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Home My WebLink About20021809.tiff RESOLUTION RE: APPROVE TRANSFER OF OWNERSHIP REQUEST FOR TAVERN LIQUOR LICENSE FROM DEEANN WOLFE, DBA FORT 21, TO THE FORT 21, LTD., DBA THE FORT 21 - EXPIRES AUGUST 8, 2003 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, The Fort 21, Ltd., dba The Fort 21, presented to the Board of County Commissioners of Weld County, Colorado, an application for a Transfer of Ownership of a Tavern Liquor License for the sale of malt, vinous and spirituous liquors, said license previously held by DeeAnn Wolfe, dba Fort 21, and WHEREAS, pursuant to Exhibit 5-H of the Weld County Code, said applicant has paid the required fees to the County of Weld for a Transfer of Ownership of the existing license, and WHEREAS, said applicant has exhibited a State Liquor License for the sale of malt, vinous and spirituous liquors for consumption by the drink on the premises only, outside the corporate limits of any town or city in the County of Weld at the location described as follows: 985 East 18th Street, Greeley, Colorado 80631 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 2002-10 to said applicant to sell malt, vinous and spirituous liquors for consumption by the drink on the premises only, only at retail at said location and 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 August 8, 2003, providing that said place where the licensee is authorized to sell malt, vinous, and spirituous liquors for consumption by the drink on the premises only, 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. 2002-1809 LC0034 TRANSFER OWNERSHIP OF LIQUOR LICENSE - THE FORT 21 PAGE 2 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 8th day of July, A.D., 2002. BOARD OF COUNTY COMMISSIONERS WELD COUNTY COLORADO ATTEST: atil i `}.: ‘, I LAAA. 5' ''�G -n Vaad G+idit -- Weld County Clerk to th:�.r.r r -q 1 Davi E. L g, Pro- e BY: it ; • _ t', _ .`� Deputy Clerk to the Boa�'►�1 >� ---,/, M. J. Geile��''// AP A F 4'0`'-'---•'•oQ+ %" William H. Jerke unty Attorney r i\ilki—' Robert D. Masden Date of signature: ' 2002-1809 LC0034 THIS LICENSE MUST BE POSTED IN PUBLIC VIEW DR 8402102/991 STATE OF COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division 1375 Sherman Street Denver,Colorado 80261 THE FORT 21 LTD THE FORT 21 985 E 18TH ST GREELEY CO 80631-6135 ALCOHOL BEVERAGE LICENSE Liability Information Account Number County City Indust. Type Liability Date LICENSE EXPIRES AT MIDNIGHT 06-27829-0000 03 057 722410 C 080902 AUG 08, 2003 Type Name and Description of License Fee 2010 TAVERN LIQUOR LICENSE - $ 75.00 MALT, VINOUS, AND SPIRITUOUS 2190 COUNTY 85 PERCENT OAP FEE $ 425.00 TOTAL FEEISI $ 500.00 This license is issued subject to the laws of the State of Colorado and especially under the provision of Title 12, Articles 46 or 47, CRS 1973, as amended. This license is nontransferable and shall be conspicuously posted in the place above described.This license is only valid through the expiration date shown above. Questions concerning this license should be addressed to the Department of Revenue, Liquor Enforcement Division, 1375 Sherman Street,Denver,CO 80261. In testimony whereof,I have hereunto set my hand. Lca AUG 1 2 2002 • Division Director Executive Director KA 0 00 di T C y -0 C M`y O O u p s al s ° ° U v z W E E yry N ° y,11 w a U U W Y M O001 p 4.4 o W tCtl .-� y 7 A ,� o y , ! 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OO se 11 4-*• = A3 •B u •°o is W F to n 1 o cod . ,P a E C eu w o' o a `� DR 8404(06/00) Page 1 21 COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION COLORADO LIQUOR DENVER CO 80261 OR 3.2% FERMENTED MALT BEVERAGE RETAIL LICENSE APPLICATION ❑ NEW LICENSE XTRANSFER OF OWNERSHIP ❑ LICENSE RENEWAL • ALL ANSWERS MUST BE PRINTED IN BLACK INK OR TYPEWRITTEN • APPLICANT MUST CHECK THE APPROPRIATE BOX(ES) • LOCAL LICENSE FEE $ • • APPLICANT SHOULD OBTAIN A COPY OF THE COLORADO LIQUOR AND BEER CODE(Call 303-321-4164) DO NOT WRITE IN THIS SPACE 1. Applicant is applying as a ❑ Individual igi Corporation ❑ Limited Liability Company ❑ Partnership(includes Limited Liability and Husband and Wife Partnerships) , ., Association or Other 2. Name of Applicant(s) If partnership,list partners'names(at least two);if corporation,name of corporation Fein Number r,;Y-k al L. fl 2a.Trade Name of Establishment(DBA) State Sales/Tax No. Business Telephone 3. Address of Premises(specify exact location of premises) 9*S F , 15-ih St -in City County State ZIP Code C ZEE.,LE_`! (..7.2)E.,1.._ C L 53o to-3 I 4. Mailing Address (Number and Street) City or Town State ZIP Code Ct c E ) 1.'rl-, S1 -e e* I G r—e \C y Cl.O s'U to3 I 5. If the