HomeMy WebLinkAbout20121176RESOLUTION
RE: APPROVAL OF RENEWAL APPLICATION FOR RETAIL LIQUOR STORE LICENSE
FROM DOROTHY NI. ZITEK, DBA HEREFORD PACKAGE LIQUOR AND
AUTHORIZE CHAIR TO SIGN - EXPIRES JUNE 18, 2013
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, Dorothy M. Zitek, dba Hereford Package Liquor, presented to the Board of
County Commissioners of Weld County, Colorado, an application for the renewal of a Retail
Liquor Store License, for the sale of malt, vinous and spirituous liquors, and
WHEREAS, pursuant to Exhibit 5-H of the Weld County Code, said applicant has paid
the sum of $137.50 to the County of Weld for the renewal of the existing license, and
WHEREAS, said applicant has exhibited a State Liquor Store License for the sale of
malt, vinous and spirituous liquors in sealed containers not for consumption at place where sold,
outside the corporate limits of any town or city in the County of Weld at the location described
as follows:
39520 County Road 136
Hereford, Colorado 80732
WHEREAS, the Licensee shall host "responsible vendor" training every six (6) months
as agreeable to the Colorado Department of Revenue Liquor Enforcement Division, and this
training shall be open to other area licensees. Each employee shall be "responsible vendor"
trained, and the Licensee shall provide documentary evidence that each employee has been
"responsible vendor" trained to the Weld County Sheriff's Office within thirty (30) days of the first
available "responsible vendor" class after hiring. Evidence of such shall be included in the
referral report submitted by the Sheriff's Office at the time of annual renewal.
NOW, THEREFORE, BE IT RESOLVED that the Board of County Commissioners of Weld
County, Colorado, having examined said application and the other qualifications of the
applicant, does hereby grant License Number 2012-10 to said applicant to sell malt, vinous and
spirituous liquors in sealed containers not for consumption at place where sold, only at retail at
said location; and the Board does hereby authorize and direct the issuance of said license by
the Chair of the Board of County Commissioners, attested to by the Clerk to the Board of Weld
County, Colorado, which license shall be in effect until June 18, 2013, providing that said place
where the licensee is authorized to sell malt, vinous, and spirituous liquors in sealed containers
not for consumption at place where sold, shall be conducted in strict conformity to all of the laws
of the State of Colorado and the rules and regulations relating thereto, heretofore passed by the
Board of County Commissioners of Weld County, Colorado, and any violations thereof shall be
cause for revocation of the license.
tu' so, nppl.
2012-1176
LC0024B
RENEW LIQUOR STORELICENSE - HEREFORD PACKAGE LIQUOR
PAGE 2
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said application.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 7th day of May, A.D., 2012.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: -5 —
Weld County Clerk to the Board
BY:
Deputy CI
Date of signature: & 19 /
Sean P. Ii� ay, Chair
Dou.las Radema her
2012-1176
LC00246
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THIS LICENSE EXPIRES JUNE 18, 2013
w
H
O
TO BE POSTED IN A CONSPICUOUS PLACE.
THIS LICENSE MUST BE POSTED IN PUBLIC VIEW
DR 8402 (11/23/11)
S A O CO ORADO
D PAR M
N O R V NU
Liquor
Enforcement
Division
1881
Pierce Street,
Suite
108
Lakewood,
Colorado
80214
ZITEK
DOROTHY
M
HEREFORD
PACKAGE
LIQUOR
39520 WCR
136
HEREFORD
CO 80732
A CO
0 B V RAG C
NS
Liability Information
Account Number
County City Indust. Type Liability Date
LICENSE EXPIRES AT MIDNIGHT
24-77634-0000
03 206 445310
I 061998
JUN
18, 2013
Type
Name and Description of License
Fee
.1941
RETAIL
LIQUOR
STORE
$
100.00
LICENSE
-
MALT,
VINOUS,
AND
SPIRITUOUS
2190
COUNTY
85
PERCENT
OAP
FEE
$ 212.50
TOTAL FEE(S)
$ 312
. 50
This
license
is issued
subject
to
the
laws:: •ote:
o
C.olrado
and
especially
under
the
provision
of
Title
12, Articles
46 or 47,
CRS
19:
. amended
�"1' s:�License
is nontransferable
and
shall
be
conspicuously
posted
in
the
place
above
es ibed:::
hfs
license is only
valid
through
the
expiration
date
shown
above.
