HomeMy WebLinkAbout20102190RESOLUTION
RE: APPROVAL OF RENEWAL APPLICATION FOR 3.2 PERCENT BEER RETAIL LICENSE
ISSUED TO MARY JENSEN, DBA HIGHLANDLAKE, INC., AND AUTHORIZE CHAIR TO
SIGN - EXPIRES NOVEMBER 9, 2011
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, Mary Jensen, dba Highlandlake, Inc., presented to the Board of County
Commissioners of Weld County, Colorado, an application for the renewal of a 3.2 Percent Beer
Retail Liquor License for the sale of fermented malt beverages, containing not more than
3.2 percent of alcohol by weight, for consumption by the drink on the premises, and in sealed
containers not for consumption at the place where sold, and
WHEREAS, pursuant to Exhibit 5-H of the Weld County Code, said applicant has paid the
sum of $107.50 to the County of Weld for the renewal of the existing license, and
WHEREAS, said applicant has exhibited a State License for the sale of fermented malt
beverages containing not more than 3.2 percent of alcohol by weight for consumption by the drink
on the premises, and in sealed containers not for consumption at the place where sold, outside the
corporate limits of any town or city in the County of Weld at the location described as follows:
16983 County Road 5
Mead, Colorado 80542
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 2010-04 to said applicant to sell fermented malt beverages,
containing not more than 3.2 percent of alcohol by weight, for consumption by the drink on the
premises, and in sealed containers not for consumption at the 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 November 9, 2011, providing that said place where
the licensee is authorized to sell fermented malt beverages containing not more than 3.2 percent of
alcohol by weight, for consumption by the drink on the premises, and in sealed containers not for
consumption at the 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.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said application.
2010-2190
LC0035
- c -L.31'1 C
RENEW 3.2 PERCENT BEER RETAIL LICENSE - HIGHLANDLAKE, INC.
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 20th day of September, A.D., 2010.
BOARD OF COUNTY COMMISSIONERS
ELD COUNTY, COLORADO
Weld County Clerk to the
BY:
Deputy Clerk to the Boar
ounty Attorney
David E. Long
D
Date of signature: 26
2010-2190
LC0035
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THIS LICENSE MUST BE POSTED IN PUBLIC VIEW
DR 8402
(10/29/07)
DEPARTMENT
ALCOHOLIC
STATE OF COLORADO
OF REVENUE
Liquor Enforcement Division
1881 Pierce Street, Suite 108
Lakewood, Colorado 80214
HIGHLANDLAKE INC
16983 CR 5
MEAD CO 80542-9737
BEVERAGE LICENSE
Liability Information
Account Number
County City Indust. Type Liability Date
LICENSE EXPIRES AT MIDNIGHT
14-27324-0000
03 206 451110 C 111087
NOV 09, 2011
Type
Name and Description of License
Fee
2126
2190
3.2 PERCENT BEER RETAIL
LICENSE (ON/OFF PREMISES)
COUNTY 85 PERCENT OAP FEE
$ 75.00
$ 42.50
TOTAL FEE(S)
This license is issued subject to the laws of the State of Colorado and especially
of Title 12, Articles 46 or 47, CRS 1973, as amended. This license is nontransferable
conspicuously posted in the place above described. This license is only valid through
date shown above. Questions concerning this license should be addressed to
Revenue, Liquor Enforcement Division, 1375 Sherman Street, Denver, CO 80261.
In testimony whereof, /I /have hereunto set my hand.
K) Division Director Executive
$ 117.50
under the provision
and shall be
the expiration
the Department of
Q
Pa
Director
DR 8400 (11/09/06) LIQUOR OR 3.2 BEER LICENSE
COLORADO DEPARTMENT OF REVENUE
DENVER, COLORADO 80261 RENEWAL APPLICATION
HIGHLANDLAKE INC
17029 RD 5
MEAD CO 80542
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.
License Number
14-27324-0000
License Type
2126
Liability Information
03 206 451110 C 111087
Business Location
16983 CR 5
MEAD CO
Current License Expires
NOV 09, 2010
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.