premises currently have a liquor or beer license,you MUST answer the following questions: Present Trade Name of Establishment(DBA) Present State License No. Present Class of License Present Expiration Date the c:c-. --r at la-X13GiK-ocoo aGIO `( - a• •c: z. LIAB t SECTION A Nonrefundable APPLICATION FEES LUAB SECTION O LIQUOR LICENSE FEES 2300 ❑ Application Fee for New License 850.00 1940 ❑ Retail Liquor Store License(city) $202.50 2300 ❑ Application Fee-New License Concurrent Review....950.00 1940 ❑ Retail Liquor Store License(county) 287.50 2310 X Application Fee for Transfer of Ownership 850.00 1950 ❑ Liquor Licensed Drugstore (city) 202.50 SECTION B 3.2%BEER LICENSE FEES 1950 ❑ Liquor Licensed Drugstore (county) 287.50 2121 ❑ Retail 3.2%Beer On Premises-(city) $71.25 1960 El Beer&Wine License (city) 326.25 2121 ❑ Retail 3.2% Beer On Premises-(county) 92.50 1960 ❑ Beer&Wine License (county) 411.25 CI H& R License ❑city ❑county 475.00 2122 LiRetail 3.2% Beer Off Premises-(city) 71.25 1970 2122 Cl Retail 3.2% Beer Off Premises-(county) 92.50 1980 CI H& R License w/opt Prem ❑ city ❑county 475.00 1990 El Club License ❑city ❑county 283.75 2123 ❑ Retail 3.2% Beer On/Off Premises-(city) 71.25 2010lgr Tavern License ❑city gcounty 475.00 2123 ❑ Retail 3.2% Beer On/Off Premises-(county) 92.50 2020 ❑ Arts License ❑city El county 283.75 SECTION C RELATED FEES AND PERMITS 2030 El Racetrack License ❑city ❑county 475.00 1985-100(999)❑Addition of related Facility Permits to existing 2040 ❑ Optional Premises License ❑ city ❑county 475.00 Resort Complex license 1905 ❑ Retail Gaming Tavern Lic ❑city ❑county 475.00 $50.00 x Total Fee 1975 ❑ Brew-Pub License 725.00 2210-100(999)❑Retail Warehouse Storage Permit $75.00 1985 ❑ Resort Complex License 475.00 1980-100(999)❑Addition of Optional Premises to existing hotel/restaurant No Fee❑3.2%Beer On/Off Premises Only Delivery Permit $75.00 x Total Fee No Fee❑Retail Liquor Store Delivery Permit ❑H/R-Tavern Manager's Registration $75.00 DO NOT WRITE IN THIS SPACE-FOR DEPARTMENT OF REVENUE USE ONLY LIABILITY INFORMATION License Issued Through County City industry Type License Account Number Liability Date (Expiration Date) FROM TO State City County Managers Reg -750(999) 2180-100(999) 2190-100(999) -750(999) Cash Fund Mew License Cash Fund Transfer L,eenee TOTAL 2300-100 2310-100 (999) (999) A 2002-1809 1C.(:.•O 3,, DR 8404(06/00) Paget APPLICATION DOCUMENTS CHECKLIST AND WORKSHEET Instructions: This check list 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. 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 E A. No larger than 8 1/2"X 11". ® B. Dimensions included (doesn't have to be to scale). Exterior areas should show control (fences,walls,etc.). ❑ C. Separate diagram for each floor(if multiple levels). ❑ D. Kitchen-identified if Hotel and Restaurant. III. PROOF OF PROPERTY POSSESSION ® A. Deed in name of the Applicant ONLY(or) ❑ B. Lease in the name of the Applicant ONLY. ❑ C. Lease Assignment in the name of the Applicant(ONLY)with proper consent from the Landlord and acceptance by the Applicant. ❑ D. Other Agreement if not deed or lease. IV. BACKGROUND INFORMATION AND FINANCIAL DOCUMENTS ❑ A. Individual History Record(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. V. CORPORATE APPLICANT INFORMATION(If Applicable) ❑ A. Certificate of Incorporation (and/or) ❑ B. Certificate of Good Standing if incorporated more than 2 years ago. ❑ C. Certificate of Authorization if foreign corporation. ❑ D. List of officers, directors and stockholders of parent corporation(designate 1 person as"principal officer). VI. PARTNERSHIP APPLICANT INFORMATION (If Applicable) ❑ A. Partnership Agreement(general or limited). Not needed if husband and wife. VII. LIMITED LIABILITY COMPANY APPLICANT INFORMATION(If Applicable) ❑ A. Copy of articles of organization(date stamped by Colorado Secretary of State's Office). ❑ B. Copy of operating agreement. ❑ C. Certificate of Authority(if foreign company). VIII. MANAGER REGISTRATION FOR HOTEL AND RESTAURANT,TAVERN LICENSES WHEN INCLUDED WITH THIS APPLICATION ❑ A. $75.00 fee. ❑ B. Individual History Record (DR 8404-I). DR 8404(06/00) Page 3 6. Is the applicant(including any of the partners,if a partnership;members or manager if a limited liability company;or officers,stock- Yes No holders or directors if a corporation)or manager under the age of twenty-one years? ❑ 21 7. 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); (a) been denied an alcoholic beverage license? ❑ (b) had an alcoholic beverage license suspended or revoked? ❑ (c) had interest in another entity that had an alcoholic beverage license suspended or revoked? ❑ [y�" If you answered yes to 7a,b or c,explain in detail on a separate sheet. 