Questions
concerning
t
it
uld
Abe addressed
to
the
Department
of
Revenue,
Liquor
Enforcement
Division, 1375
Si: • .
. ..........
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ar
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..........
80261.
.
...„........:::.:.:.:.:.,.........•......„:::::...:::.:.::.
........................„.............
............
......................................................
......
In
testimony
whereof,
I
have
hereunto
set.
073m444,-14,t,A.`
JUN
06
201;
si,„64,,,a-Atetc
Division
Director
Executive
Director
DR 8400 (11/09/06) LIQUOR OR 3.2 BEER LICENSE
COLORADO DEPARTMENT OF REVENUE RENEWAL APPLICATION
DENVER, COLORADO 80261
ZITEK DOROTHY M
HEREFORD PACKAGE LIQUOR
PO BOX 45
HEREFORD CO 80732
❑ This renewal reflects no changes from the last ap-
plication. Complete page 2 and file now!
❑ Yes there are changes from the last application.
If applicant is a Corporation or Limited Liability com-
pany, use DR 8177 and send in with this renewal.
Any other changes of ownership require a transfer
of ownership. See your Local Licensing Authority
immediately.
LicensNumber
24-77634-0000
License p
1941
Liability Information
03 206 445310 I 061998
Business Location
39520 WCR 136
HEREFORD CO
Current License Expires
JUN 18, 2012
DEPARTMENTAL USE ONLY
Total Amount Due
Total Paid
$
Date
Wholesaler, manufacturer, importer, and public transportation
system license renewals do not need Local Licensing Author-
ity approval and must be returned directly to the Colorado De-
partment of Revenue at least 30 days prior to the current li-
cense expiration date.
This application for renewal must be returned to your CITY OR
COUNTY Licensing Authority at least 45 days prior to the expira-
tion date of your current license. Failure to do so may result in
your license not being renewed. Include both pages of this renewal
and payment.
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.
,,z2.67#7,46; orized Signature p
)17±iTitle
Date
'{.,/3 /z
Business Phone
pav 3s z1/o
/-L4IMe...
Sales Tax Number
24"'94,31/ 0000
REPORT AND APPROVAL OF CITY OR COUNTY LICENSING AUTHORITY
The foregoing application has been examined and the premises, business conducted an f the applicant are satisfactory, and we
do hereby report that such license, if granted, will comply with the provisions of Title 1 •il °s 6 , C.R.S.
THEREFORE THIS APPLICATION IS APPROVED.
Local Licensing Authority for -
Weld County, Colorado
y
4`;•E
Date
2012
Signature �—T (D
Title Chair, Board of it
County Commissioners/-
s.
� DEfACF'
Sean P. Conway
accr TAri;l DC)NOT DETACH . - - t.� rk to the
DENVER,
....,--
Business
SUB -TOTAL $ 312.
ADD $100.00 TO RENEW RETAIL WAREHOUSE STORAGE PERMIT2210-100(999) $ •
TOTAL AMOUNT DUE $
2012-1176
DR 8401 (02/19/09)
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1881 PIERCE
LAKEWOOD. CO 80261
(303) 205-2300
ATTACHMENT TO LIQUOR OR
3.2 BEER LICENSE RENEWAL APPLICATION
This page must be completed and attached to your signed renewal application form.
Failure to include this page with the application may result in your license not being renewed.
Trade Name of Establishment C
11 671 E cil Rd PAGE'/S<f LiyeiO/z
State License Number
1. Operating Manager i%
PotefAy 4l Z,°/f 1
Home Address
°ys.)0 LeAE,Rd /3‘ N6Rf50Rd, C,”, BnOdz
Date of Birth
--,,,:,-,
2. Do yili have legal possession of the premises for which this application
Are the premises owned or rented: ........... If rented,
for license is made?
expiration date of lease:
Yes No
X
3,
Has there been any change in financial interest (new notes, loans, owners, etc.) since the last annual application? If yes, explain in
Yes No
detail and attach a listing of all liquor businesses in which these new lenders or owners, (other than licensed
materially interested.
financial institutions)
are
v
�6
4.
