.---
---CHRIS CHRISTIE
GO VEl/NOR
KIM GUADAGNO
LT. GOV!ii/NOI/
STATE OF NEW JERSEY
OFFICE OF THE ATTORNEY GENERAL DEPARTMENT OF LAW AND PUBLIC SAFETY DIVISION OF ALCOHOLIC BEVERAGE CONTROLP.O. Box 087 TRENTON, NJ 08625-0087
PHONE: (609) 984-2830 FAx: (609) 633-6078
WWW.NJ.GOV/OAG/ABC
SOLICITOR'S PERMIT
PROCESSING
JOHN J. HOFFMAN
ACTING A ?TORNEY GENERAL MICHAEL I. HALFACRE
DIIIECTOII
The following procedures must be completed when applying for a Solicitor's Permit:
APPLICATION
Section I must be completed by the employing wholesaler. All questions on Section II must be answered by the applicant. If applicant will be employed by two or more wholesalers within the same year or has previously been employed by a licensed New Jersey wholesaler, each company's name and license number must be listed in Question 3. The signatures of the applicant and an authorized representative of the employing wholesaler are required in the notarized statement in Section III.
FINGERPRINTS
All candidates for Solicitor's Permits must comply with the procedure for obtaining fingerprint impressions. (Call Lori Rosati at 609-292-0322 for the form. ) Solicitors out of the industry for at least three years must be reprinted.
PHOTOGRAPHS
Each original application must be accompanied by one (1) passport size (2" X 2") photograph of the applicant.
FEES
The fees for Solicitor's Permits are as follows:
$15.00 for those employed by SBD licensees and
$25.00 for those employed by all other wholesale licensees.
Payment should be made in the form of a check or money order payable to the Division of Alcoholic Beverage Control.
NOTE:
Upon termination of employment, the solicitor or his employer must surrender the original Solicitor's Permit to our Bureau for cancellation. If the solicitor commences employment with another wholesale licensee, he/ she must apply for a new Solicitor's Permit by submitting a new application, fee and passport photograph to this Division.STATE OF NEW JERSEY
DEPARTMENT OF LAW AND PUBLIC SAFETY DIVISION OF ALCOHOLIC BEVERAGE CONTROL
P.O. BOX 087, 140 EAST FRONT STREET TRENTON, NJ 08625-0087
APPLICATION FOR SOLICITOR'S PERMIT
A.B.C. USE ONLYSOLICITOR NO. ---DATE
_____________
!
____________ ! ____________ _
Revised 11/19/07
THIS APPLICATION CONSISTS OF FOUR (4) PAGES WHICH MUST BE FULLY COMPLETED.
SECTION I: TO BE COMPLETED BY NEW JERSEY WHOLESALE LICENSEE
1. Employer's New Jersey License Number: 2. License Name: ---3. License Address: 4. 6. 7. ---(Street)
(City) (State) (Zip Code)
Contact Name:
--- 5. Contact Phone # ____________________ __
Type(s) of Compensation Received by Applicant: Salary
Commission
Bonus
Expenses Percentage
No Compensation [
Date Employment will Commence:
____
!
!
_ _
_
Month Day YearSECTION II: TO BE COMPLETED BY APPLICANT
8. Solicitor Name:
---(Last) (First) (Middle)
9. Home Address:
--~--~--~----~---~---~---(Number/PO Box) (Street)
(City) (State) (Zip Code)
10. Mailing Address: __________
~---(If Different) (Number/PO Box) (Street)
3403 26 623 001
T Elenteny Holdings, LLC
66 West Broadway, Suite 301
New York NY 1007
.---~~
11. Telephone Number
12. Date of Birth
______
!
___
!
___
_
Month Day Year 13. Social Security No:14. Drivers License No.:
_________
!
_________________________________ ___
(State) (Number)
15. Have you been previously employed by a New Jersey wholesale licensee?
Yes ( No ( ) If yes, please provide the following information.
