):

Sole Proprietor/Husband and Wife Partnership:

Corporate Applicant Information:

Partnership Applicant Information:

Fee Receipt:

Limited Liability Company Applicant Information:

Location Details

Registrant Organization:[[registrant_organization]]

Organization Name:[[organization_name]]

Legal Entity Type:[[legal_entity_type]]

Is there a DBA Name for this Organization?=IF([[is_dba_name_org_name_yn]]==1,'Yes - Provide DBA Name','No - Same as Legal Name')

Organization DBA Name:[[organization_dba_name]]

Business Physical Address:[[business_physical_address]]

Business Mailing Address:[[business_mailing_address]]

Signature Details

Signature:

Signature Image

Signature Date Submitted:[[signature_date_submitted]]

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Keystone Licensing Agent

Before proceeding with the deletion of the record from the object, it's crucial to review its dependencies across various components.

Please take a moment to examine all the dependent components where this record is being utilized.

Table of dependent components where the record is being utilized.
Object	Field	Row ID

I understand the risks and choose to proceed with the deletion