8a. 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. ❑ 8b. Has a 3.2 beer license for the premises to be licensed been denied within the preceding one year?If"yes,"explain in detail. ❑ 9. Are the premises to be licensed within 500 feet of any public or private school that meets compulsory education requirements of ❑ El Colorado law,or the principal campus of any college,university or seminary? 10. 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. - ç' -. + „ 11. Does the Applicant,as listed on line 2 of this application, have legal possession of the premises for at least 1 year from the date that this license will be issued by virtue of ownership,lease or other arrangement? lR1 ❑ Ownership ❑ Lease ❑ Other(Explain in Detail) a. If leased,list name of landlord and tenant,and date of expiration, EXACTLY as they appear on the lease: Landlord Tenant Expires Attach a diagram and outline 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". (Doesn't have to be to scale) 12. 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. NAME DATE OF BIRTH FEIN OR SSN INTEREST 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. 13. Optional Premises or Hotel and Restaurant Licenses with Optional Premises Yes No A local ordinance or resolution authorizing optional premises has been adopted. ❑ ❑ Number of separate Optional Premises areas requested. 14. Liquor Licensed Drug Store applicants,answer the following: (a) Does the applicant for a Liquor Licensed Drug Store have a license issued by the Colorado Board of Yes No Pharmacy?COPY MUST BE ATTACHED. ❑ ❑ 15. Club Liquor License applicants answer the following and attach: (a) Is the applicant organization operated solely for a national,social,fraternal,patriotic,political or athletic purpose and ❑ ❑ not for pecuniary gain? (b) 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? (c) How long has the club been incorporated? (d) How long has applicant occupied the premises (Three years required) to be licensed as a club?(Three years required) 16. Brew-Pub License Applicants answer the following: (a) Has the applicant received or applied for a Federal Brewers Notice? ❑ 1O (Copy of notice or application must be attached) Date of Birth 17a. Name of Manager (If this is an application for a Hotel, Restaurant or Tavern License,the manager must also submit an Individual History Record(DR 8404-I). 17b. Does this manager act as the manager of,or have a financial interest in,any other liquor Yes No licensed establishment in the State of Colorado? If yes,provide name,type of license and account number. ❑ ❑ 18. Tax Distraint Information. Does the applicant or any other person listed on this application and including its partners,officers. Yes No 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. DR 8404(06/00) Page 4 19. If applicant is a corporation, partnership,association or a limited liability company, it is required to list by position ail officers and directors, general partners,managing members,all stockholders,partners(including limited partners)and members who have a 10%or greater financial interest in the applicant.All persons listed here or by attachment must submit and attach a DR 8404-I(Individual History Record) and provide fingerprint cards to their local licensing authority. NAME HOME ADDRESS,CITY&STATE DATE OF POSITION %OWNED TH Nee Arrw ( nY c�OseSeD1 a�� I a�eeSe'1 Q e 8031 ( r e- 1OO 20. Has the Applicant provided,or does the applicant intend to provide their staff with server training. es No Additional Documents to be submitted by type of entity ❑ CORPORATION E Cert.of Incorp. ❑ Cert.of Good Standing(if more than 2 yrs.old) ❑ Cert.of Auth.(if a foreign corp.) ❑ PARTNERSHIP ❑ Partnership Agreement(General or Limited) ❑ Husband and Wife partnership(no written agreement) ❑ LIMITED LIABILITY COMPANY ❑ Articles of Organization ❑ Cert.of Authority(if foreign company) ❑ Operating Agrmt. ASSOCIATION OR OTHER Attach copy of agreements creating association or relationship between the parties Registered Agent(if applicable) Address for Service OATH OF APPLICANT 1 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 Title Date + e - .�., Cesar ( .L .\-- ( P s- ac D -oa 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 (1))C.R.S. Each person required to file DR 8404-I: Yes No a.Has been fingerprinted ® ❑ b.Background investigation and NCIC and CCIC check for outstanding warrants conducted c.The local authority has already conducted,or intends to conduct,a premise inspection to insure that the applicant is IA in compliance with,and aware of,liquor code provisions affecting their class of license. If not,does the authority want the state to conduct such an inspection. (date of inspection) 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 O TOWN,CITY Weld Cou ?) ,. 