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1 Colorado Liquor Retail License Application New License New-Concurrent Transfer of Ownership • All answers must be printed in black ink or typewritten • Applicant must check the appropriate box(es) • Applicant should obtain a copy of the Colorado Liquor and Beer Code: www.colorado.gov/enforcement/liquor • Local License Fee 1. Applicant is applying as a/an Corporation Partnership (includes Limited Liability and Husband and Wife Partnerships) Individual Limited Liability Company Association or Other 2. Applicant If an LLC, name of LLC; if partnership, at least 2 partner's names; if corporation, name of corporation FEIN Number 2a. Trade Name of Establishment (DBA) State Sales Tax Number Business Telephone 3. Address of Premises (specify exact location of premises, include suite/unit numbers) City County State ZIP Code 4. Mailing Address (Number and Street) City or Town State ZIP Code 5. Email Address 6. If the premises currently has a liquor or beer license, you must answer the following questions Present Trade Name of Establishment (DBA) Present State License Number Present Class of License Present Expiration Date Section A Nonrefundable Application Fees Section B (Cont.) Liquor License Fees Application Fee for New 600.00 Application Fee for New License w/Concurrent Review.....$ 700.00 Application Fee for 600.00 Liquor Licensed Drugstore Liquor Licensed Drugstore (County) Manager Registration - H & $ 75.00 Manager Registration - $ 75.00 Master File Location 25.00 X_ Total Master File Background X_ Optional Premises License Optional Premises License Racetrack License Racetrack License Resort Complex License Resort Complex License Retail Gaming Tavern License Retail Gaming Tavern License Retail Liquor Store License Retail Liquor Store License Tavern License Tavern License Vintners Restaurant License Vintners Restaurant License Section B Liquor License Fees Add Optional Premises to H & X _ Total Add Related Facility to Resort Complex......$ 75.00 X _ Total Arts License Arts License (County) Beer and Wine License Beer and Wine License Brew Pub License (City) $750.00 Brew Pub License Club License Club License (County) Distillery Pub License Distillery Pub License Hotel and Restaurant License Hotel and Restaurant License (County) Hotel and Restaurant License w/one opt premises Hotel and Restaurant License w/one opt Questions? Visit: www.colorado.gov/enforcement/liquor for more information Do not write in this space - For Department of Revenue use only Liability Information License Account Number Liability Date License Issued Through (Expiration Date) Total $ DR 8404 (04/27/15) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division (303) 205-2300 ---PAGE BREAK--- 2 Application Documents Checklist and Worksheet Instructions: This checklist should be utilized to assist applicants with filing all required documents for licensure. All documents must be properly signed and correspond with the name of the applicant exactly. All documents must be typed or legibly printed. Upon final State approval the license will be mailed to the local licensing authority. Application fees are nonrefundable. Questions? Visit: www.colorado.gov/enforcement/liquor for more information Items submitted, please check all appropriate boxes completed or documents submitted I. Applicant information A. Applicant/Licensee identified B. State sales tax license number listed or applied for at time of application C. License type or other transaction identified D. Return originals to local authority E. Additional information may be required by the local licensing authority II. Diagram of the premises A. No larger than 8 1/2" X 11" B. Dimensions included (does not have to be to scale). Exterior areas should show type of control (fences, walls, entry/exit points, etc.) C. Separate diagram for each floor (if multiple levels) D. Kitchen - identified if Hotel and Restaurant E. Bold/Outlined Licensed Premises III. Proof of property possession (One Year Needed) A. Deed in name of the Applicant (or) (matching question date stamped / filed with County Clerk B. Lease in the name of the Applicant (or) (matching question C. Lease Assignment in the name of the Applicant with proper consent from the Landlord and acceptance by the Applicant D. Other Agreement if not deed or lease. (matching question (Attach prior lease to show right to assumption) IV. Background information and financial documents A. Individual History Records(s) (Form DR 8404-I) B. Fingerprints taken and submitted to local authority (State Authority for Master File applicants) C. Purchase agreement, stock transfer agreement, and or authorization to transfer license D. List of all notes and loans (Copies to also be attached) V. Sole proprietor / husband and wife partnership A. Form DR4679 B. Copy of State issued Driver’s License or Colorado Identification Card for each applicant VI. Corporate applicant information (if applicable) A. Certificate of Incorporation dated stamped by the Secretary of State B. Certificate of Good Standing C. Certificate of Authorization if foreign corporation D. List of officers, directors and stockholders of Applying Corporation (If wholly owned, designate a minimum of one person as Principal Officer of Parent) VII. Partnership applicant information (if applicable) A. Partnership Agreement (general or limited). Not needed if husband and wife B. Certificate of Good Standing (If formed after 2009) VIII. Limited Liability Company applicant information (if applicable) A. Copy of articles of organization (date stamped by Colorado Secretary of State's Office) B. Certificate of Good Standing C. Copy of operating agreement D. Certificate of Authority if foreign company IX. Manager registration for hotel and restaurant, tavern licenses when included with this application A. $75.00 fee B. Individual History Record (DR 8404-I) C. If owner is managing, no fee required ---PAGE BREAK--- 3 7. Is the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or officers, stockholders or directors if a corporation) or manager under the age of twenty-one years? Yes No 8. Has the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or officers, stockholders or directors if a corporation) or manager ever (in Colorado or any other state): Been denied an alcohol beverage license? Had an alcohol beverage license suspended or revoked? Had interest in another entity that had an alcohol beverage license suspended or revoked? If you answered yes to 8a, b or c, explain in detail on a separate sheet. 9. Has a liquor license application (same license class), that was located within 500 feet of the proposed premises, been denied within the preceding two years? If "yes", explain in detail. 