Form Plcb 3 – Fill Out and Use This PDF

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Form Plcb 3 PDF Details

Form Plcb 3 is an important document for property owners and managers in Pennsylvania. This document provides specific instructions on how to properly complete plcb 3 forms, which are used to report information about structures and properties. Completing these forms correctly is essential for ensuring that your property is in compliance with state regulations. In this blog post, we will provide a brief overview of the contents of Form Plcb 3, as well as instructions on how to complete it correctly. We hope that this information will be helpful for you in filing accurate reports for your property. Thank you for reading!

Question	Answer
Form Name	Form Plcb 3
Form Length	4 pages
Fillable?	No
Fillable fields	0
Avg. time to fill out	1 min
Other names	PLCB-3, plcb gcc license, licensefill com, PLCB-21

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PLCB-3 2/12

COMMONWEALTH OF PENNSYLVANIA

PENNSYLVANIA

LIQUOR CONTROL BOARD

APPLICATION FOR CLUB LIQUOR OR

RETAIL DISPENSER LICENSE

BUREAU OF LICENSING

		(SEE INSTRUCTIONS PAGE 2 OF 2 REVERSE)			PAGE 1 OF 2
(ANSWER ALL QUESTIONS)
	The undersigned organization hereby applies for the following type of License:			CLUB LIQUOR (C)
				CLUB LIQUOR (C)

		PRIVATELY-OWNED PRIVATE GOLF COURSE CLUB LIQUOR (PGC)		CLUB RETAIL DISPENSER (G)

		PRIVATELY-OWNED PRIVATE GOLF COURSE CATERING CLUB LIQUOR (GCC)		CATERING CLUB LIQUOR (CC)


1.	NAME OF APPLICANT ORGANIZATION

2.	ADDRESS OF PREMISES

		(STREET, RURAL ROUTE, P.O. BOX NO.)	(POST OFFICE)	(STATE)	(ZIP)

3. NAME OF MUNICIPALITY

TYPE OF MUNICIPALITY
CITY	BORO	TWP.

INC.

TOWN

COUNTY

4. NAME OF OWNER OF PREMISES

DEED BOOK VOLUME NO. PAGE NO./ INSTRUMENT NO.

4(A). NAME OF OFFICERS, DIRECTORS, SHAREHOLDERS, PARTNERS OR MEMBERS OF PROPERTY OWNER. (ATTACH SEPARATE SHEET IF NECESSARY)

TITLE

5. ADDRESS OF OWNER OF PREMISES

LEASE EXPIRATION DATE

6.	IS A CURRENT HEALTH LICENSE				IF ‘YES’, WHEN DOES IT EXPIRE? GIVE MONTH, DAY, YEAR.
	POSTED ON THE PREMISES?
	(CATERING CLUB ONLY)	YES	NO
		YES	NO

7.	HAS THE APPLICANT PREVIOUSLY FILED AN				IF ‘YES’, WHEN AND WHERE?
	APPLICATION FOR LICENSE?	YES		NO
		YES		NO

8.PREMISES TO BE LICENSED

LIST COMPLETE INFORMATION FOR EVERY ROOM WHICH IS TO BE USED IN THE OPERATION OF THE LICENSED BUSINESS, INCLUDING A SEPARATE KITCHEN, IF ANY, AND AREA TO BE USED FOR STORAGE OF ALCOHOLIC BEVERAGES. (ATTACH SEPARATE SHEET, IF NECESSARY.)

ROOM

LOCATED ON WHAT FLOOR

SEATING

DESIGNATED USE:

WIDTH

LENGTH

CAPACITY

SERVING, KITCHEN OR STORAGE

IS THE APPLICATION TO BE CONSIDERED FOR PRIOR APPROVAL?

YES

10.

IS THE APPLICATION TO BE CONSIDERED FOR NATIONAL VETERANS’ ORGANIZATION?

YES

11.

THE PRIMARY INTEREST OR ACTIVITY OF THE CLUB IS

12. DATE CLUB ORGANIZED

DATE AND PLACE INCORPORATED

13.IS A MANAGEMENT COMPANY EMPLOYED OR OTHERWISE CONTRACTED TO OPERATE, MANAGE OR OTHERWISE SUPERVISE ALL OR PART OF THE OPERATION?

