In the Commonwealth of Pennsylvania, individuals or entities looking to engage in activities requiring a license from the Pennsylvania Liquor Control Board (PLCB) must navigate through several regulatory requirements, one of which involves the PLCB-193 form, also known as the "Affidavit of Compliance Regarding Notice Posting as Required by Pennsylvania Liquor Code and Board Regulations." This form is a critical component in the application process for new licenses, transfers, extensions, or changes in corporate control or officers within the realm of alcoholic beverage sales and service. It serves as a sworn statement by the applicant that they have adhered to the specific requirement of conspicuously posting a "Public Notice of Application" on the premises in question, from the moment the application is filed up until a decision is made by the Board. This requirement not only ensures transparency in the licensing process but also affirms the applicant's commitment to compliance with state liquor laws and regulations. Signed under penalty of perjury, the form underscores the seriousness of the affidavit, with violations leading to potential legal repercussions. It caters to various types of applications, including those with or without an amusement permit and highlights the importance of public notice in the regulatory oversight of alcohol-related activities. This affidavit, integral to maintaining the integrity of the licensing process, must be executed with precision, reflecting the applicant's acknowledgment of their responsibilities under state law.
| Question | Answer |
|---|---|
| Form Name | Form Plcb 193 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | plcb193, plcbonlineordering, palcb gov, plcb license renewal form |
COMMONWEALTH OF PENNSYLVANIA
PENNSYLVANIA
LIQUOR CONTROL BOARD
AFFIDAVIT OF COMPLIANCE
BUREAU OF LICENSING
REGARDING NOTICE POSTING AS REQUIRED BY
PENNSYLVANIA LIQUOR CODE AND BOARD REGULATIONS
License Number |
___________________ LID #: ______________ |
Applicant |
________________________________________ |
Address of Premises |
________________________________________ |
|
________________________________________ |
|
|
(ZIP CODE) |
Type of Application: |
|
|
New with an |
New without an |
Transfer with an |
Amusement Permit |
Amusement Permit |
Amusement Permit |
Extension |
Change of Officers |
|
Transfer without an Amusement Permit
The undersigned applicant for a license action concerning alcoholic beverages, _____________
_______________________________________________________________ , swears or affirms
that a “Public Notice of Application” has been and will be continuously and conspicuously posted on the premises for which the license action is applied, in the manner prescribed by the Liquor Code and Board Regulations, from the date the application was filed with the Board, ___________________ .
(INSERT DATE)
(SIGNATURE)
(SIGNATURE)
(SIGNATURE)
The foregoing statements are provided under penalty of perjury, 18 Pa. C.S.A. §4903 and §4904, and 47 P.S.
This affidavit must be submitted in conjunction with each new, transfer, or extension application and any notice of change in officers or stockholders constituting a change of corporate control. New and transfer applications for retail licenses, except clubs, performing arts and public venues, must indicate if the transaction includes an amusement permit. The “Public Notice of Application” must be posted on the date the application or notice is filed and must remain posted until the application has been approved or refused by the Board.
This affidavit must be executed by the same person or persons who signed the application or notice. If the applicant is a corporation, the corporate officer(s) who signed the application of notice shall execute this affidavit by affixing the same signature(s) and title(s) hereon. If the applicant is a limited liability company, the member(s) who signed the application of notice shall execute this affidavit by affixing the same signature(s) hereon.
NOTE: If the transfer of controlling interest in a corporation affects more than one license, EACH LICENSED PREMISES must be properly posted.
List additional license numbers here: _______________________________________________