IN ORDER FOR THE STATE LIQUOR AUTHORITY TO PROPERLY EVALUATE AND DETERMINE THE 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering the date at the top of the form. This is crucial for tracking the referral timeline.
3. Fill in the License Serial Number located in the upper left corner, followed by the Name of Licensee and DBA (Trade Name). Ensure accuracy as this identifies the establishment involved.
4. Provide the Address of Premises and Certificate Number found in the lower right corner. This information is essential for proper identification.
5. Indicate the Date and Time of Violation, along with the Name of Person in Charge and their Title (e.g., Licensee, Manager).
6. Select the Status of Investigation by checking either 'Open' or 'Closed'.
7. Specify if Supporting Documents are Attached by checking 'Yes' or 'No'. If 'No', provide an explanation and approximate availability date.
8. List Officers directly involved, including their Address, City/Town or Village, and Phone Number for follow-up.

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