IF YES, LIST THE NAME AND ADDRESS OF THE ENTITY:

YES

14.IS THE CLUB CHARTER IN POSSESSION OF THE ORIGINAL INCORPORATORS?

IF ‘NO’, IS IT IN THE POSSESSION OF THEIR DIRECT OR LEGITIMATE SUCCESSORS?

YES

N/A

DO NOT WRITE BELOW THIS LINE

CO/MNCP _ _ - _ _ _ ZIP _ _ _ _ _ - _ _ _ _

15.	RESOLUTION

TYPE OF PERMIT TO BE GRANTED

NEW LICENSE

TRANSFER OF LICENSE

At a regular or special meeting held on _________________________________ , 20 __________ by the

applicant, it was resolved that said application be filed with the Pennsylvania Liquor Control Board, and that

_____________________________________ and/or _______________________________ is/are hereby

(NAME OF OFFICER/TITLE)

authorized to execute said application, and any other papers required by the Board.

COMPLETE IN DETAIL QUESTIONS 16 THRU 19 - ATTACH SEPARATE SHEET, IF NECESSARY.

16.

U.S.

DATE AND

SALARY

NAME OF OFFICERS & DIRECTORS

CITIZEN?

TITLE

HOME ADDRESS

PLACE

PAID

OR TRUSTEES

OF BIRTH

BY CLUB

YES

NAME

17.

U.S.

NAME OF STEWARD OR MANAGER

HOME ADDRESS

DATE AND

CITIZEN?

OR RESPONSIBLE OFFICER

PLACE OF BIRTH

YES

NAME

18.

NAME OF EMPLOYEE(S)

POSITION

HOME ADDRESS

NAME

19.

TYPE OF MEMBERS

ACTIVE

SOCIAL

OTHER

ANNUAL DUES PER MEMBER

NUMBER OF MEMBERS

PLCB-3 2/12

COMMONWEALTH OF PENNSYLVANIA

PENNSYLVANIA

LIQUOR CONTROL BOARD

APPLICATION FOR CLUB LIQUOR OR

RETAIL DISPENSER LICENSE

BUREAU OF LICENSING

(SEE INSTRUCTIONS ON REVERSE)

PAGE 2 OF 2

20.CONVICTION RECORD: The following is a record of all felony and misdemeanor convictions of the individual owner, all partners, the manager and all corporate officers, directors and stockholders. (Attach separate sheet, if necessary.)

If there have been NO such CONVICTIONS, CHECK HERE:			NO SUCH CONVICTIONS

NAME

DATE OF

CONVICTION

CHARGE

DISPOSITION

LOCATION OF COURT (COUNTY AND STATE)

21.Do any oficers, directors, agents or employees of the club hold any license issued by this Board?

22.Are any officers, directors, agents or employees of the club also employees of this Board or of any licensee?

YES

23.Does the applicant or any officer, director, stockholder, agent or employee have any financial interest, either directly or indirectly,

in any other class of license or permit issued by this Board, or in the ownership, leasehold, or equipment, of any property used by such other licensee or permittee, or mortgage lien against the same, or have they loaned any money, or given credit, or anything of value, for equipping, maintaining or conducting an establishment used in such other license or permit?

YES

24.Will any person having any financial interest as an individual, or as an officer, director, stockholder, agent or employee in another class of license or permit issued by this Board be in any manner interested, either directly or indirectly, in the business proposed to be licensed under this application, or in the ownership or leasehold of the property or equipment to be used in the operation of

the said business, or any mortgage lien against the same, or have they loaned any money, or given credit, or anything of value, to the applicant, or any officer, director, stockholder, servant, agent or employee of said applicant, for equipping, maintaining or

conducting this business?	YES	NO

IF A ‘YES’ RESPONSE IS GIVEN TO QUESTIONS 21, 22, 23 OR 24, ATTACH SEPARATE SHEET, WITH DETAILS.

25.A placard, PLCB-1296, Public Notice of Application Alcoholic Beverages, was posted on (DATE) _____________ in a conspicuous place on the outside of the premises as required by the Liquor Code and Regulations of the Board, and will remain posted until a notice of ap- proval or refusal is received by the applicant.

