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  • Ny Sla Form 1041 2018

Get Ny Sla Form 1041 2018-2026

SUBMIT COPIES OF ALL ARREST REPORT/S; INCIDENT REPORTS; SUPPLEMENTAL REPORTS; WRITTEN STATEMENTS AND AFFIDAVITS; VERBAL ADMISSION FORMS; DRUG BUY SHEETS; LAB/FIELD TEST REPORTS; NAMES ADDRESSES AND PHONE NUMBERS OF WITNESSES; AND ANY OTHER PERTINENT DOCUMENT/S OR INFORMATION WITH THE REFERRAL TO: SLAreferralszone2 sla.ny.gov Date: Information from License Certificate License Serial# (Upper left corner) Name of Licensee DBA (Trade Name) Address of Premises Certificate # (Lower Right corn.

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How to fill out the NY SLA Form 1041 online

Filling out the NY SLA Form 1041 online is an important step for reporting referrals to the State Liquor Authority. This guide will provide clear, step-by-step instructions to help you complete the form accurately and efficiently.

Follow the steps to fill out the NY SLA Form 1041 online.

  1. Click ‘Get Form’ button to obtain the form and open it in the editor.
  2. Enter the date of the referral at the designated field at the top of the form.
  3. Fill in the license serial number, which can be found in the upper left corner of the license certificate.
  4. Input the name of the licensee as it appears on the liquor license.
  5. Provide the trade name (DBA) of the establishment in the corresponding field.
  6. Enter the full address of the premises where the violation occurred.
  7. Locate and input the certificate number, found in the lower right corner of the certificate.
  8. Document the date and time when the violation took place.
  9. Fill in the name and title of the person in charge during the violation.
  10. Indicate the status of the investigation by choosing either 'Open' or 'Closed'.
  11. Specify the department involved in the investigation.
  12. Answer whether supporting documents are attached by selecting 'Yes' or 'No'. If 'No', provide an explanation and an approximate date for availability.
  13. List the names and contact details of any officers directly involved.
  14. Complete the address, city, town, or village, and phone number fields as required.
  15. Review all your entries for accuracy before proceeding.
  16. Finally, save your changes, download the completed form, print it for your records, or share it as necessary.

Complete your NY SLA Form 1041 online today to ensure a smooth referral process.

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