't: .o (970)356-4000 X4200 at COUNTY Signs / Ti c enn Vaad, Chair, Weld County Date ,r ' / ., A rd of Commissioners 07/08/2002 Sig at 1�atte. I� � lrift? Titl D4ate 1{ ;;�:. ,,� �/ , Deputy 07/08/2002 If premises are located within a •s city v . al should be signed by the mayor and clerk,if in a county,then by the chairman of the board of county commissio . afa clot r� • �rd. If,by ordinance or otherwise,the local licensing authority is some other official, then such approval should be give t.�t�oia ,k/ ARTICLES OF INCORPORATION Form 001 Filing fee: $50.00 revised 12/27/01 rtL-CL�p yoDoN' Deliver 2 copies to: Colorado Secretary of State COLORADOSECRET mY°F sin Business Division, 1560 Broadway, Suite 200 LF'f_1L; 'i i,),40J Y i Denver, CO 80202-5169 $ cigG This document must be typed or machine printed SECRETARY OF STATE Please include a self-addressed envelope. ABOVE SPACEfPASR,OiFi¢enlWiSEonk . . e= The undersigned, acting as the incorporator of a corporation for profit pursuant to § 7-102-102, Colorado Revised Statutes (C.R.S.), delivers these Articles of Incorporation to the Colorado Secretary of State for filing, and states as follows: 1. The entity name of the corporation is: THE FORT 21, LTD. The entity name of a corporation must contain the term "corporation", "incorporated", "company", or"limited", or an abbreviation of any of these terms§7-90-601(3)(a), C.R.S. 2. The corporation is authorized to issue: (number) 50,000 shares of(class)NPV (number) shares of(class) If more classes are authorized, include attachment indicating class(es)and number of shares in each class. 3. The street address of the corporation's initial registered office and the name of its initial registered agent at that office are: Street Address: 985 E. 18th St., Greeley, CO 80631 (must be a street or other physical address in Colorado)if mail is undeliverable to this address,ALSO include a post office box address:— ; Registered Agent Name: DEE ANN COSNER The undersigned consents to appointment as the corporation's initial registered agent: Registered Agent Signature C 4. The address of the corporation's initial principal office is: 985 E. 18`h St., Greeley, CO 80631 5. The name and address of the incorporator is: Name DEE ANN COSNER Address 2501 26th St., Greeley, CO 80631 6. The address to which the Secretary of State may send a copy of this document upon completion of filing (or to which the Secretary of State may return this document if filing is refused) is: DON J. HOFF, ATTORNEY AT LAW, 1025 9th Ave., Ste. 309, Greeley, CO 80631 If applicable, these articles are to have a delayed effective date of n/a (not to exceed 90 days) Incorporator Signature � '3"..--a "(Wr Signer's Name-printed DEE ANN COSNER. OPTIONAL. The electronic mail and/or Internet address for this entity is/are: e-mail Web site The Colorado Secretary of State may contact the following authorized person regarding this document: name DON J. HOFF address 1025 9th Ave., Ste. 309, Greeley, CO 80631 voice 970-356-6767 fax 970-353-7504 e-mail OI]daimcn This fern and any related instructions,are not intended to provide meal business or ron'dries,ad are offered as a public service without representation or warranty While this form is betided to satisfy minimum legal requirements as or it,«dsion dam.compliance with approme law,as the same may be amended from time,o uom remains the responsibility of the user fifth's form.Questions should be addressed to the user attorney. AFFIDAVIT OF TRANSFER AND STATEMENT OF COMPLIANCE Pursuant to the requirements of 12-47-303(3)(b), Colorado Revised Statutes, Licensee hereby states that all accounts for alcohol beverages sold to the Applicant are: Paid in full. There are no outstanding accounts with any Colorado Wholesalers. Licensee hereby certifies that the following is a complete list of accounts for alcohol beverages that are unpaid: Licensee and Applicant agree that all accounts will be paid for from the proceeds at closing by the: Licensee _Applicant Applicant will assume full responsibility for payment of the outstanding accounts as listed above. Licensee hereby authorizes the transfer of its Colorado Retail Liquor License to the Applicant, its agent, or a company, corporation, partnership or other business entity to be formed by the Applicant. Dated this /a day of -r -2 , 200 L . LCD Lia/oa C I L ri 1kcl (O / , k I 0 2 Licensee(Seller) U Date Applicant (Buyer) Date NAF- `C�--( aI �IIIIN11111111111111111 III inn 111112 ��11111IIIlIIII 1 6 of&1TR 6.0/1999 D 0.002JATP Suki Weld Ta kamot CO o q Quit Claim Deed T}DS DEED is a conveyance from the individual(s),caporation(s)or other entity(ies)named below as GRANTOR to the individual(s)orentity(ies)named below as GRANTEE of whatever interest the GRANTOR may have in the real property described below. The GRANTOR hereby sells and quit claims to the GRANTEE the real property described below with all its appurtenances. The specific terms of this deed are: Grantor: (Give name(s)and plre(.)of residence.if the mane of the owner-grantor ujoining in this Deed to release homestead eights identify grantors ea Ivoba d and wife) Richard Lee Wilhelm DeeAnn Wilhelm 33738 Weld County Road 39 and 985&975 E.18th Street Lucerne,CO 80646 Greeley,CO 80631 Grantee: (Give name(s)and ad&ea{m),—mad of deeee,including available road and wen rmbs,is required) Dee Ann Wolfe 985&975 E. 18th Street Greeley,CO 80631 Form of Co-Ownership: (If there are two or more grantees named,they will be considered to take as imats-imonron unha the wore"in joint tenancy)or words of the ewe lutanist'ire added in the mace below) None Property Deserlption: (Include county and gate) Lot A, according to Exemption No. 0961-9-4-RE333,recorded August 30, 1978,in Book 843 as Reception No.1765081,being a portion of West 2 acres of Lot 3 of NE'/e of SE/.:cod of the E%of Lot 7 of NW'/,of SE'/.of Section 9,Township 5 North,Range 65 West of the 6th P.M.,County of Weld,State of Colorado. • Properly Address: 985&975 East 18th Street,Greeley,CO 80631 Reservations-Restrictions: (If the GRANTOR intends to reserve any interest in the propilfy or to convey tea than he owns,or if the GRANTOR it restricting ut,pit sNTEI S'Owns, Those of public record. eropeny,maas rePtvaiamialk.tion) 1 < •n p 1 Emoted by the Orator on/[• t'd -) .1999. /jam 7�' • Signature Oars Tor Corporation,Partnenhlp orA Association: _.I� y/we.N-' l/ }�dNreYy(s) „ n. ),id Name ofCspsatis.Partnership or Association RIC f!L per rr fork, K_, DY DEE ANN WILHEIM.Greater M Anne STATE OF COLOkADO ) COUNTY OF WELD )a J,j)lit '/t WITNESS IItgell Thforegoing ihnd and official sewu7dgad berme me this .l my oCsd��l .by CHARD LEE WIINEfM. I eo my innan wa..laeat n Mymarusion • LCY` 'L _ t - 11MaetbYY. F C OF ERADO ) COUNTY OF WELD )or Theforegoingaatnmwt was acknowledged before tee this day of ,1999,by DEE ANN,WIINEIM. WITNESS my band and official stet. . My commission expires: Notary Public THIS FORM HAS IMPORTANT LEGAL CONSEQUENCES AND THE PARTIES SHOULD CONSULT LEGAL COUNSEL BEFORE SIGNING BUSINESS LEASE ' This lease,dated June 5. 2002 ,is between DEEANN COSNER ,as Landlord, '' and THE FORT 21, LTD. ,as Tenant. In consideration of the payment of the rent and the performance of the covenants and agreements by the Tenant set forth herein, i' the Landlord does hereby lease to the Tenant the following described premises situate in Weld i II County,in the State of Colorado;the address of which is 985 E. 18th St., Greeley, CO 80631 H Property Address I i',, regal Description I I II' Said premises,with all the appurtenances,are leased to the Tenant from the date of June 10, 2002 ! or on the date a liquor license is granted to The Fort 21, Ltd. , whichever is late*, until the date of June 30, 2005 at and for a rental for the full term of$ 54,000 , I!, iI payable in monthly installments of$ 1500 , I l 'I II in advance,on the 1St day of each calendar month during the term of this lease,payable at 2501 26th St. , I II I! Greeley, CO 80634 Address ,without notice. I I I THE TENANT, IN CONSIDERATION OF THE LEASING OF THE PREMISES AGREES AS FOLLOWS: ii I. The Tenant shall pay the rent for the premises above-described. II I j 2. The Tenant shall,at the expiration of this lease,surrender the premises in as good a condition as when the Tenant entered the premises, I ', ordinary wear and tear excepted.The Tenant shall keep all sidewalks on and around the premises free and clear of ice and snow;keep the entire I, exterior premises free from all litter,dirt,debris and obstructions;and keep the premises in a clean and sanitary condition as required by the II ordinances of the city and county in which the property is situate. I 3. The Tenant shall not sublet any part of the premises,nor assign the lease,or any interest therein,without the written consent of the I I I Landlord. ' 4. The Tenant shall use the premises only as a liquor licensed establishment ';' and shall not use the premises for any purposes prohibited by the ' laws of the United States or the State of Colorado,or of the ordinances of the city or town in which said premises are located,and shall neither permit nor suffer any disorderly conduct,noise or nuisance having a tendency to annoy or disturb any persons occupying adjacent premises. 