New Jersey Administrative Code
Title 13 - LAW AND PUBLIC SAFETY
Chapter 69A - APPLICATIONS
Subchapter 5 - FORMS
Section 13:69A-5.17 - Casino Hotel Alcoholic Beverage License Resubmission

1. Any official or trade name used by the applicant;

2. The permanent address and telephone number of the applicant;

3. The Atlantic City address and telephone number of the business or enterprise;

4. The name, address and telephone number of a person to be contacted in reference to the application;

5. The name, address and telephone number of the attorney of record;

6. The Federal Employer Identification Number;

7. The Vendor Identification Number and Casino Hotel Alcohol Beverage casino service industry license number;

8. A description of the primary and additional uses, hours of operation and type of CHAB authorization for each location within the facility where alcoholic beverages are served;

9. The address of any off-premises facility that is or will be used for the storage of alcoholic beverages and a copy of the license for the facility issued by the New Jersey Division of Alcoholic Beverage Control, or a copy of the application for such license if a license has not yet been issued;

10. A description of where the CHAB license is displayed;

11. The name, address and telephone number of any officer, director, shareholder, owner, partner, holding company, intermediary company, subsidiary, employee or individual connected with the business or enterprise who has any direct or indirect interest in the manufacture, wholesale, importation or distribution of alcoholic beverages in New Jersey or any other jurisdiction and the percentage of that interest;

12. The names of all parties to any lease agreement between the CHAB licensee and a casino licensee;

13. Any management agreement, profit-sharing, franchise agreement or service agreement related to the operation of proposed licensed CHAB facility, whether written or unwritten;

14. A current listing of all employees of the licensee pursuant to 13:69I-2.3(c);

15. A listing of all alcoholic beverage enterprises, including wholesale distributors, suppliers and manufacturers, with which the licensee conducted business during the previous license term;

16. Within the past five years or since the time of the last submission, any changes to the following:

17. A detailed description of any other written or verbal agreements in effect between the CHAB licensee and any casino licensee during the past five years;

18. The total amount of compensation and a description of the method of calculation paid pursuant to any agreement with a casino licensee; and

19. The total amount of alcoholic beverage sales for the period commencing from the date the CHAB license was granted or the last five-year period and ending within 30 days of the date when this application is filed.

1. A certification of truth, which shall be dated, notarized and signed by the following: