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Form 180 021b Nys Liquor Authority 2011
Office Building
333 E. Washington St. Room 205
Syracuse, NY 13202
Telephone: 315-428-4198
Certified check, bank check, money order, or personal check payable to the New York State Liquor Authority for the
amount of fee as shown on Application for Approval of Corporate Change (SLA Form 180-021).
On Application for Corporate Change list all officers, directors and stockholders other than those retiring. Club
licensees must submit Personal Questionnaire and fingerprint card for the ABC Officer...
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