Form Plcb 193 PDF Details

When you are starting a new business, there are many things you need to do in order to get it up and running. One important step is getting your business licensed, and for that you will need to complete Form PLcb 193. This form is used to apply for a license from the Pennsylvania Liquor Control Board (PLCB). In this post, we will take a closer look at what is required on Form PLcb 193, and provide tips for completing it correctly. Let's get started!

QuestionAnswer
Form NameForm Plcb 193
Form Length1 pages
Fillable?No
Fillable fields0
Avg. time to fill out15 sec
Other namesplcb193, plcbonlineordering, palcb gov, plcb license renewal form

Form Preview Example

PLCB-193 6/07

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. §4-403(h) and/or §4-436(j).

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: _______________________________________________