Since the date of filing of the last annual application, has the applicant, or any of its agents, owners, managers.
(other than licensed financial institutions), been convicted of a crime? If yes, attach a detailed explanation.EN
principals. or lenders
Yes No
5.
Since the date of filing of the last annual application, has the applicant, or any of its agents. owners, managers, principals, or lenders
(other than licensed financial institutions), been denied an alcoholic beverage license, had an alcoholic beverage license suspended or
Yes No
revoked, or had interest in any entity that had an alcoholic beverage license denied, suspended or revoked? If yes, attach a detailed
explanation.
AA
6.
Does the applicant, or any of its agents, owners, managers, principals, or lenders (other than licensed financial institutions), have a
direct or indirect interest in any other Colorado liquor license (include loans to or from any licensee, or interest in a loan to any
licensee)? If yes, attach a detailed explanation.
Yes No
igl
7.
Corporation or Limited Liability Company (LLC) or Partnership applicants must answer these questions.
Since the date of filing of the last annual license application:
(a) Are there, or have there been: any officers or directors; or managing members; or general partners added to or deleted from
applicant for renewal of a 3.2 beer or liquor license?
(b) Are there or have there been: any stockholders with 10% or more of the issued stock of the Corporation; or any members with
10% or more membership interest in the LLC; or any partners with 10% or more interest in the partnership added to or deletedXI
from the applicant for renewal of a 3.2 beer or liquor license?
(c) If Yes to (a) or (b), complete and attach Form DR 8177: Corporation, Limited Liability Company or Partnership Report of Changes,
and all supporting documentation, and fees your Local Licensing Authority immediately.
Yes No
riAr
Yes No
8.
Sole proprietorships, Husband -Wife Partnerships or Partners in General Partnerships:
EVIDENCE OF LAWFUL PRESENCE
Each person identified above must complete and sign the following affidavit. Please make additional copies if necessary.
Each person must also provide a copy of their driver's license or state issued identification card.
In lieu of form DR 4679, the undersigned swears or affirms under penalty of perjury under the laws of the State of Colorado
that (check one):
(r�4 I am a United States Citizen
❑ I am not a United States Citizen but I am a Permanent Resident of the United States
❑ I am not a United States Citizen but I am lawfully present in the United States pursuant to Federal Law
I am a foreign national not physically present in the United States
I understand that this sworn statement is required by law because I have applied for a public benefit. I understand that state law
requires me to provide proof that I am lawfully present in the United States prior to receipt of this public benefit. I further acknowledge
that making a false, or fraudulent statement or misrepresentation in this sworn affidavit is punishable under the criminal laws of
Colorado Revised Statute 18-8-503 and it shall constitute a separate criminal offense each time a public benefit is fraudulently received.
Si nature
Printed name
Date
� �
boasFhK,M-,2Viia(<
N r3 iz
Apr 25 12 0.1:47p
mark zitek
970-895-2216
p.1
CEASE AGREEMENT
I, Mark W. Zitek, on this date
lease to k Dorothy M. Zit is for May 26, 2011
WCR 136 a , hereby extend a
Hereford, Colorado g portion of my building at 39520
store. This lease 0732 for use as a
foot traffic and calls out that it is for package liquor
will have its own package liquor only, no
has always entrance. This business is, and
continue under been, called Hereford Package
such business name. e Liquor and will
s
for as long as Dorothy The term for this lease is her package liquor business. Z�tek wishes to utilize the space for
Agreed to by:
_
Doroth'/I. Zi , Hereford Package Liquor
}
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HOW PAID
CASH
CHECK
13.1
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MONEY
ORDER
RECEIPT
DATE q - I - /
RECEIVED FROM Hen corgi 'Podia
e L1 tAUr
ADDRESS LID oV
86393
KAI ithaau d k
FOR LC -0,7) 4 >
HOW PAID
CASH
CHECK3
31a
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MONEY
ORDER
a loo $ a.cjo
e. it liquor U Ctn5R 7Rksttwoi
4 fTV\TL i
-'n
BY -,1- •
RECEIPT DATE Li-ii-tca
NO, 86394
RECEIVED FROM iki0corcl. (\IA aI 2. Uotkier
ADDRESS C.lo Qor&Ayw\ ic\c
OflItla�rul,�,d ll�a, - A,rt l "'I tar $ I?er,� a9 FOR LC. °D9 -1 e R-C�G L C''
en 141
BY ciA •
To: Weld County Board of Commissioners
From: Deputy Lisa Carpenter
Date: February 6, 2012
RE: Dorothy M. Zitek/ DBA Hereford Package Liquor
Dear Commissioners,
I have researched and found no reported calls for service to the Hereford Package Liquor,
located at 39520 Weld County Road 136, Hereford, CO 80732 for the Calendar year of 2011 to
present day.