I swear or afirm, subject to the penalties provided by 18 Pa. C.S. §4904 and 47 P.S. §4-403 (h) and/or §4-436 (j), that the foregoing answers and statements provided herein are true and complete to the best of my knowledge and belief.

SIGNATURE	TITLE	NAME OF ATTORNEY REPRESENTING YOU IN THIS MATTER, IF ANY

HOME ADDRESS	PHONE	ADDRESS

SIGNATURE	TITLE

HOME ADDRESS	PHONE	PHONE

PREMISES PHONE NO.		DATE SIGNED

E-MAIL ADDRESS.

INSTRUCTIONS

The Application for Club Liquor or Retail Dispenser License is to be submitted to apply for a new club license OR to apply for the transfer of an existing club license. All questions must be answered. All attached separate sheets must include the applicant's name and the ad- dress of the establishment. Fees and documents to be submitted with this application include:

1.FEES - The fee to transfer an existing license is $650.00 for person to person, $550.00 for place to place, OR $700.00 for both person to person and place to place. The fees for a new license are a $700.00 filing fee AND a license fee of:

a.$125.00 for a club retail dispenser license, OR

b.$150.00 for a club liquor or privately-owned private golf course club liquor license, OR

c.$200.00 to $700.00 (depending on population) for catering club liquor or privately-owned private golf course catering club liquor license.

2.PLCB-1773, Appendix Social Security Information MUST be submitted showing the social security number(s), name(s), and title(s) of each officer, director, stockholder, trustee, steward, manager or responsible officer.

3.PLCB-1898, Tax Certification Statement for the applicant AND if a person to person transfer or a double transfer, one from both the applicant and the current licensee.

PLCB-1898A, Tax Certification Statement for Management Company, is also required if a management company (any entity employed or otherwise contracted by the licensee or the applicant to operate, manage or supervise all or part of the operation of the licensed premises) is utilized. If a transfer application and if both buyer and seller use a management company, each company must submit the form.

4.PLCB-193 Affidavit of Compliance, regarding the notice of posting must be completed and submitted.

5.MEMBERSHIP ROLL - A complete list of all members of the club, together with dates of admission or election, must accompany the application, EXCEPT for transfer of license from one premise to another premise. Membership Roll (form PLCB-6) may be used.

6.Recent, individual photograph, of the manager, 1½" x 1½" in size, identified with the individual's name, and applicant's name and ad- dress of the premises on the reverse. Photograph must have a matte finish.

7.Recent, premises photographs, 4" x 6" in size, of the exterior of the premises, AND the main club room, identified with the applicant's name and address of the premises on the reverse. Photographs must have a matte finish.

8.If the application is for transfer, PLCB-21, Application for Transfer of License and Permit.

9.A Request for Criminal Record Check (PLCB-2018) must be submitted for each officer, director, trustee, manager or steward, EXCEPT for the transfer of license from one premise to another premise, with a $10.00 remittance per form.

10.If a transfer to another municipality in the same county (unless the licensee is a unit of a national veterans' organization), written ap- proval from the governing body of the receiving municipality must be submitted if the quota of the receiving municipality is filled or exceeded.

11.If the premises is not licensed, floor plans, 8½" x 11" in size, depicting room dimensions. A separate floor plan must be submitted for each floor to be licensed. The plan must be clear and readable.

12..Owner of premises name, address, principals and their titles must be listed.

INFORMATION

a.An application for a new license or for the transfer of an existing license to a new location not presently licensed may be filed for “PRIOR APPROVAL” of planned alterations or construction. Submit a site plan clearly showing the premises proposed to be licensed as it will be upon completion of the alterations or construction of the building. A site plan must be on 8½" x 11" paper depicting the location of the proposed premises in relationship to identifiable property lines or easily identifiable landmarks or reference points with measurements to the property lines, landmarks or reference points. The plan must be clear and readable.

b.A new license for premises in a county with no quota vacancy may be considered if the organization is an incorporated unit of a national veterans' organization, as defined by Section 461.1 of the Liquor Code.

