Fillable Form 30: Permit ALCOHOLICBEVERAGE CONTROL (New York State)

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Form 30: Permit ALCOHOLICBEVERAGE CONTROL (New York State)

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OFFICE
USE
ONLY
Amended
Date
Original
30
revised
11/19/2019
Print
Form
Permit
NEWYORK STATE LIQUOR AUTHORITY
INSTRUCTIONS&APPLICATION
for
ALCOHOLICBEVERAGE CONTROL
SOLICITOR PERMIT
CONTENTS
∙
Instructionsforcompletingforms
∙
Pro‐RatedFeeChart
∙
Application
DIRECTIONSFORCOMPLETINGTHEPERMITAPPLICATIONS
∙
Mustbe
TYPED
∙
Completeapplicableforms
FULLY.
∙
Followinstructionscarefully.
∙
Retainacompletedcopyoftheapplicationforyourrecords.
Completed applications and any supporting information should be mailed to:
NEW YORK STATE LIQUOR AUTHORITY
PO BOX 782772
PHILADELPHIA , PA 19178-2772
OFFICE
USE
ONLY
Amended
Date
Original
30
Print
Form
DescriptionofSolicitorPermitandInstructions
Authorizesthepermitteetoofferforsaleortosolicitordersforthesaleofanyalcoholicbeve
rageonlyonbehalfofthe
licenseewhosenameappearsuponsuchpermit.
(Section93ABCLaw)
Please be guided by Solicitor Permit Advisory
2017-4.
**EffectiveNovemb er6,2016pleasenotethatasolicitorpermitisnotrequiredforp ersonwhoissolicitingorders
onbehalfofacraft/farmmanufacturer.
Thefollowinginformationandmaterialisr equire dwiththecompletedapplication:
•
CompletionofaPersonalQuestionnaire:
https://sla.ny.gov/system/files/documents/2018/08/personalquestionnaireuniversal08092018.pdf
•
ProofofCitizenshipIfU.S.Citizen
•
IfsolicitorisnotaU.S.citizen,submitacopyofalienregistrationcardorworkauthorization.
•
Drivers License or Non-Drivers Id from applicants state of residence
•
Eachapplicantisrequiredtobefingerprintedandmustfollowthefingerprintinginstructionsavailable
onthefiling receiptoronourwebsite:
https://sla.ny.gov/system/files/documents/2019/07/
Electronic-Fingerprinting-Instructions-09262018-7-31MS.pdf
SOLICITOR(SP)–EXPIRES12/31/21
The 3 year solicitor permit fee is $98
SOLICITOR PERMIT PRORATED FEE SCHEDULE
For applications submitted 01/01/19-12/31/19 the fee submitted should be $98
For applications submitted 01/01/20–12/31/20 the fee submitted should be $72
For applications submitted 01/01/21–10/31/21 the fee submitted should be $46
Please note applications submitted after 10/31/21 will require a fee of $98 and will be processed effective
01/01/22
and will expire 12/31/24
revised
11/19/2019
OFFICE
USE
ONLY
Amended
Date
Original
30
revised
1
1/19/2019
Page
1of2
Print
Form
SOLICITORPERMITAPPLICATION
NameofApplicant :
(FullNameofApplicant)
ResidenceStreet Address:
City:
State:
ZipCode:
Applicant e-mail address:
MailingAddressofApplicant:
City:
State:
ZipCode:
NYSWholesalerorManufacturer (Employer)
License Number:
NameofManufactureror
Wholesaler:
Address:
City:
,NY
ZipCode:
County:
Telephone Number:
E‐mailaddress:
MailingAddressifdiffere
nt:
revised
11/19/2019
Page
2
of
2
Print
Form
OFFICE
USE
ONLY
Amended
Date
Original
30
SOLICITOR
PERMIT
APPLICATION
THEFOLLO WINGCERTIFICATIONISTOBESIGNEDANDDATEDBYTHEEMPLOYEROFTHEAPPLICANT
Icertifythatthebelowcaptionedsolicitorwillbeemployedbybelowlisted
employer,andthatIhavecomparedthe
applicant'sdriver'slicenseornon‐driversIDphotowiththeapplicantandthattheenclosedDMVID#andsignatureare
thatoftheapplicant.IfurthercertifythatIknowthecontentsofthisapplicationandthestatementsandanswerstherein;
thatthesamearetruetomykn
owledge;thatIhavebeenauthorized,byorderoftheBoardofDirectorsofsaidapplicant
corporation,grouporassociationtomakethestatementsandanswersinthisapplicationonbehalfofsaidcorporationor
companywiththesameforceandeffectasifsaidcorporationorcompanymade
suchstatementsandanswersitself.I
certifythatIhavereadthetermsandconditionsforthepermitappliedforandagreetocomplywiththoseconditions.
NameofEmployer(wholesaler):
Applicant(solicitor) Name:
AuthorizedSignatureofEmployer:
PrintNameandTitleofAuthorizedSignature:
THEFOLLOWINGCERTIFICATIONMUSTBESIGNEDANDDATEDBYTHEINDIVIDUAL
APPLICANT(SOLICITOR).
I certify that I am the applicant above named; that I know the conte
nts of the above application and the statements contained
thereinandthatthesamearetruetomyknowledge. IcertifythatIhavereadtheconditionsforthepermitappliedforandagree
tocomplywiththose conditions.
Signature
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Form 30: Permit ALCOHOLICBEVERAGE CONTROL (New York State)

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Completed 16 September 2021

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