I find no grounds for disapproval for the renewal of the liquor license.
Respectfully Submitt
eputy Lisa Carpenter
Community Resource Officer
Weld County Sheriffs Office
1950 "O" Street
Greeley, CO 80631
LIQUOR/BEER RENEWAL REVIEW FORM
Date: March 3, 2011
TO: Lisa Carpenter and/or Jeremy Frey
FROM: CTB — Tonya Disney
SUBJECT: Liquor License Check
In accordance with the new procedure for Liquor and/or beer license checks, please review all
records on the following establishment for any associated reports during the last year and return
your report to the Weld County Clerk to the Board's Office within two weeks. Your report will
be used by the Board of County Commissioners in considering renewal of the liquor and/or beer
license.
PLEASE RESPOND NO LATER THAN: February 14, 2012
ESTABLISHMENT: DOROTHY M. ZITEK
DBA HEREFORD PACKAGE LIQUOR
39520 WELD COUNTY ROAD 136
P.O. BOX 45
HEREFORD, CO 80732
Current license expires: JUNE 18, 2012
No concerns
//1),;
Deputy's Initials
The Sheriffs Office had a concern and the deputy has mutually
worked with the licensee to correct the concern.
(Complete Attached Worksheet)
Unresolved concerns exist requiring a Probable Cause Hearing
scheduled by the Board of County Commissioners.
(Complete Attached Worksheet)
Please notify at Extension
Board of Commissioner's renewal hearing.
of the date and time of the
Liquor/Beer License Worksheet
The following concerns are noted:
The Licensee and the Sheriffs Office have collectively agreed to implement the following to
correct concerns noted above: (A time line and corrective action should be listed for each
concern)
Estaiatishmertt-OwnerrPlease Print
Establishment Signature
Date
ePnature
r72</
Cu/SK
Use another sheet of paper or attach separate proposal to this packet if needed.
Attach copies of all reports associated with this establishment for the last year.
Both the Deputy and the Owner of the establishment will be required to attend the Liquor
Hearing to testify to the above agreement.
WELD COUNTY SHERIFF'S OFFICE
Community Resource Office
LIQUOR ENFORCEMENT WORKSHEET
•
1950 O'Street
Greeley, Colorado 80631
Voice (970) 356-4015 • Fax (970) 304-6467
inspection Report
Incident Report
CR#:
i crrwe Made t+ame.. O f ,� �
Licensee Namer/ `4 / /j..0 ,7�l tai-:
`~
License/!Type. , i{� ] c.C�.c 1 t✓t,
C
Date of Report !Incident: _ 7--/J
-
Address: S _ c",./.
rS &
`'C
Person Contacted: /1 jai k 7, lei_
``„J/)
City. State. Zip: :e_ it., rci t- t- • 5,;./.6-,7.3..1...
Telephoto t •,;iii
Yes No NIA
Yes No NIA
State Liquor License Posted
,1
Manager Registered
`---i
State Sales Tax License Posted
LLicense in Control of Premises
✓`
County Liquor License Posted
,/
Trade Name Properly Registered
1. --
Federal Form 11 ' Call (800) 398-2822
,/
Prernises Physical Control Adequate
✓
Food Service License Posted
✓
Acceptable Dispensing System
Minor Warning Sign Posted
n;/'
Off Premise Storage Licensed
--Only
1. --
Meals and Snacks Available
v"
Permitted Items Sold
Cleanliness Adequate
✓i
Alcohol From Permitted Source
I ,..-
Books & Invoices Available
'�
Discuss Sales of Liquor to Minors
.--
Alcohol Beverage Stock Acceptable
✓
Discuss Sales to Intoxicated Persons
[1Warning LFollow-Up Inspection
Licensee preaentati re S gnature ��
0 t
VNatborl:
Date:
Time:
Subject:
Hat.