5. The Tenant shall neither hold,nor attempt to hold,the Landlord,its agents,contractors and employees,liable for any injury,damage, I claims or loss to person or property occasioned by any accident,condition or casualty to,upon,or about the premises including,but not limited j to,defective wiring,the breaking or stopping of the plumbing or sewage upon the premises,unless such accident,condition or casualty is directly I caused by intentional or reckless acts or omission of the Landlord. Notwithstanding any duty the Landlord may have hereunder to repair or I maintain the premises,in the event that the improvements upon the premises are damaged by the negligent,reckless or intentional act or omission I I I of the Tenant or any employees,agents,invitees,licensees or contractors,the Tenant shall bear the full cost of such repair or replacement.The 'I Tenant shall hold Landlord,Landlord's agents and their respective successors and assigns,harmless and indemnified from all injury,loss,claims III II or damage to any person or property while on the demised premises or any other part of landlord's property,or arising in any way out of Tenant's business, which is occasioned by an act or omission of Tenant, its employees, agents, invitees,licensees or contractors. The Landlord is not i I responsible for any damage or destruction to the Tenant's personal property. 6. The Tenant shall neither permit nor suffer said premises, or the walls or floors thereof, to be endangered by overloading, nor said j, j premises to be used for any purpose which would render the insurance thereon void or the insurance risk more hazardous, nor make any alterations in or changes in,upon,or about said premises without first obtaining the written consent of the Landlord. I 7. The Tenant shall obtain and keep in full force,at Tenant's expense,fire and liability insurance as may be reasonably required by the j j, Landlord.Tenant shall provide copies of such insurance policies upon the Landlord's request. I I 8. The Tenant shall permit the Landlord to place a"For Rent"sign upon the leased premises at any time after sixty(60)days before the I jend of this lease. I I;' 9. The Tenant shall allow the Landlord to enter upon the premises at any reasonable hour. II I IT IS EXPRESSLY UNDERSTOOD AND AGREED BETWEEN LANDLORD AND TENANT AS FOLLOWS: W. The Tenant shall be responsible for paying the following: X3 Electric Xl Gas Xl Water X3 Sewer Xl Phone fNRefuse Disposal ! 0 Janitorial Services L�Other minor maintenance and painting I The 0 Landlord X3 Tenant agrees to keep all the improvements upon the premises, including but not limited to, structural components, interior and exterior walls,floors,ceiling,roofs,sewer connections,plumbing,wiring and glass in good maintenance and repair at their expense. In the event the Landlord is responsible for repair of the premises,the Tenant shall be obliged to notify the Landlord of any condition upon the I I premises requiring repair and the Landlord shall be provided a reasonable time to accomplish said repair. I', 11. No assent,express or implied,to any breach or default of any one or more of the agreements hereof shall be deemed or taken to be a waiver of any succeeding or other breach or default. 12. lf,after the expiration of this lease,the Tenant shall remain in possession of the premises and continue to pay rent without a written agreement as to such possession, then such tenancy shall be regarded as a month-to-month tenancy,at a monthly rental,payable in advance, I I equivalent to the last month's rent paid under this lease,and subject to all the terms and conditions of this lease. I I 13. If the premises are left vacant and any part of the rent reserved hereunder is not paid,then the Landlord may,without being obligated to Il I do so,and without terminating this lease,retake possession of the said premises and rent the same for such rent,and upon such conditions as the i,,I I Landlord may think best,making such changes and repairs as may be required,giving credit for the amount of rent so received less all expenses of ' such changes and repairs,and the Tenant shall be liable for the balance of the rent herein reserved until the expiration of the term of this lease. 