Application Forms and Documents

Information and Procedure Bulletins

Public Convenience or Necessity Forms and Documents 

Pre-Application Review Forms and Documents

Temporary Approval Forms and Documents

Application Modification Forms and Documents

Application Supplements and Worksheets

All Application Forms (In Numerical Order)

All Application Forms (In Alphabetical Order)

These forms and documents are intended for use in DCR's Licensing Portal (Accela). Please do not submit official documents via email. DCR may accept electronic signatures on forms, unless the form specifically requires a notarized signature.


Information and Procedure Bulletins

LIC-4001-IPB PCN Information and Procedure Bulletin
LIC-4002-IPB Pre-application Review Information and Procedure Bulletin
LIC-4003-IPB Temporary Approval Information and Procedure Bulletin
LIC-4004-IPB Application Modification: Business Premises Relocation Information and Procedure Bulletin
SEP-6001-IPB Social Equity Program - Entity Verification Information and Procedure Bulletin

Public Convenience or Necessity Forms and Documents

LIC-4001-IPB PCN Information and Procedure Bulletin
LIC-4001-WF PCN Workflow
LIC-4001-FORM Public Convenience or Necessity Finding Request ("PCN Request Form")
LIC-4002-FORM Stakeholder Input Request

Pre-Application Review Forms and Documents

LIC-4002-IPB Pre-Application Review Information and Procedure Bulletin
LIC-4002-WF Pre-Application Review Workflow
LIC-4003-FORM List of Primary Personnel and Owner(s)
LIC-4004-FORM Primary Personnel and Owner Attestation
LIC-4007-FORM Landowner Attestation
LIC-4008-FORM Ownership and Financial Interest Holder Form
BCC Form Business Premises Diagram

Temporary Approval Forms and Documents

LIC-4003-IPB Temporary Approval Information and Procedure Bulletin
SEP-6001-IPB Social Equity Program - Entity Eligibility Verification Information and Procedure Bulletin. 
LIC-4003-WF Temporary Approval Workflow
BCC FORM Financial Information Form
LIC-4005-FORM Indemnification Agreement
LIC-4006-FORM Labor Peace Agreement
LIC-4007-FORM Landowner Attestation
LIC-4008-FORM Ownership and Financial Interest Holder Form
LIC-4009-FORM Radius Map Attestation
LAFD FORM Statement of Intended Use
BCC FORM Security Plan
LIC-4010-FORM Temporary Approval Attestation
SEP-6001-FORM Social Equity Program - Owner Compliance Attestation
BCC Form Business Premises Diagram
LIC-4012-FORM Staffing Plan

In addition to the DCR forms, the Temporary Approval Process requires that the Applicant submit following documents:

  • Business Formation and Organization Documents
  • Business Tax Registration Certificate (BTRC)
  • Certificate of Occupancy
  • Dated Radius Map
  • Equity Share Documents
  • Executed Lease Agreement or Property Deed
  • Site Plan

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Social Equity Program Forms and Documents

SEP-6001-IPB Social Equity Program - Entity Verification Information and Procedure Bulletin
SEP-6001-FORM Social Equity Program - Owner Compliance Attestation
SEP-6001-MOD Application Modification Request - Phase 3 Applicant Entity Substitution 

Application Modification Forms and Documents

Applicants and licensees seeking to request an Application/License modification must fill out the "Application Modification Request - Cover Page" along with the specific modification request form. Modification request forms are intended for use in DCR's Licensing Portal (Accela). Please do not submit official documents via email.

LIC-4004.1-WF Application Modification: General Modification Request Workflow
LIC-4004-WF Application Modification: Business Premises Relocation Workflow
LIC-4004.1-IPB Registration of Intent to File a Modification Request Information and Procedure Bulletin
LIC-4004-IPB Application Modification: Business Premises Relocation Information and Procedure Bulletin
LIC-4001-MOD Application Modification Request - Cover Page
LIC-4002-MOD Application Modification Request - Business Premises Relocation
SEP-6001-MOD Appllication Modification Request - Phase 3 Applicant Entity Substitution 
LIC-4004-MOD Application Modification Request - Ownership Structure
LIC-4005-MOD Application Modification Request - Removal of Owner(s)

Application Supplements and Worksheets 

LIC-4001-WS Accela Record Worksheet - Contact Type & Ref ID
LIC-4002-WS Initial Inspection Worksheet

All Application Forms (in Numerical Order)

LIC-4001-FORM Public Convenience or Necessity Finding Request
LIC-4002-FORM Stakeholder Input Request
LIC-4003-FORM List of Primary Personneel and Owner(s)
LIC-4004-FORM Primary Personnel and Owner Attestation
BCC FORM Financial Information Form
BCC FORM Business Premises Diagram
LIC-4005-FORM Indemnification Agreement
LIC-4006-FORM Labor Peace Agreement
LIC-4007-FORM Landowner Attestation
LIC-4008-FORM Ownership and Financial Interest Holder Form
LIC-4009-FORM Radius Map Attestation
LAFD FORM Statement of Intended Use
BCC FORM Security Plan
LIC-4010-FORM Temporary Approval Attestation
LIC-4012-FORM Staffing Plan
SEP-6001-FORM Social Equity Applicant - Owner Compliance Attestation

All Application Forms (in Alphabetical Order)

BCC FORM Business Premises Diagram
BCC FORM Financial Information Form
LIC-4005-FORM Indemnification Agreement
LIC-4006-FORM Labor Peace Agreement
LIC-4007-FORM Landowner Attestation
LIC-4003-FORM List of Primary Personnel and Owner(s)
LIC-4008-FORM Ownership and Financial Interest Holder Form
LIC-4004-FORM Primary Personnel and Owner Attestation
LIC-4001-FORM Public Convinience or Necessity Finding Request
LIC-4009-FORM Radius Map Attestation
BCC FORM Security Plan
SEP-6001-FORM Social Equity Program - Owner Compliance Attestatiion
LIC-4012-FORM Staffing Plan
LIC-4002-FORM Stakeholder Input Request
LAFD FORM Statement of Intended Use
LIC-4010-FORM Temporary Approval Attestation