PLENARY RETAIL CONSUMPTION LICENSEE TO SERVE OFF THE LICENSED PREMISES

Application must be accompanied by a fee of $100.00 for each 24-hour period, payable by CHECK or MONEY ORDER to the Division of Alcoholic Beverage Control

Pursuant to N.J.S.A. 33: 1-74, undersigned makes application for a Special Permit to sell, dispense and serve alcoholic beverages off the licensed premises.

IMPORTANT: APPLICATIONS SHOULD BE SUBMITTED AT LEAST TWO WEEKS PRIOR TO THE EVENT

SUBMIT A DETAILED SKETCH OF THE LOCATION WHERE ALCOHOLIC BEVERAGES ARE TO BE DISPENSED. PLEASE INCLUDE THE BAR AREA AND LOCATION OF PERSON/PERSONS CHECKING ID'S FOR ANYONE UNDER THE LEGAL AGE.

APPLICANT DETAILS

Name of Licensee:*
License Number:*
Address of Licensed Premises:
Applicant Email:	Phone or Email Required
Phone Number:
For what type of event is this Permit sought?:
Location of premises where affair will be held:
Location Name: *
Location Address:
Is affair to be held indoors or outdoors? :*	Indoor Outdoor
State date affair will be held and between what hours alcoholic beverages will be dispensed:
Date:*
Time:*	FROM:   HH: 00 01 02 03 04 05 06 07 08 09 10 11 12    00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59    AM PM TO:   HH: 00 01 02 03 04 05 06 07 08 09 10 11 12    00 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59   AM PM
Rain Date:
Will a charge be assessed by ticket, contribution or otherwise?: *	Yes No
Will there be a cash bar?: *	Yes No
Are the premises where the affair is to be held owned by a municipality, county or the State?: *	Yes No
Is affair to be held on church property?: *	Yes No
Are the premises where affair is to be held licensed?: *	Yes No
Check the types of alcoholic beverages to be dispensed if Permit is granted:	Wine Distilled Spirites Malt Alcoholic Beverages
The applicant represents that if a Special Permit is issued, the permittee will fully abide by all provisions of the New Jersey Alcoholic Beverage Law, State Rules and Regulations, and Municipal Ordinances and Regulations, the same as if the sale and service were occurring upon the applicant's licensed premises. The following consent is to be signed by the person so authorized at the premises where the affair is to be held, including property under the control of a unit of government, municipality, county or State; a church; or a premises under license or other privately owned facility. I certify that I am the person authorized to permit the sale and service of alcoholic beverages on the premises described in the application form, and I certify that there is no objection to the sale and service of alcoholic beverages as herein specified.
Please enter the verification code in the box: *