*New* Refreshment License

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Assumed Name
Type Business Entity
Incorporated in NYS
License Suspended/Revoked
Operating before 9/17/18
Felony/Crime/Violation
Change in COP
Method of Payment
Your Name HereClick to Sign
Role
Signature HereClick to Sign
07/02/2026Click to Sign
Payment Received
Alcohol
Own Property
Signature HereJeaneth Guinansaca Will Sign Here
07/02/2026
Signature HerePolice Department Will Sign Here
07/02/2026
CoF
Site Plan
Signature HereGregory Grose Will Sign Here
07/02/2026
Debt/Obligation
Signature HereDale Brennan Will Sign Here
07/02/2026
Police Complaints
OPD Calls
Open Permits
Code Violations
Inspection Passed
x

Additional Signatures Required