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Your Name HereClick to Sign

Signature HereClick to Sign

04/02/2026Click to Sign

Signature HereJeaneth Guinansaca Will Sign Here

04/02/2026

Signature HereDale Brennan Will Sign Here

04/02/2026

Signature HerePolice Department Will Sign Here

04/02/2026

Signature HereGregory Grose Will Sign Here

04/02/2026

Additional Signatures Required

Document Signers

- 1 Applicant
- 2 Jeaneth Guinansaca
- 3 Dale Brennan
- 4 Police Department
- 5 Gregory Grose

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Certificate of Assumed Name or DBA Click Here to Upload

Certificate of authority to conduct business in NYS Click Here to Upload

NYS Liquor License Click Here to Upload

Landlord Letter Click Here to Upload

Cabaret - Floor Plan Click Here to Upload

Coin - Location of Devices for Clarity Click Here to Upload

Change in Commercial Occupant permit Click Here to Upload

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Listed Signers

	Signer Details	Me?
Applicant
I'm not a signer listed above

Other Signers (The signers below will be invited to sign once the above signers have signed.)

	Jeaneth Guinansaca
	Dale Brennan
	Police Department
	Gregory Grose