List each previous employer individually (use extra paper if necessary):
A. Wholesaler's Name:
Dates Employed: FROM ]/( TO l
I
lMonth Year Month Year B. Wholesaler's Name:
Dates Employed: FROM l
I
l TO ]/( Month Year Month Year16. Do you presently hold, or have you ever held, an interest, directly or
indirectly, in any type of alcoholic beverage license in the United States, or are you receiving any payments from the sale of an alcoholic beverage license in the United States?
Yes No [ If yes, please provide the following:
A. State of Issue
-License No. Name of Licensed Entity
---B. Type of License: Retail
Wholesale/Supplier Manufacturer
c.
Indicate if your interest has been: Surrendered Revoked Canceled Transferred LapsedD. Date interest was terminated:
________
!
______ __
Month Year
-17. Are you currently a member of a Municipal Alcoholic Beverage License Issuing Authority in the State of New Jersey? Yes ( No ( )
If yes : Municipality ____________________________________________ _ County __________________________________________________ __ Position
-18. Do you currently hold any official position related to law enforcement in the State of New Jersey? Yes ( ) No ( )
If yes: Jurisdiction
---Title
---19. Have you ever been denied a New Jersey Solicitor's Permit?
Yes ( ) No ( If yes, on what date and for what wholesaler had you been contracted to solicit?
(Date) (Wholesaler/Employer)
20. Are you being investigated or have you ever been convicted of a violation of any law or regulation, etc., concerning the manufacture, sale, possession, distribution or transportation of alcoholic beverages? Yes ( ) No ( )
21. Are you being investigated or have you ever been convicted of any criminal matter of any type whatsoever? Yes ( No (
If yes: Nature of Offense
---Penalty (or status of investigation)
---Date of Conviction
_________
!
_________
!
_______ __
Jurisdiction: Federal State County [ Municipal [
22. If you answered "YES" to Question 20 or 21, have you petitioned the Director of the Division of Alcoholic Beverage Control for a disqualification removal/eligibility? Yes ( No ( )
If Granted: Docket No. Date of Determination
I
I
---***Please note statement #3 of the enclosed affidavit (page 6) . If you are unable to attest to the truth of statement #3, do not sign the affidavit. You must provide a written explanation to the Division of Alcoholic Beverage Control which:
1. Lists the names of immediate family members, defined as husband, wife, son, daughter, grandson, granddaughter, brother, sister, father, mother, brother-in-law, sister-in-law, son-in-law or daughter-in-law that have any direct or indirect financial interest or participates in the operation of a retail alcoholic beverage license; and
2. Lists the license number(s) in which your immediate family member(s) have any direct or indirect financial interest in or participate in the operation of and
3. Whether you are claiming an exemption to N.J.A.C. 13:2-16.11 and the basis for your claim.
SECTION III: AFFIDAVIT - TO BE COMPLETED BY LICENSEE AND APPLICANT. ALSO TO BE NOTARIZED BY A NOTARY PUBLIC OR ATTORNEY AT LAW OF THE STATE OF NEW JERSEY STATE OF
---COUNTY OF __________________________ __
The applicant specifically avers the following:
1. I do not presently have an interest, directly or indirectly, in any type of alcoholic beverage license other than described in question number 16 of my Solicitor's Permit Application; and
2. No immediate family member of mine, meaning husband, wife, son, daughter, grandson, granddaughter, brother, sister, father, mother, brother-in-law, sister-in-law, son-in-law or daughter-in-law has any direct or indirect financial interest or participates in the operation of a retail alcoholic beverage license.
3. I am aware of my continuing obligation to report to the Division of Alcoholic Beverage Control any changes to the facts contained in my Solicitor's Permit application.