14. The Landlord acknowledges receipt of a deposit in the amount of$ 100 to be held by the Landlord for the faithful III i performance of all of the terms,conditions and convenants of this lease.The Landlord may apply the deposit to cure any default under the terms of this lease and shall account to the Tenant for the balance.The Tenant may not apply the deposit hereunder to the payment of the rent reserved !I jl I hereunder or the performance of other obligations. I No.1044.Rev.1-96. BUSINESS LEASE Bradford Publishing,1743 Wazee St.,Denver,CO 80202-(303)292.2500—2-97 Copyright 1985 15. If the Tenant shall be in arrears in payment of any installment of rent,or any portion thereof,or in default of any other covenants or agreements set forth in this lease,and the default remains uncorrected for a period of three(3)days after the Landlord has given written notice thereof pursuant to applicable law,then the Landlord may,at the Landlord's option,undertake any of the following remedies without limitation: (a)declare the term of the lease ended;(b)terminate the Tenant's right to possession of the premises and reenter and repossess the premises pursuant to applicable provisions of the Colorado Forcible Entry and Detainer Statute;(c)recover all present and future damages,costs and other relief to which the Landlord is entitled;(d)pursue breach of contract remedies;and/or(e)pursue any and all available remedies in law or equity. In the event possession is terminated by a reason of default prior to expiration of the term,the Tenant shall be responsible for the rent occurring5 nd for the remainder of the term,subject to the Landlord's duty to mitigate such damages.Pursuant to applicable law [13-40-104(d.5),(e.5) . ) 13-40-107.5,C.R.S.]which is incorporated by this reference,in the event repeated or substantial default(s)under the lease occur,the Landlord may terminate the Tenant's possession upon a written Notice to Quit,without a right to cure.Upon such termination,the Landlord shall have available any and all of the above-listed remedies. 16. If the property or the premises shall be destroyed in whole or in part by fire,the elements,or other casualty and if,in the sole opinion of the Landlord,they cannot be repaired within ninety(90)days from said injury and the Landlord informs the Tenant of said decision;or if the premises are damaged in any degree and the Landlord informs the Tenant it does not desire to repair same and desires to terminate this lease; then this lease shall terminate on the date of such injury.In the event of such termination,the Tenant shall immediately surrender the possession of the premises and all rights therein to the Landlord;shall be granted a license to enter the premises at reasonable times to remove the Tenant's property;and shall not be liable for rent accruing subsequent to said event.The Landlord shall have the right to immediately enter and take possession of the premises and shall not be liable for any loss,damage or injury to the property or person of the Tenant or occupancy of,in or upon the premises. If the landlord repairs the premises within ninety(90)days,this lease shall continue in full force and effect and the Tenant shall not be required to pay rent for any portion of said ninety(90)days during which the premises are wholly unfit for occupancy. 17. In the event any dispute arises concerning the terms of this lease or the non-payment of any sums under this lease,and the matter is turned over to an attorney,the party prevailing in such dispute shall be entitled,in addition to other damages or costs,to receive reasonable attorneys'fees from the other party. IS. In the event any payment required hereunder is not made within ten(10)days after the payment is due,a late charge in the amount of 5 %of the payment will be paid by the Tenant. 19. In the event of a condemnation or other taking by any governmental agency,all proceeds shall be paid to the Landlord hereunder,the Tenant waiving all right to any such payments. 20. This lease is made with the express understanding and agreement that in the event the Tenant becomes insolvent,the Landlord may declare this lease ended,and all rights of the Tenant hereunder shall terminate and cease. 21. The Tenant and the Landlord further agree: A. Tenant to provide fire, hazard and general liability insurance on the premises in the amount of at least $100,000 and shall name the landlord as an additional insured. - B. Landlord shall be responsible for major repairs and maintenance, such as roof replacement or required structural maintenance. C. Tenant shall maintain the heating and air conditioning systems, any air filtration system and general maintenance. D. Ad valorem taxes shall be paid by the landlord. All other taxes incurred as a result of the operation of the business shall be paid by tenant and shall not be allowed to become a lien upon the premises. This lease shall be subordinate to all existing and future security interests on the premises.All notices shall be in writing and be personally delivered or sent by first class mail,unless