In the complex landscape of regulatory compliance within New York's alcohol beverage industry, the SLA 1041 form emerges as a fundamental tool, serving as a bridge between law enforcement and the State Liquor Authority (SLA). Ensconced within the framework of the Executive Department's Division of Alcohol Beverage Control, this form facilitates a meticulous evaluation of incidents involving licensees, ensuring that the SLA is well-positioned to determine an appropriate course of action. Through its detailed requirements, the form mandates the submission of comprehensive documentation including, but not limited to, arrest reports, incident reports, supplementary reports, written statements, affidavits, and any other relevant documents or information that might aid in the assessment of a reported violation. Integral to this process is the provision of specifics such as the license serial number, the name of the licensee, the trading name, the address of the premises, the certificate number, details of the violation, and the person in charge at the time of the incident. Additionally, it queries the status of the investigation and the availability of supporting documents, streamlining communication between different enforcement offices across New York including Albany, Buffalo, and New York City. Aimed at bolstering the enforcement of alcohol beverage control laws, the SLA 1041 form underscores the collaborative effort required to maintain regulatory integrity and public safety in this sector.
| Question | Answer |
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| Form Name | Sla Form 1041 |
| Form Length | 1 pages |
| Fillable? | No |
| Fillable fields | 0 |
| Avg. time to fill out | 15 sec |
| Other names | SLA, CityTown, PERTINENT, REFERRAL |
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STATE OF NEW YORK |
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ENFORCEMENT OFFICES |
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EXECUTIVE DEPARTMENT |
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DIVISION OF ALCOHOL BEVERAGE CONTROL |
Albany |
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Buffalo |
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POLICE REFERRAL FORM |
New York City |
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IN OR D ER FOR TH E |
S TATE LIQU OR AU TH OR ITY TO P R OP ER LY |
EVALU ATE |
AN D |
D ETER M IN E TH E |
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AP P R OP R IATE COU R S E |
OF ACTION ON TH IS R EFER RAL IT IS N ECES S AR Y |
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TH E R EP OR TIN G |
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OFFICER / AGEN CY S U B M IT COP IES OF ALL AR R ES T R EP OR T/ S ; IN CID EN T R EP OR TS ; S U P P LEM EN TAL R EP OR TS ; W R ITTEN S TATEM EN TS AN D AFFID AVITS ; VER B AL AD M IS S ION FOR M S ; D R U G B U Y S H EETS ; LAB / FIELD TES T R EP OR TS ; N AM ES AD D R ES S ES AN D P H ON E N U M B ER S OF W ITN ES S ES ; AN D AN Y OTH ER P ER TIN EN T D OCU M EN T/ S OR IN FORM ATION W ITH TH E R EFER R AL
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DIVISION OF ALCOHOLIC BEVERAGE CONTROL |
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ATTN: COUNSEL’S OFFICE |
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80 SOUTH SWAN, SUITE 900 |
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Date: |
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ALBANY, NY 12210 |
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INFORMATION FROM LICENSE CERTIFICATE |
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License Serial# |
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(Upper left corner) |
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Name of Licensee |
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DBA (Trade Name) |
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Address of Premises |
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Certificate # |
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(Lower Right corner) |
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Date and Time of Violation |
Name of Person in Charge and Title |
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(Licensee, Manager, Bartender, Etc) |
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Status of Investigation: |
Open |
Closed |
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Supporting Documents Attached? |
Yes |
No |
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If no, explain why and date of approximate availability. |
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Department: |
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Officers directly involved: |
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Address: |
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City,Town or Village |
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Phone # |
Fax # |
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(SLA FORM #1041 11/03)