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Page 3 PLEASE TYPE OR PRINT ALL INFORMATION <br /> STATE ASSIGNED LICENSE NUMBER 0722_ 44 - 046 - 008 <br /> The following questions identify information about the licensed premises. This describes the area or place which is to be licensed for the <br /> sale,service,consumption,delivery,receipt or storage of alcoholic beverages. If the license is inactive and NOT SITED AT A PLACE OF <br /> BUSINESS,answer question 3,1 only,entering NIA for"not applicable.° [If you use N/A as a response to question 3.1,question 2.2 on Page <br /> 2 should also be answered N/A.] <br /> 3.1 HOW MANY SEPARATE BUILDINGS ARE TO BE INCLUDED UNDER THIS LICENSE? 1 <br /> If more than one building is to be included under this license,a separate Page 3 is to be submitted covering each building. <br /> An up-to-date sketch of the entire licensed premises should be submitted for inclusion in the State ABC license file. <br /> 3.2 BUILDING NO. 1 OF 1 TO BE LICENSED. <br /> 3.3 IS THE ENTIRE BUILDING TO BE LICENSED? XX Yes No <br /> If the answer to question 3.3 is°No,"specify which floors are to be under license and which ones are not by answering the <br /> following questions:. <br /> 3.4 Basement Yes No All of it Yes No <br /> 1b'floor Yes No All of it Yes No <br /> 2"0 floor Yes No All of it Yes No <br /> 3rd floor Yes No All of it Yes No <br /> Specify each additional floor number to be included under this license: <br /> If only part of any floor is to be licensed,attach a more detailed explanation with sketches to clearly delineate licensed areas <br /> from unlicensed areas. <br /> 3.5 ARE ANY GROUNDS ADJACENT TO THE BUILDING UNDER LICENSE TO BE INCLUDED AS PART OF THE LICENSED <br /> PREMISES? <br /> Yes XX No <br /> 3.6 IS THERE ANY UNLICENSED AREA LOCATED BETWEEN BUILDINGS UNDER THIS LICENSE OR BETWEEN LICENSED <br /> ADJACENT GROUNDS? <br /> Yes XX No <br /> IF THE ANSWER IS"YES,"ATTACH A SKETCH OF THE LICENSED AND UNLICENSED AREAS SHOWING DIMENSIONS <br /> IN FEET. <br /> 3.7 DOES THE APPLICANT OWN THE BUILDING? Yes XX No <br /> IF"YES,"IS THERE A MORTGAGE ON THE BUILDING? Yes No <br /> DOES THE APPLICANT LEASE THE BUILDING? XX Yes No <br /> If there is a mortgage on the property,answer question 3.8. If the licensed premise is leased, answer question 3.9. <br /> 3.8 MORTGAGEE(HOLDER OF MORTGAGE): N/A <br /> (Last Name, First Name, Middle Initial or Corporate Name) <br /> Street Address_ Number Street Name <br /> P.O. Box# Municipality State <br /> Zip <br /> 3.9 LANDLORD(HOLDER OF LEASE) Mutual Life Insurance Company <br /> (Last Name, First Name,Middle Initial or Corporate Name) <br /> Street Address 17$.0 Broadway <br /> Number Street Name <br /> P.O. Box# Municipality New York State NY <br /> Zip 10019 - <br />