10. Are the premises to be licensed within 500 feet of any public or private school that meets compulsory education requirements of Colorado law, or the principal campus of any college, university or seminary? Waiver by local ordinance? Other:_ or 11. Has a liquor or beer license ever been issued to the applicant (including any of the partners, if a partnership; members or manager if a Limited Liability Company; or officers, stockholders or directors if a corporation)? If yes, identify the name of the business and list any current financial interest in said business including any loans to or from a licensee. 12. Does the Applicant, as listed on line 2 of this application, have legal possession of the premises by virtue of ownership, lease or other arrangement? Ownership Lease Other (Explain in a. If leased, list name of landlord and tenant, and date of expiration, exactly as they appear on the lease: Landlord Tenant Expires b. Is a percentage of alcohol sales included as compensation to the landlord? If yes complete question 13. c. Attach a diagram and outline or designate the area to be licensed (including dimensions) which shows the bars, brewery, walls, partitions, entrances, exits and what each room shall be utilized for in this business. This diagram should be no larger than 8 1/2" X 11". 13. Who, besides the owners listed in this application (including persons, firms, partnerships, corporations, limited liability companies), will loan or give money, inventory, furniture or equipment to or for use in this business; or who will receive money from this business. Attach a separate sheet if necessary. Last Name First Name Date of Birth FEIN or SSN Interest/Percentage Last Name First Name Date of Birth FEIN or SSN Interest/Percentage Attach copies of all notes and security instruments, and any written agreement, or details of any oral agreement, by which any person (including partnerships, corporations, limited liability companies, etc.) will share in the profit or gross proceeds of this establishment, and any agreement relating to the business which is contingent or conditional in any way by volume, profit, sales, giving of advice or consultation. 14. Optional Premises or Hotel and Restaurant Licenses with Optional Premises: Has a local ordinance or resolution authorizing optional premises been adopted? Number of additional Optional Premise areas requested. (See license fee chart) 15. Liquor Licensed Drug Store applicants, answer the following: Does the applicant for a Liquor Licensed Drug Store have a license issued by the Colorado Board of Pharmacy? If "yes" a copy of license must be attached. 16. Club Liquor License applicants answer the following: Attach a copy of applicable documentation Is the applicant organization operated solely for a national, social, fraternal, patriotic, political or athletic purpose and not for pecuniary gain? Is the applicant organization a regularly chartered branch, lodge or chapter of a national organization which is operated solely for the object of a patriotic or fraternal organization or society, but not for pecuniary gain? How long has the club been incorporated? Has applicant occupied an establishment for three years (three years required) that was operated solely for the reasons stated above? 17. Brew-Pub License or Vintner Restaurant Applicants answer the following: Has the applicant received or applied for a Federal Permit? (Copy of permit or application must be attached) 18a. For all on-premises applicants. (If this is an application for a Hotel, Restaurant or Tavern License, the manager must also submit an individual History Record - DR 8404-I) Last Name of Manager First Name of Manager Date of Birth 18b. Does this manager act as the manager of, or have a financial interest in, any other liquor licensed establishment in the State of Colorado? If yes, provide name, type of license and account number. Name Type of License Account Number 19. Tax Distraint Information. Does the applicant or any other person listed on this application and including its partners, officers, directors, stockholders, members (LLC) or managing members (LLC) and any other persons with a 10% or greater financial interest in the applicant currently have an outstanding tax distraint issued to them by the Colorado Department of Revenue? If yes, provide an explanation and include copies of any payment agreements. ---PAGE BREAK--- 4 20. If applicant is a corporation, partnership, association or limited liability company, applicant must list all Officers, Directors, General Partners, and Managing Members. In addition, applicant must list any stockholders, partners, or members with ownership of 10% or more in the Applicant. All persons listed below must also attach form DR 8404-I (Individual History Record), and submit fingerprint cards to the local licensing authority. Name Home Address, City & State DOB Position %Owned Name Home Address, City & State DOB Position % Owned Name Home Address, City & State DOB Position % Owned Name Home Address, City & State DOB Position % Owned Name Home Address, City & State DOB Position % Owned If Applicant is owned 100% by a parent company, please list the designated principal officer on question #20 Corporations - The President, Vice-President, Secretary and Treasurer must be accounted for on question #20 (Include ownership percentage if applicable) If total ownership percentage disclosed here does not total 100%, applicant must check this box: Applicant affirms that no individual other than these disclosed herein, owns 10% or more of the applicant, and does not have ownership in a prohibited liquor license pursuant to Title 47 or 48, C.R.S. Oath Of Applicant I declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete to the best of my knowledge. I also acknowledge that it is my responsibility and the responsibility of my agents and employees to comply with the provisions of the Colorado Liquor or Beer Code which affect my license. Authorized Signature Printed Name and Title Date Report and Approval of Local Licensing Authority (City/County) Date application filed with local authority Date of local authority hearing (for new license applicants; cannot be less than 30 days from date of application 12-47-311 C.R.S.) The Local Licensing Authority Hereby Affirms that each person required to file DR 8404-I (Individual History Record) has: Been fingerprinted Been subject to background investigation, including NCIC/CCIC check for outstanding warrants That the local authority has conducted, or intends to conduct, an inspection of the proposed premises to ensure that the applicant is in compliance with, and aware of, liquor code provisions affecting their class of license (Check One) Date of inspection or anticipated date_ Will conduct inspection upon approval of state licensing authority The foregoing application has been examined; and the premises, business to be conducted, and character of the applicant are satisfactory. We do report that such license, if granted, will meet the reasonable requirements of the neighborhood and the desires of the adult inhabitants, and will comply with the provisions of Title 12, Article 46 or 47, C.R.S. Therefore, this application is approved. Local Licensing Authority for Telephone Number Town, City County Signature Print Title Date Signature (attest) Print Title Date