SIGNATURE OF APPLICANT AUTHORIZED SIGNATURE OF LICENSEE
PRINT NAME OF APPLICANT PRINT NAME OF LICENSEE
The above persons, being duly sworn according to law, upon their oaths, depose and state that the answers, statements and declarations made in the foregoing application are true to the best of their knowledge and belief and are aware that if any of the foregoing answers, statements or declarations are willfully false, they will be subject to punishment. SWORN TO BEFORE ME AND SUBSCRIBED IN MY PRESENCE
THIS ______________ __ DAY OF
---' 20 ______ __
NOTARY PUBLIC OR OFFICER ADMINISTERING OATH
CHRIS CHRISTIE GOVERNOR
KIM GUADAGNO LT. GOVh"RNOI?
STATE OF NEW JERSEY
OFFICE OF THE ATTORNEY GENERAL
DEPARTMENTOFLAW AND PUBLIC SAFETY
DIVlSION OF ALCOHOLIC BEVERAGE CONTROL
P.O. Box 087 TRENTON, NJ 08625-0087
PHONE: (609) 984-2830 FAx: (609) 633-6078
WWW.NJ.GOV/OAG/ABC
JOHN J. HOFFMAN
ACTING A7TORNEY GENERAL
MICHAEL l. HALFACRE
DIRECTOR
TO: ALL APPLICANTS FOR NEW JERSEY SOLICITOR'S PERMITS
New Jersey law requires that every applicant for aNew Jersey Solicitor's Permit must submit to a fingerprint procedure as part of the application process in order to determine whether or not to issue your Solicitor's Permit. (N.J.S.A. 33:1-25, N.J.S.A. 33:1-26 and N.J.S.A. 33:1-67.) All candidates for Solicitor's Permits must comply with the Division's procedure in obtaining fingerprint
impressions. WE DO NOT ACCEPT INKED FINGERPRINT CARDS. (EXCEPTIONS
WILL ONLY BE MADE FOR GOOD CAUSE.)
In order to have your fingerprints taken, you must call the vendor designated by the New Jersey State Police to take fingerprint impressions. The vendor, MorphoTrak will take information from you over the telephone, including the codes on the reverse side of this letter. An appointment will be scheduled for you to report to a local site and have your fingerprint impressions taken. On
the day you report, you MUST BRING A PHOTO ID ISSUED BY A GOVERNMENTAL
AGENCY AND THIS FORM (see reverse side for details). Failure to follow this direction will result in your being turned away at the center and will require you to make a second trip. To arrange to have your fingerprints taken, you must call MorphoTrak toll-free at (877) 503-5981 Monday through Saturday, 8am to 5pm. You can also contact them via their website. The web address is www.bioapplicant.com/nj. Please keep this letter handy as you will need to provide MorphoTrak with the information listed on the reverse side of this letter.
The fee for the fingerprinting is $67.50. Cash will not be accepted. Please see attached
for payment instructions.
Once you are fingerprinted, the vendor will give you a special number, called a PCN. You should write this number down on this form and keep it for your records. This proves that you have had the fingerprints completed and can help us track down information or to re-send your fingerprints in the future. Make sure that the vendor records the PCN number on the back of this form.
REMEMBER: You must complete and forward all the necessary information
required by the Division as part of the application process before
the Director will render any determination on your application. The fingerprinting process is a part ofthe overall investigation to determine whether or not the Division of Alcoholic Beverage
www.bioapplicant.com/nj
Formerly Sagem Morpho Inc
(1) Originating Agency Number (ORI #) (2) Category (3) Statute Number
NJ920620Z ABK NJSA 33:1-26
(4) Reason for Fingerprinting (5) Document Type
LIQUOR INDUSTRY EMPLOYMENT RB1
I
(6) Payment Information FEE: $67.50
(7) Contributor's Case# (Unique Identifier) (8) Miscellaneous
SO LIT
(9) First Name (10) Ml (11) Last Name
(12)Daytime Phone Number (13) Social Security (14) Date of Birth (15) Height (16) Weight
Number
( )
-(17) Maiden Name (if married female) (18) Place of Birth (U.S. State -for US Citizen; (19) Country of Citizenship
Country for all others) (20) Horne Address
Address City State Zip
(21) Gender (Select one) (22) Hair Color (Indicate most (23) Eye Color (24) Race (Select One)
Male { ) predominant color, one only) A Asian/ Pacific Islander { includes Asian Indian)
Female { ) B Black W White { Includes Hispanic/ Spanish Origin)
Both { ) u Unknown I American Indian I Alaska Native
{25) Occupation (26) Employer (Name) Employer Address
City State Zip
APPLICANT INFORMATION - READ THIS FORM CAREFULLY AND FOLLOW ALL INSTRUCTIONS TO COMPLETE THE FINGERPRINT
PROCESS. You MUST present this completed form at your appointment to be FINGERPRINTED. NO EXCEPTIONS ALLOWED. Applicants without forms or with incomplete forms will not be printed.
