Required Forms & Documents

1. Legal Business Entity Record (LBER) Record [LA-B-0000000000]

Required For All Applicants

LIC-4004-FORM(PDF, 331KB) - Owner / Primary Personnel Attestation
LIC-4008-FORM(PDF, 858KB) - Legal Business Entity Record Disclosure Form
Must include an organizational chart
State Registration Documents
Articles of Incorporation and/or Statement of Information
Business Formation Documents (if applicable: For SEIA’s)
Examples: Operating Agreement, Bylaws, etc.

Only Required If Applicable

LIC-4009-FORM(PDF, 315KB) - Authorized Agent Acknowledgement
Only required if you have an authorized agent
SEP-6001-FORM(PDF, 324KB) - Owner Compliance Attestation
Only required for Social Equity Individual Applicants

Required For All Applicants

LIC-4016-FORM(PDF, 354KB) - Landowner Attestation Location Eligibility

Required For All Applicants

LIC-4021-FORM(PDF, 306KB) - Initial Inspection Attestation
Lease Agreement
LIC-4024-FORM(PDF, 387KB) - Business Premises Diagram Checklist
Note: This document is a checklist. The applicant must submit the actual Business Premises Diagram.

Only Required If Applicable

Required For All Applicants

LIC-4021-FORM(PDF, 306KB) - Initial Inspection Attestation
LIC-4020-FORM(PDF, 269KB) - No Alcohol or Tobacco Applicant Attestation
LIC-4005-FORM(PDF, 301KB) - Indemnification Agreement
LIC-4010-FORM(PDF, 322KB) - Temporary Approval Attestation
LIC-4013-FORM(PDF, 778KB) - Project Specific Information
LIC-4024-FORM(PDF, 387KB) - Business Premises Diagram Checklist
Note: This document is a checklist. The applicant must submit the actual Business Premises Diagram.
Lease Agreement

All documents would already be received.

Required For All Applicants

Only Required If Applicable

LIC-4019-FORM(PDF, 279KB) - Business Premises Surrender Form
Only required for a loss of site control

Required For All Applicants

LIC-4001-MOD(PDF, 850KB) - Modification Request Cover Page
LIC-4004-FORM(PDF, 331KB) - Owner Primary Personnel Attestation
LIC-4006-MOD(PDF, 3MB) - General Applicant Entity Substitution Form
LIC-4008-FORM(PDF, 858KB) - Legal Business Entity Record Disclosure Form
(Must include an organizational chart)

Only Required If Applicable

Required For All Applicants

LIC-4001-MOD(PDF, 850KB) - Modification Request Cover Page
LIC-4004-MOD(PDF, 3MB) - Ownership Structure Change
LIC-4005-MOD(PDF, 2MB) - Removal of Owners
LIC-4008-FORM(PDF, 858KB) - Legal Business Entity Record Disclosure Form
(Must include an organizational chart)

Only Required If Applicable

None

Required For All Applicants

LIC-4005-FORM(PDF, 301KB) - Indemnification Agreement
LIC-4008-FORM(PDF, 858KB) - Legal Business Entity Record Disclosure Form
LIC-4024-FORM(PDF, 387KB) - Business Premises Diagram Checklist
Note: This document is a checklist. The applicant must submit the actual Business Premises Diagram.
Evidence of Site Control
Examples: Executed Lease, Property Deed, etc.

Only Required If Applicable

LIC-4018-FORM(PDF, 298KB) - Successor In Interest Form
Only required if not previously submitted or there is an update needed from your prior submission.

LIC-4001-MOD(PDF, 850KB) - Application Modification Request Cover Page
LIC-4002-MOD(PDF, 3MB) - Application Modification Request - Business Premises Relocation
LIC-4004-MOD(PDF, 3MB) - Application Modification Request - Ownership Structure
LIC-4005-MOD(PDF, 2MB) - Application Modification Request - Removal of Owner(s)
LIC-4006-MOD(PDF, 3MB) - Application Modification Request - Applicant Entity Substitution (General)

LIC-4001-IPB(PDF, 315KB) - PCN Information and Procedure Bulletin
LIC-4002-IPB(PDF, 375KB) - Pre-Application Review Information and Procedure Bulletin
LIC-4003-IPB(PDF, 327KB) - Temporary Approval Information and Procedure Bulletin
LIC-4004-IPB(PDF, 290KB) - Application Modification - Business Premises Relocation