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Signature HerePolice Department Will Sign Here

04/03/2026

Signature HereGregory Grose Will Sign Here

04/03/2026

Signature HereDale Brennan Will Sign Here

04/03/2026

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 Click Here to Upload

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

Valid NYS Liquor License Click Here to Upload

Landlord Letter Click Here to Upload

Copy of the 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