Wgt:
Eyes: I Hair:
Clothing:
Address
City:
State:
DL I ID#
Stale:
HAY Phone
Summons
Court Date:
Evidence: Yes NO
Photos: Yes NO
Narrative:. -2 V- /7Z 3
j
Deputy: - y`/ ./l#:iA-%0 ( -5 .e
Date: - /;_
Tonya Disney
From:
Sent:
To:
Subject:
Janet Carter
Tuesday, April 17, 2012 2:43 PM
Tonya Disney
RE: Liquor License Renewal - Hereford Package Liquor do Dorothy Zitek
This is an existing facility. Public Works does not have any comments at this time.
Janet L Carter
Traffic Engineer
Weld County Public Works Dept.
P.O. Box 758, Greeley, CO 80632
Tele-970.356.4000 ext 3726
Fax- 970.304.6497
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for
the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise
protected from disclosure. If you have received this communication in error, please immediately notify sender by return
e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the
contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
From: Tonya Disney
Sent: Tuesday, April 17, 2012 1:45 PM
To: Bethany Salzman; Dan Joseph; Janet Carter; Jeremy Frey; Jonathan Gesick; Lisa Carpenter; Roy Rudisill
Cc: Brad Yatabe; David Clarke; Deb Adamson; Margie Martinez; Sara Evans; Tonya Disney
Subject: Liquor License Renewal - Hereford Package Liquor c/o Dorothy Zitek
The following applicant has submitted a request for renewal of its Retail Liquor License, LC0024B. Please provide any
comments you may have before May 1, 2012. A .pdf copy of the application materials is attached.
License Number:
24-77634-0000
Applicant:
Hereford Package Liquor
c/o Dorothy M. Zitek
Current License Expires:
June 18, 2012
Thank you,
Tonya Disney
Memorandum
TO: Tonya Disney
FROM: Dan Joseph
SUBJECT: Liquor license inquiry
DATE: 4/19/12
CC: Cindy Salazar; Debra Adamson
In response to your request, Environmental Health Services has reviewed the Retail Food Service
Establishment file for Hereford Packaged Liquor, located at 39520 WCR 136, in Hereford,
Colorado. While the Department doesn't currently inspect this facility (it is not regulated by the
Department) we are involved with the food facility located immediately adjacent to it. The
liquor store prepares ice that is to be sold at the food facility. The ice is produced with an
approved water system.
Based on this, the Department is recommending for approval of their liquor license.
Should you have any questions regarding this matter, please contact me via e-mail at
djoseph@co.weld.co.us or by phone at 970-304-6415 extension 2206.
Thank you.
Dan Joseph
Environmental Specialist III
TY
MEMORANDUM
To: Tonya Disney, Deputy Clerk to the Board April 20, 2012
From: Bethany Salzman, Zoning Compliance Officer, Dept. of Planning Services
Subject: LC0024-B
Review of the following liquor license renewal by the Department of Planning Services shows the following:
24-77634-0000
Hereford Package Liquor
c/o Dorothy M Zitek
39520 WCR 136
PO Box 45
Hereford, CO 80732
Zone District: Agricultural
This use existed prior to zoning and is permitted as a "Nonconforming Use" (NCU-336).
No violations are occurring on the property at this time.
SERVICE, TEAMWORK, INTEGRI'!Y, QUALITY
Tonya Disney
From:
Sent:
To:
Subject:
Roy Rudisill
Friday, April 27, 2012 4:40 PM
Tonya Disney; Jonathan Gesick
RE: Liquor License Renewal - Hereford Package Liquor c/o Dorothy Zitek
No Concerns for this on from me.
Director Roy Rudisill
Weld County Office of Emergency Management
1150 O St. Greeley Co. 80632
970-304-6540 Office
970-381-0417 Cell
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for
the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise
protected from disclosure. If you have received this communication in error, please immediately notify sender by return
e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the
contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
From: Tonya Disney
Sent: Friday, April 27, 2012 4:23 PM
To: Roy Rudisill; Jonathan Gesick
Subject: FW: Liquor License Renewal - Hereford Package Liquor c/o Dorothy Zitek
Just a reminder that I would like to have your referrals by May 1, 2012.
