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OFFICE USt ONLY ; C) Original © Amended Date —SS Standardized NOTICE FORM for Providing 30-Day Advance Notice to a Local Municipality or Community Board SSS a ee SS 1. Date Notice Sent: 19/15/2024 la. Delivered by: |Parsonal Delivery with Pp 09 of Re ceipt BYE te ane \ 2. Select the type of Application that will be filed with the Authority for an On-Premises Alcoholic Beverage License: = V7 |.) A> OF oo For premises outside the City of New York: CROTOH-Os-HUBSON, RLY, oO New Applciation © Removal @ class Change For premises in the City of New York: © New Application © New Application and Temporary Retail Permit © Renewat © Alteration © Removal O class Change © Method of Operation O Corporate Change For New and Temporary Retail Permit applicants, answer each question below using all information known to date For Renewal applicants, answer all questions For Alteration applicants, attach a complete written description and diagrams depicting the proposed alteration(s) For Corporate Change applicants, attach a list of the current and proposed corporate principals For Removal applicants, attach a statement of your current and proposed addresses with the reason(s) for the relocation For Class Change applicants, attach a statement detailing your current license type and your proposed license type For Method of Operation Change applicants, although not required, if you choose to submit, attach an explanation detailing those changes Please include all documents as noted above. Failure to do so may result in disapproval of the application. This 30-Day Advance Notice is Being Provided to the Clerk of the Following Local Municipality or Community Board: 3. Name of Municipality or Community Board: Village of Croton-on-Hudson, NY Applicant/Licensee Information: 4, Licensee Serial Number {if applicable): Expiration Date (if applicable): 5. Applicant or Licensee Name:|Baked By Susan Inc. 7. Street Address of Establishment: 1379 South Riverside Avenue. 9, Business Telephone Number of applicant/ Licensee: 914 862 0874 10. Business E-mail of Applicant/Licensee: |pbakedb susan@gmail.com 11. Type(s) of alcohol sold or to be sold: © Beer & cider © Wine, Beer & Cider © Liquor, Wine, Beer & Cider 12. Extent of Food Service: © Full Food menu; full kitchen run by a chef/cook © Menu meets legal minimum food requirements; food prep area required “he 33. Type of Establishment: |BarfTavern | f O Seasonal Establishment O Juke Box Cpise Jockey oO Recorded Music oO Karaoke f 14. Method of Operation: eae - that a noly) O Live Music (give details j.e., rack bands, acoustic, jazz, etc.): PT (J PatronDancing Employee Dancing [J Exotic Dancing (J Toptess Entertainment CO Video/Arcade Games CJ Third Party Promoters CJ Security Personnel [=] other (specify: {Pop up chef for special brunch or dinner events 15, Licensed Outdoor Area: (_] None Patioor Deck LL} Rooftop _) Garden/Grounds L) Freestanding Covered Structure (check all that apply) (_] sidewalk Cafe [_] Other (specify): Baga 1 nf 9 UrFILE USt UNLY : . | © Original © Amended Date | 16. List the floor{s) of the building that the establishment is located on: 17. List the room number(s} the establishment is located in within the building, if appropriate: 18. Is the premises located within 500 feet of three or more on-premises liquor establishments? O ves (* No 19. Will the license holder or a manager be physically present within the establishment during all hours of operation? © Yes © No 20. if this is a transfer application (an existing licensed business is being purchased) provide the name and serial number of the licensee: Po Name Serial Number 21. Does the applicant or licensee own the building in which the establishment is located? ~ Yes (if YES, SKIP 23-26) ONo Owner of the Building in Which the Licensed Establishment is Located 25. Business Telephone Number of Building Owner: Representative or Attorney Representing the Applicant in Connection with the Application for a License to Traffic in Alcohol at the Establishment Identified in this Notice 27, Representative/Attorney's Street Address: CO” 29. Business Telephone Number of Representative/Attorney: FO] 30. Business E-mail Address of Representative/Attorney: | | am the applicant or licensee holder or a principal of the legal entity that holds or is applying for the license. Representations in this form are in conformity with representations made in submitted documents relied upon by the Authority when granting the license. | understand that representations made in this form will also be relied upon, and that false representations may result in disapproval of the application or revocation of the license. By my signature, | affirm - under Penalty of Perjury - that the representations made in this form are true. t ~ © \ Principal Signature: