Document Text
--- Document: Social Affair Permit Application Document ---
APPLICATION FOR
SOCIAL AFFAIR PERMIT [SA]
STATE OF NEW JERSEY
DEPARTMENT OF LAW AND PUBLIC SAFETY
DIVISION OF ALCOHOLIC BEVERAGE CONTROL
P.O. BOX 087, 140 EAST FRONT STREET
TRENTON, NJ 08625-0087
APPLICATION MUST BE SUBMITTED AT LEAST TWO WEEKS PRIOR TO THE EVENT
Applications must be accompanied by a fee of $100.00 PER DAY for Civic, Religious, or Educational Organizations; $150.00 PER DAY
for all other NON-PROFIT organizations, in the form of a check or money order payable to the DIVISION OF ALCOHOLIC BEVERAGE
CONTROL.
NOTICE: ORGANIZATIONS MAKING APPLICATION FOR THE FIRST TIME, MUST SUBMIT PROOF OF NON-PROFIT STATUS IN
NEW JERSEY. COMBINATIONS OF CERT IFICATE OF INCORPORATION, CHARTER OR BY-LAWS, FEDERAL TAX EXEMPT
CERTIFICATE, FINANCIAL RECORDS A ND MEMBERSHIP LIST (NAMES AND A DDRESSES INCLUDED) ARE ACCEPTABLE
FORMS OF PROOF. THE DIVISION OF ALCOHOLIC BEVERAGE CONTROL RESERVES THE RIGHT TO REQUEST ADDITIONAL
INFORMATION IF DOCUMENTATION SUBMITTED IS NOT SUFFICIENT.
Pursuant to N.J.S.A. 33: 1-74 and N.J.A.C. 13:2-5.1, the undersigned makes application for a Special Permit to sell, dispense and serve
alcoholic beverages for consumption at an affair as stated herein:
Organization Information
1.
Name of Organization: _____________________________________________________________________________________
Address: ________________________________________________________________________________________________
2.
Does organization hold a liquor license? Yes ☐ No ☐ If yes, ____________-______31_____-_____________-_____________
(CLUB LICENSE’S ONLY)
3.
Has organization held a special permit for Social Affair during the past 3 years? Yes ☐ No ☐ If no, supply proof of non-profit
status from NOTICE paragraph above. Previous Permit No: _______________________
4.
Contact ____________________________________________ Phone Number: _______________________________________
5.
E-mail address ___________________________________________________________________________________________
6.
Mailing address ___________________________________________________________________________________________
Premises Information
7.
Location of premises where affair will be held: (Describe Specifically)
Name of premises _________________________________________________________________________________________
Address of premises _______________________________________________________________________________________
8.
Is the above named premises licensed? Yes ☐ No ☐ If yes, __________-__________-__________-__________
9.
Are the premises where the affair is to be held owned by a municipality, county or state? Yes ☐ No ☐
If yes, state the name of owner _______________________________________________________________________________
For what purposes are premises used? ________________________________________________________________________
Does the premise conduct mercantile business? Yes ☐
No ☐ If yes, what is sold? ____________________________________
Event Information
10. What date(s) will affair be held and between what hours alcoholic beverages will be dispensed (Dates must be consecutive to be
on one application):
Rain Date (only one rain date): __________________________________________________________
/ /
/ /
/ /
am pm
am pm
am pm
am pm
am pm
am pm
END
START
MM/DD/YY
11. What is the specific fundraising event being held? ________________________________________________________________
12. How is a charge assessed? Ticket ☐ Contribution ☐ Other : ____________________________________________________
(SPECIFY OTHER)
13. Who is the recipient of the proceeds? __________________________________________________________________________
14. Check the types of alcoholic beverages to be dispensed if permit is granted:
Wine ☐
Distilled Spirits ☐
Malt Alcoholic Beverages ☐
15. What are cup sizes for alcoholic beverages?
Wine ___________
Beer ___________
Spirits ___________
16. How many people are expected to attend your event on a daily basis? ________________________________________________
17. What is the approximate age group of the attendees? _____________________________________________________________
18. Will persons under the legal age to consume alcohol be in attendance?
Yes ☐ No ☐
19. Explain in detail the security plans for the event. The plan should include the number of people checking for ID's, plans to prevent
pass-offs to minors, the t ype of securit y at the event, the limit of alco
holic beverages per transacti on, and any other relevant
information pertaining to the event. Please attach another sheet if necessary.