Thank you,
Tonya Disney
Clerk to the Board
1150 O Street I PO Box 758 Greeley, Colorado 80632
Phone: 970-336-7215 x 5226
1
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for
the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise
protected from disclosure. If you have received this communication in error, please immediately notify sender by return
e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the
contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
From: Tonya Disney
Sent: Tuesday, April 17, 2012 1:45 PM
To: Bethany Salzman; Dan Joseph; Janet Carter; Jeremy Frey; Jonathan Gesick; Lisa Carpenter; Roy Rudisill
Cc: Brad Yatabe; David Clarke; Deb Adamson; Margie Martinez; Sara Evans; Tonya Disney
Subject: Liquor License Renewal - Hereford Package Liquor c/o Dorothy Zitek
The following applicant has submitted a request for renewal of its Retail Liquor License, LCOO24B. Please provide any
comments you may have before May 1, 2012. A .pdf copy of the application materials is attached.
License Number:
24-77634-0000
Applicant:
Hereford Package Liquor
c/o Dorothy M. Zitek
Current License Expires:
June 18, 2012
Thank you,
Tonya Disney
Clerk to the Board
1150 O Street PO Box 758 Greeley, Colorado 80632
Phone: 970-336-7215 x 5226
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for
the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise
protected from disclosure. If you have received this communication in error, please immediately notify sender by return
e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the
contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
2
Tonya Disney
From:
Sent:
To:
Subject:
Jonathan Gesick
Monday, April 30, 2012 7:36 AM
Tonya Disney
RE: Liquor License Renewal - Hereford Package Liquor do Dorothy Zitek
The building Department has no concerns.Thanks
Jonathan D Gesick
Plans Examiner/Building lnpsector
Building Department
1555 N 17th Ave
Greeley, CO 80631
tel: (970)353-6100 Ext. 3532
Confidentiality Notice: This electronic transmission and any attached documents or other writings are intended only for
the person or entity to which it is addressed and may contain information that is privileged, confidential or otherwise
protected from disclosure. If you have received this communication in error, please immediately notify sender by return
e-mail and destroy the communication. Any disclosure, copying, distribution or the taking of any action concerning the
contents of this communication or any attachments by anyone other than the named recipient is strictly prohibited.
From: Tonya Disney
Sent: Tuesday, April 17, 2012 1:45 PM
To: Bethany Salzman; Dan Joseph; Janet Carter; Jeremy Frey; Jonathan Gesick; Lisa Carpenter; Roy Rudisill
Cc: Brad Yatabe; David Clarke; Deb Adamson; Margie Martinez; Sara Evans; Tonya Disney
Subject: Liquor License Renewal - Hereford Package Liquor c/o Dorothy Zitek
The following applicant has submitted a request for renewal of its Retail Liquor License, LC0024B. Please provide any
comments you may have before May 1, 2012. A .pdf copy of the application materials is attached.
License Number:
24-77634-0000
Applicant:
Hereford Package Liquor
c/o Dorothy M. Zitek
Current License Expires:
June 18, 2012
Thank you,
Tonya Disney
1
Clerk to the Board
1150 O StreetIPO Box 758IGreeley, Colorado 80632
Phone: 970-336-7215 x 5226
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2
Fedbc. USAirbill
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Express
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Number
8715 2808 1689
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5-8-12 Senders FedEx
Date Account Number
S NDi l � ''1253-'-194'8'-3 -.
CLERK TO THE BOARD
Senders COUNTY OF WELD
Name
Company COUNTY OF WELD
Phone 970) 356-4000
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Address-18T+F—S4' 1150 0 Street — Print shop
Ciro GREELEY
2 Your Internal Billing Reference
FM 04 mernnenwn appear en imtita.
3 To 6 Special Handling and Delivery Signature Options
Na QienrLIQUOR ENFORCEMENT DIVISION phoned 303) 205-2300 ❑I rim xUR2bm,eetaeardatweWreau Ara Overnight Fey corners Saint or FedEx May Freight
State C O
Deptmnariouieaoan
zip 80631-1117
4a Express Package Service •muse Iaca Packages up to l5albs
FedEx Priority Overnight
I ! Noonan. owning Fader
mipmwrs,wl b dnn,e,ed on Monday
unless SAThADAY Datum is :Bladed
[x FedEx2Day
se<ments imosdaynoode.
shipments colts delmme on Monday
unless GNRnty relxen is selected.