DO N O T S UB M I T A NY O T H E R DO CUM E NT ( E . G . , L E AS E , A G R E E M E NT ) W I T H T HI S A P P L I C AT I O N P A CK E T . SHOULD YOU BE REQUIRED TO SUBMIT SUCH DOCUMENTATION, OTHER THAN FOR THE INVESTIGATION OFFICER'S REVIEW, YOU WILL BE NOTIFIED IN WRITING.

I F Y O U R E Q U I R E A S S I S T A N C E I N C O M P L E T I N G T H E A P P L I C A T I O N P A C K E T , C A L L T H E L I C E N S I N G INFORMATION CENTER AT (717) 783-8250.

SEND THE APPLICATION PACKET TO: PENNSYLVANIA LIQUOR CONTROL BOARD, BUREAU OF LICENSING, P.O. BOX 8940, HARRISBURG, PA 17105-8940.

How to Edit Form Plcb 3 Online for Free

With the help of the online editor for PDFs by FormsPal, you are able to fill in or modify PLCB-6 here. To make our tool better and simpler to utilize, we constantly implement new features, bearing in mind suggestions coming from our users. Here's what you'd have to do to get started:

Step 1: Hit the "Get Form" button above on this webpage to get into our tool.

Step 2: With this advanced PDF file editor, you may accomplish more than simply fill out blank fields. Edit away and make your docs appear high-quality with custom textual content put in, or adjust the original content to excellence - all comes with an ability to incorporate your own graphics and sign it off.

So as to complete this form, make certain you type in the information you need in each and every field:

1. When completing the PLCB-6, be certain to complete all essential blanks in their relevant area. It will help to speed up the process, making it possible for your details to be handled fast and properly.

2. The next step is usually to fill out these fields: IS A CURRENT HEALTH LICENSE HAS, POSTED ON THE PREMISES CATERING, YES, YES, IF YES WHEN DOES IT EXPIRE GIVE, IF YES WHEN AND WHERE, LIST COMPLETE INFORMATION FOR, ROOM, WIDTH, LENGTH, LOCATED ON WHAT FLOOR, SEATING CAPACITY, DESIGNATED USE, SERVING KITCHEN OR STORAGE, and IS THE APPLICATION TO BE.

POSTED ON THE PREMISES CATERING, IF YES WHEN DOES IT EXPIRE GIVE, and LOCATED ON WHAT FLOOR in PLCB-1773

People frequently get some things incorrect when completing POSTED ON THE PREMISES CATERING in this area. Ensure you re-examine what you type in right here.

3. Completing IS A MANAGEMENT COMPANY EMPLOYED, OR OTHERWISE SUPERVISE ALL OR PART, IF YES LIST THE NAME AND ADDRESS, YES, IS THE CLUB CHARTER IN POSSESSION, IF NO IS IT IN THE POSSESSION OF, YES, YES, COMNCP ZIP, and DO NOT WRITE BELOW THIS LINE is essential for the next step, make sure to fill them out in their entirety. Don't miss any details!

4. This next section requires some additional information. Ensure you complete all the necessary fields - TYPE OF PERMIT TO BE GRANTED, RESOLUTION, NEW LICENSE, TRANSFER OF LICENSE, At a regular or special meeting, applicant it was resolved that, andor isare hereby, NAME OF OFFICERTITLE, NAME OF OFFICERTITLE, authorized to execute said, COMPLETE IN DETAIL QUESTIONS THRU, NAME OF OFFICERS DIRECTORS, OR TRUSTEES, TITLE, and HOME ADDRESS - to proceed further in your process!

5. This document has to be concluded by filling out this part. Here you can see a full list of form fields that require correct information for your document usage to be complete: D NAME, E NAME, F NAME, NAME OF STEWARD OR MANAGER, OR RESPONSIBLE OFFICER, HOME ADDRESS, DATE AND, PLACE OF BIRTH, CITIZEN, YES, NAME, NAME OF EMPLOYEES, POSITION, HOME ADDRESS, and A NAME.

Step 3: Immediately after proofreading the entries, click "Done" and you are good to go! Try a free trial subscription at FormsPal and acquire immediate access to PLCB-6 - which you are able to then make use of as you would like inside your FormsPal account. FormsPal provides secure document tools devoid of personal data record-keeping or sharing. Rest assured that your details are in good hands here!

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