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
20. Please use the space below or attach a detailed sketch of the area to be licensed. The sketch should include entrances and exits,
ID checking area(s), location of where alcoholic beverages will be dispensed and any other relevant information pertaining to the
event. No permit will be issued if a sketch is not attached.
Event Organizer Information
Is the event being handled by a promoter, Production Company, or other entities? Yes ☐
No ☐ If yes, attach contract.
Company Name _______________________________________________________________________________________
Company Contact _____________________________________________________________________________________
Phone Number __________-__________-___________x___________ Title________________________________________
NO PERMIT WILL BE GRANTED UNLESS WRITTEN APPROVALS FOR BELOW ARE OBTAINED
ORIGINAL SIGNATURES ONLY
If a Special Permit is granted, applicant agrees that alcoholic beverages will not be sold or served to anyone under the legal age, nor
will such persons be permitted to co nsume alcoholic beverages at aforesaid affair a nd certifies that all c onditions set forth i n said
Permit, all rules and regulations pertaining thereto and all ordinances and/or resolutions of the municipality where aforesaid affair is to
be held will be complied with; and that permission is hereby given the Director of the Division of Alcoholic Beverage Control, Division of
Taxation, and their d uly authorized investigators and agents, and to a ny local peace officer to investigate the sale of alcoholic
beverages at the social affair for which this application is made.
Gambling, mock gambling and gambling paraphernalia are not permitted on the premises licensed by the Special Permit unless
otherwise approved by the Legalized Games of C hance Commission (973) 273-8000. I HEREBY CERTIFY THAT THIS
ORGANIZATION HAS NOT EXCEEDED ITS LIMIT OF 12 SPECIAL PERMITS DURING THIS CALENDAR YEAR.
_________________________________________________
_________________________________________________
(Signature of Authorized Officer and Title)
(Name of Organization)
Date of Signature___________________________________
I hereby certify that there is no objection to the granting of a Special Permit to above applicant to sell alcoholic beverages at the affair to
be held on aforesaid date and premises, subject to, however, the following Special Conditions (if any):
_________________________________________________
_________________________________________________
(Signature of Chief of Police)
(Municipality where affair is to be held)
Date of Signature___________________________________
I hereby certify that the License Issuing Authority of this municipality has no objection to the granting of a Special Permit herein applied
for and consents thereto. I further certify that the issuance of said Permit is not contrary to any local ordinance, resolution, regulation or
policy which would prohibit same.
_________________________________________________
(Signature of Clerk)
_________________________________________________
Date of Signature: _______________________________
(Municipality where affair is to be held)
The following consent is to be signed by the person so authorized of the premises where the affair is to be held.
I hereby certify that I am the person in charge of the premises upon which the herein affair will be held, that I am fully authorized to and
do hereby certify that there are no objections to the sale and service of alcoholic beverages upon such premises at suc h affair. I
HEREBY CERTIFY THAT THIS PREMISE HAS NOT EXCEEDED ITS LIMIT OF 25 SPECIAL PERMITS DURING THIS CALENDAR
YEAR.
_________________________________________________
Date of Signature___________________________________
(Signature and Title)
NOTE: THE DIVISION MUST BE NOTIFIED FOR CANCELLATION OR RESCHEDULING PRIOR TO THE DATE OF
THE EVENT.
Issuance of the Special Permit will allow the organization to purchase alcoholic beverages for resale at the affair specified in
the application from any licensed wholesaler or retailer. All advertising, tickets, etc., for the affair which contain reference to
alcoholic beverages must include this Permit Number.
Rev. 01/13