46 Express Freight Service-Tenoekosw. Packages over 150 lbs.
Fed Ex IDay Freight
I tenbusiiess day"' Riney ebipmemawbi
L— be&bored on Monday unleu WORM fag nonFbnaaceee No
FedEx Standard Overnight
Neal been. afternoon!
Saturday Diner NOT available
FedEx Express Saver
s wrdey onliceoq NOr evaiuble
FedEx First Overnight
Earliest ectboe morningr
oroe
Saturday Triune? NOT amiable.
FedEx 2Dey Freight
El
ascend business day. Thursday shipments rag be dneaN
on Monday unless SATURDAY Delivery 2 visaed.
5 Packaging
FedEx
Envelope'
C' FedEx 3Day Freight
business deg.' Saturday Delivery NOT available.
• Named vaY.lira6
FedEx Pak'
Includes FedEx Small Pak FedEx
urge Pat and F EA SG,dv Pak.
FedEx Box ❑ FedEx Tube ❑ Other
HOW Weekday
Company Colorado Department of bmebrtaa0�lmkuo.
Fete fee Ovemillit
Revenue
Address 1375 SHERMAN STREET
We cannot delivery P.O. boxes or PA. ZIP codes.
HOLD Saturday
below
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rimed
and F nyu sad aabam
Address
Prat FedEx loonier ada,na bare it NOLO option is selected.
onpamrsun.Pmm
Day DENVER
state CO
ZIP
80261
0415722399
No Signature Required Direct Signature
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oMeioingesgnemmk,eefrven. ngngobrileheivhelacPIXas
Does this shipment contain dangerous goods?
------ One ben meat be checkers.
Indirect Signature
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Yes Yes
No ❑oeremnbne ❑ se V 0rsFadun ❑ Orylce _ a
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oerawauntei eTicnmelce"th" thfirdeF"*1 ❑ Cargo Aircraft Only
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7 Payment Biro:
Sender
LJ Iw9 Ronda
WFx Ac No.
CuexCod No.
Total Packages Total Weight Total Declared Valuet
Enter reaes Rea No. or Cede CM lb Slow,
LI Recipient ❑ Third Party ❑ Credit Card Cash/Checl
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leerliability is rimmed to 51C9 unless you declare higher vamn.See hackkr details. Byeang Patiury
agree.
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DOROTHY ZITEK
DBA HERFORD PACKAGE LIQUORS
PH. 970-895-2338
39525 WELD CR. 136
HERFORD, CO 80732
Pay To
The Order Of
76-162-1041
1172
20 '-
Fec
POINTS WEST COMMUNITY BANK
TELEBANK1-800-361751U 906c0 HRS.)
O2O42
U.S. Postal Servicemi
CERTIFIED MAILTM RECEIPT.
(Domestic Mail Only; No Insurance Coverage Provided)
Postage
Certified Fee
Return Receipt Fee
(Endorsement Required)
Restricted Delivery Fee
(Endorsement Required)
Total Postage 8 Fees
Postmark
Here
Sent To � "A / l
WLb}h Zi k QI&I/e.rrlue_l -A lief Zito or
Street, Apt. N
or PO Box No. 3 cj5&b C.e /J...11 City, State, ZIP+4 �C
A/ere fort=6O
■ Complete items 1, 2, and 3. Also complete
item 4 if Restricted Delivery is desired.
• Print your name and address on the reverse
so that we can return the card to you.
• Attach this card to the back of the mailpiece,
or on the front if space permits.
pro}hvt zI k
O�W %ert ord o. e U (Uor
'Y15O CIJZ 13u 0001.
1 � 0-isbeck Cx svi3
2. Article Number
(Transfer from service label)
D. Is delivery address different from item 1? ❑ Yes
If YES, enter delivery address below: O No
1. Article Addressed to:
3. Service Type
'=atertlfled Mail
❑ Registered
❑ Insured Mail
❑ Express Mail
❑ Return Receipt for Merchandise
o C.O.D.
4. Restricted Delivery? (Extra Fee)
7004 2890 0003 5709 8761
❑ Yes
PS Form 3811, February 2004
Domestic Return Receipt
102595-02-M-1540
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