Authorized Signature
&/u ,i" Q, �, �,i
Date
7 -LW - 1O
Business Phone
Title I 1
MG —%1 y 62)Asex\ — Pawl ic-t
Sales Tax Number 970--5.3s-4Z s3
-41-,-27.9,2c -Cati o
REPORT AND APPROVAL OF CITY OR COUNTY LICENSING AUTHORITY
has been examined and the premises, business conducted and character of the applicant are satisfacto and v
The foregoing application
do hereby report that such license, if granted, will comply with the provisions of Title 12, Articles 46 and 47, C.R.S.+ fir`
THEREFORE THIS APPLICATION IS APPROVED. A, IS L ')
Local Licensing Authority for
C nt Colorado
D'1l ry
Signat>Wild
tg3�vn2 ca" -'
s Rade acher
Title Chair, Board of Weld
County Commissioners
Attest
•r t \ '�.<.i/
t�
ByA � 4/' s a�, ♦�/ G„`.F
- - DO.NOTDETACH
DR 8400 (11/09/06) LIQUOR OR 3.2 BEER LICENSE
COLORADO DEPARTMENT OF REVENUE RENEWAL APPLICATION
DENVER, COLORADO 80261
Business Name
HIGHLANDLAKE INC
LICENSE NUMBER (Use for all reference)
14-27324-0000
PERIOD
11-11
TYPE OF LICENSE ISSUED
CASH FUND
STATE FEE
3.2 PERCENT BEER RETAIL
COUNTY 85% OAI
LICENSE (ON/OFF PREMISES)
2330-100(999)
2126-750(999)
2190-100(999
$ 50.00
$ 25.00
$ 42.50
Make check payable to: Colorado Department of Revenue The State ma) e.$4-ybsf
check to a one time electronic banking transaction. Your bank account may be detailed as
earty as the same day received by t e State. f converted, your check will not be returned.
If your check is rejected due to insufficient or uncollected funds, the Department of Rev-
enue may collect the payment amount direct y from your banking account electronicalty.
21
$ 117.
2010-2190
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
t# V cwtdlc a, ANC_
State License Number
)L -I -2-132L -cc (:0
1. Operating Manager
Mani 542),sselm
Home Address
lloZCL C ,S, Mead, Cc &DSC(Z
Date of Birth
2.
Do you have legal possession of the premises for ` which this application for license is made?
Are the premises owned or rented: I wne_C If rented, expiration date of lease:
Yes No
I t -I'
3.
Has there been any change in financial interest (new notes, loans, owners, etc.) since the last annual application? If yes, explain in
detail and attach a listing of all liquor businesses in which these new lenders or owners, (other than licensed financial institutions) are
interested.
Yes No
`4"materially
4.
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 convicted of a crime? If yes, attach a detailed explanation.
Yes No
14
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
revoked, or had interest in any entity that had an alcoholic beverage license denied, suspended or revoked? If yes, attach a detailed
explanation.
Yes No
p -
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
❑ IL -1-
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 deleted
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
I-4-
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):
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.
Signature
i7.14/i61f
Printed name
MMN Jensevn, Presccvi4-
Date
7 -29' -Id
Ott
WI�Yc
COLORADO
MEMORANDUM
TO: JENNY VANEGDOM, CTB
FROM: DAN JOSEPH
ENVIRONMENTAL HEALTH SERVICE
SUBJECT: LIQUOR LICENSE INQUIRY
DATE: SEPTEMBER 8, 2010
CC: CINDY SALAZAR; DEBRA ADAMSON
In response to your request, Environmental Health Services has reviewed the Retail Food
Service Establishment file for Highland Lake Inc., located at 16983 WCR 5, in Mead,
Colorado. At this time, there are no problems or concerns regarding this establishment.
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
At4wo.
IIMc
COLORADO
Subject:
To:
From:
Date:
MEMORANDUM
Jenny VanEgdom, Deputy Clerk to the Board
Bethany Salzman, Zoning Compliance Officer
September 3, 2010
Liquor License Referral
Review of the following liquor license renewal by the Department of Planning Services shows the following:
14-27324-0000
Highlandlake, Inc.
dba: Highlandlake, Inc.
16983 CR 5
Mead, CO 80542
Zone District: A (Agricultural)
This use has existed prior to zoning and a Nonconforming Use File (NCU-141), has been set up by the
Department of Planning Services. Any expansion or remodel may require updated zoning permits.
The Department of Planning Services is not aware of any violations occurring on the property at this time.
SERVICE, TEAMWORK, INTEGRITY, QUALITY
Jennifer VanEgdom
From:
Sent:
To:
Cc:
Subject:
Jennifer,
Glen Cowan
Tuesday, September 14, 2010 7:57 PM
Jennifer VanEgdom
Ken Poncelow
RE: Liquor Referral for Highlandlake
There were no problems to note with the establishment
From: Jennifer VanEgdom
Sent: Tuesday, September 14, 2010 4:51 PM
To: Glen Cowan
Cc: Ken Poncelow
Subject: Liquor Referral for Highlandlake
Deputy Cowan,
I have not received a referral on this establishment. Are there any concerns to be noted?
Since it is only a 3.2 Percent license, you will not be required to attend the hearing; however, I do need a referral
for the file.
Thanks.
Jenny VanEgdom I I Deputy Clerk to the Board of County Commissioners I I Weld County, Colorado
(970) 356-4000, ext. 4228 I 1915 10th Street, 3rd Floor, Greeley, Colorado 80631 I www.co.weld.co.us
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