/DENT/FICA T/ON 1$ REQUIRED- ACCEPTABLE ID REQUIREMENTS -ID MUST include Photo, Name, Address (Home/ Employer) and
Date of Birth. Acceptable ID MUST be issued by a Federal, State, County or Municipal entity for Identification purposes. Examples of acceptable ID are: 1) Valid Photo Drivers License or Valid Photo ID issued by any State DMV or NJ MVC, 2) Passport. Acceptable ID
MUST meet all of the underlined requirements above and MUST be present on one (1) 10. Combinations of documents are NOT
acceptable. If acceptable ID is not presented you will not be fingerprinted.
For applicants who are required to pay for their own fingerprinting fees, payment is required at the time of scheduling. Payment may be made with a credit card or electronic debit from a checking account. Remember your account will automatically be debited. An $11 fee is charged to cover the cost of a scheduled appointment for applicants who do not cancel/reschedule by noon on the business day prior to your scheduled appointment (Saturday noon for Monday appointments). All appointments can be canceled/rescheduled via the web without penalty if cancellation requirements are met. The $11 fee will also apply for applicants who are turned away from the printing sites due to the inability to present proper 10, who fail to present this completed Universal Fingerprint Form provided to you by your requesting agency or employer, or who are turned away because information on this form does not match the information provided during the scheduling process. You will be refunded State and Federal search fees only.
Appointment scheduling is available via the web at www.bioapplicant.com/nj, 24 hours per day, 7 days per week. For applicants who do not have web access, appointments can be made by contacting us toll free at (877) 503-5981 on a first call, first served basis Monday through Friday, 8 00 AM to 5:00 PM EST and Saturday, 8:00AM to 12 noon EST. English and Spanish speaking operators are available. Hearing impaired
scheduling is available at (800) 673-0353. ONLY applicants who schedule through the call center can make payment by money order at the fingerprint site. No other form of payment is accepted at the fingerprint site.
Your APPLICANT 10, Site, Date, Time of your appointment, and payment authorization will be confirmed by the call center agent or web confirmation when scheduling is complete. You must record this information in the appropriate blocks below while speaking with the operator. If you appear for fingerprinting at a site where you are not scheduled or on a different date and time, you will be turned away and not fingerprinted. If applicable, you may incur the $11 appointment fee.
Your PCN number will be recorded when your fingerprinting has been completed. You MUST retain a copy of the form and a copy of the receipt provided to you by the Fingerprint Technician for your records. NO RECEIPTS WILL BE PROVIDED AFTER THE DATE OF PRINTING.
Applicant ID No.
I
Scheduled Site/ Date/ TimeI
PYMT AuthorizationI
PCNAgency Information #1 I Agency Information #2
MORPHOTRAKPAYMENTPROCEDURES
SCHEDULING APPOINTMENT BY PHONE
Effective July 25, 2003, applicants who are responsible for payment of fees associated with fingerprinting will be required to pay at the time the appointment is scheduled. Payment will only be accepted in the form of credit card, debit card with MasterCard or VISA logo or check.
Should an applicant be unable to provide payment by one of these methods, a money order for the exact amount of the fee shall be accepted at the fingerprint sites. No other form of payment will be accepted at the sites.
