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
| 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 |