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ALTERNATIVE IV. STIPULATED PENALTY <br />PURSUANT TO RULE 1.12 OF THE RULES AND REGULATIONS <br />OF THE LIQUOR CONTROL ADJUDICATION BOARD <br />I acknowledge receipt of this Notice of Complaint and <br />Accusation and do hereby admit to the allegation therein and <br />stipulate that disciplinary action may be taken on this <br />Complaint and Accusation according to law, without my presence. <br />The undersigned informs the Liquor Control Adjudication <br />Board of the selection to waive its right to a hearing and to be <br />subject to penalties pursuant to Rule 1.12. <br />Dated <br />Violation: <br />❑ First Offense $100 <br />❑ Second Offense $200 <br />Licensee <br />dba <br />By <br />Title <br />Effective August 18, 2006 15 <br />