Fee Payment Procedures
Credit Card, Debit Card or Payment via Check at Time of Scheduling
• Applicant completes and retains Universal Form (NJAPS2). Form must be obtained from the
authorizing agency.
• Applicant contacts the call center toll free number (877) 503-5981 and schedules an appointment.
• Applicant provides credit card, debit card with MasterCard or VISA logo or check information.
• Credit, debit or check billing is verified.
• Applicant is given an appointment and an Applicant ID number.
• Applicant must retain a copy of the Universal Form for his/her use when contacting the call
center toll free number to schedule an appointment, and for presentation to the fingerprint technician at the time the applicant is fingerprinted.
-OR-Money Order Payment at Time of Fingerprinting
• Applicant completes and retains Universal Form (NJAPS2). Form must be obtained from the
authorizing agency.
• Applicant contacts call center toll free number (877) 503-5981 to schedule an appointment.
• Applicant is given an appointment and an Applicant ID number.
• Applicant pays via money order at time of fingerprinting.
• Applicant presents Universal Form to fingerprint technician at the time of fingerprinting.
NOTE:: Applicants MUST bring their completed Universal form and acceptable photo ID to the fingerprinting site to complete processing.
SCHEDULING APPOINTMENT VIA INTERNET
MorphoTrak also offers scheduling via a dedicated web site: http://www.bioapplicant.com/nj.
Fee Payment Procedures
Payment Via Credit Card, Debit Card or Check
• Applicant obtains and completes the Universal Form (NJAPS2). Form must be obtained from the
• Applicant utilizes any PC with Internet access to contact the web scheduling site at h.!tn: I /www_,.htoaQI?.Jican.L<:_Q!l.1:'ni.
• Applicant enters demographic data from the Universal Form (NJAPS2).
• Applicant enters credit card, debit card with MasterCard or VISA logo, check information or
payment authorization by agency.
• Applicant selects date, time and location of appointment and records this information along with
an Applicant ID number, on the Universal Form.
• Applicant presents Universal Form to technician at time of printing.
-OR-Payment via Money Order
• Applicant obtains and completes the Universal Form (NJAPS2). Form must be obtained from the
authorizing agency.
• Applicant utilizes any PC with Internet access to contact the web scheduling site at
http://www .bioapglicant.com/nj.
• Applicant enters demographic data from the Universal Form (NJAPS2).
• Applicant mails money order and provides additional information as instructed on the web site.
• Applicant waits 3 business days to complete the scheduling process via the web site by again contacting the web site at http://www.bioapplicant.com/nj.
• Applicant selects date, time and location of appointment and records this information along with
an Applicant ID number, on the Universal Form.
Applicants will be able to access the web site as many times as they choose during the scheduling process. Actual scheduling of an appointment will not occur until the demographic entry and payment processing have been completed in full.
Note: Applicants MUST bring their completed Universal form and acceptable photo ID to the
fingerprinting site to complete processing.
CANCELLATION PROCEDURES/NO SHOW FEE
Deadlines for notifYing the Call Center when an applicant is unable to be present for their scheduled appointment are as follows:
Tuesday- Saturday Appointments: 12:00 Noon on the day prior to the scheduled appointment.
Monday Appointments: 12:00 Noon on the Saturday prior to the scheduled appointment.
There is no charge to an applicant who cancels or reschedules an appointment prior to the above
deadlines.
An applicant who fails to notify the Call Center or web site in accordance with the cancellation deadlines
provided above would be issued a partial refund for the portion of their fee that covers the cost of the State and Federal search. $14 of the fee paid to MorphoTrak for scheduling the appointment will not be refunded.
When rescheduling after failing to keep a scheduled appointment and providing no advance notification
the Call Center or web site, the applicant will again be charged the full fee for all required fingerprinting services.
Names of applicants who fail to show at the scheduled time will be submitted to the licensing or
