Premises Location Ownership And Description Of Premises

AGD Stamp New Mexico Regulation and Licensing Department | Alcohol and Gaming Division | Page 2 Revised 5/16 PO Box 25101 Santa Fe, NM 87504-5101 | Phone: (505) 476-4875 Fax: (505) 476-4595 PREMISES LOCATION, OWNERSHIP, AND DESCRIPTION NMSA §60-6B-10 1. The land and building which is proposed to be the licensed premises is: (check one) Owned by Applicant, copy of deed/document attached Leased by Applicant, copy of lease/document attached Other (provide details): ____________________________________________________________________________ 2. If the land and building are not owned by Applicant, indicate the following: A. Owner(s): ________________________________________________________________________________ B. Date and Term of Lease:____________________________________________________________________ 3. Premises location is Zoned (example C-1, see Zoning Statement): _____________________________________________, Zoning Statement attached, which must be obtained from the Local Government, listing the proposed location by address, Type of Zone, state whether alcoholic beverages are allowed at proposed location, and if applicable, whether packaged sales, patio service and/or manufacturing is allowable. If there is no zoning in the proposed location, attach Statement from the local government, indicating there is no zoning. 4. Distance* from nearest Church: (Property line of church to closest point of licensed premises--shortest distance) Name of Church: _________________________________________________________ Miles/feet: _________________ Address/location of Church: ___________________________________________________________________________ 5. Distance* from nearest School: (Property line of school to closest point of licensed premises--shortest distance) Name of School __________________________________________________________ Miles/feet _________________ Address/location of School: ___________________________________________________________________________ 6. Distance from military installation *(Property line of military installation to closest point of licensed premises-shortest distance.) Name of Military Installation, circle one: Miles: ________________ Kirtland Air Force Base (Albuquerque), White Sands Missile Range (Las Cruces), Holloman Air Force Base (Alamogordo), Cannon Air Force Base (Clovis) 7. Attach Detailed Floor Plan, must include the Total Square Footage of premises; List nearest cross street; Show which direction is North; Show each level (floor) where alcoholic beverages will be sold or consumed, exterior walls, doors, and interior walls; Patio Area with type of barrier used; Highlight Bonded Areas. The floor plan should be no larger than 8½ x 11 inches and must be labeled with designated areas highlighted, which will reflect the proposed Licensed Premises. 8. Type of Operation: Hotel Lounge Package Grocery Restaurant Racetrack Small Brewer Craft Distiller Winery Wholesaler Other (specify):__________________________________________________________________________________ *NOTE: If the distance is beyond 300 feet, but less than 400 feet, a Registered Engineer or Licensed Surveyor must complete a Survey Certificate showing the exact distance. American LegalNet, Inc. www.FormsWorkFlow.com