otherwise provided by law,to the respective parties.If any term or provision of this lease shall he invalid or unenforceable,the remainder of this lease shall not be affected thereby and shall be valid and enforceable to the full extent permitted by law. This lease shall only be modified by amendment signed by both parties.This lease shall be binding on the parties,their personal representatives, successors and assigns.When used herein,the singular shall include the plural ex/la.,l01.. AttestCOSNER n ^ u ^ ,- f Date ti- � r, tt"� Date DEANN DEANN COSNER, PRESIDENT THE FORT 21 LTD. Date Attest: Date GUARANTEE For value received,I guarantee the payment of the rent and the performance of the convenants and agreements by the Tenant in the within lease. Date Signature ASSIGNMENT AND ACCEPTANCE assignor, For value received assigns all right,title and interest in and to the within lease to assignee,the heirs,successors and assigns of the assignee,with the express understanding and agreement that the assignor shall remain liable for the full payment of the rent reserved and the performance of all the covenants and agreements made in the lease by the Tenant.The assignor will pay the rent and fully perform the covenants and agreements in case the assignee fails to do so.In consideration of this assignment,the assignee assumes and agrees to make all the payments and perform all the covenants and agreements contained in the lease and agreed to by the Tenant. Date Date Assignee Assignor CONSENT OF ASSIGNMENT Consent to the assignment of the within lease to is hereby given,on the express condition,however,that the assignor shall remain liable for the prompt payment of the rent and performance of the covenants on the part of the Tenant as herein mentioned,and that no further assignment of said lease or sub-letting of the premises,or any part thereof,shall be made without further written agreement. Date Date Signature Signature LANDLORD'S ASSIGNMENT In consideration of One Dollar,in hand paid,I hereby assign to my interest in the within lease,and the rent therein reserved. Date Landlord o b o 10 rn v ,i woos lava 301330 I I AR 31V9 I '7I I j r - _.�.._ I r..�T�z� _ I . Imo- •= ul a O II II I I , i' ' I. ii J DI I I I I � w w I I Olldd Iri I I I O 1 i ii� I I I' i i ce I I } I o I : O v � ! I i 1. .ar I I ,= , I_. I I, , I III ! II ' I I I I I I I I • 33N3j.8 FORT 05/22/2002 9:51 AM Form SS-4 Application for Employer Identification Number (Re;;.December 2001) (For use by employers,corporations,partnerships,trusts,estates,churches, EIN 02-06031 77 Department of the Treasury government agencies,Indian tribal entities,certain individuals,and others.) Internal Revenue Service See separate instructions for each line. Ill: Keep a copy for your records. OMB No.1545-0003► 1 Legal name of entity(or individual)for whom the EIN is being requested p THE FORT 21, LTD r 2 Trade name of business(if different from name on line i 1) 3 Executor,trustee,"care or name Tn y t 4a Mailing address(room,apt.,suite no.&street,or P.O.box) 5a Street address(if different)(Do not enter a P.O.box.) Pc 985 E 18TH STREET e I 4b City,state,and ZIP code 5b City,state,and ZIP code oe GREEELY CO 80631 r r 6 County and state where principal business is located i WELD CO Y 7a Name of principal officer,general partner,grantor,owner,or imstor 7b SSN,ITIN,or EIN DEE ANN COSNER Ba type of entity(check only one box) — Estate(SSN of decedent) — Sole proprietor(SSN) _ Plan administrator(SSN) Partnership — Trust(SSN of grantor) Corporation(enter form number to be filed)► 1120 S — National Guard State/local government — Personal service corp. — Farmers'cooperative Federal govemment/military Church or church-controlled organization _ REMIC Indian tribal govemments/enterprises — Other nonprofit organization(specify).. Group Exemption Number(GEN)► Other(specify)► 8b If a corporation,name the state or foreign country State Foreign country (if applicable)where incorporated _ COLORADO _ 9 Reason for applying(check only one box) — Banking purpose(specify purpose)* ® Started new business(specify type)* _ Changed type of organization(specify new type)► BAR AND LOUNGE — Purchased going business Hired employees(Check the box and see line 12.) — Created a trust(specify type) — Compliance with IRS withholding regulations _ Created a pension plan(specify type)► Other(specify)► 10 Date business started or acquired(month,day,year) 11 Closing month of accounting year 7/01/02 12 12 First date wages or annuities were paid or will be paid(month,day,year).Note:If applicant is a withholding agent,enter date income will first be paid to nonresident alien.(month,dayyear) . ► 7/30/02 13 Highest number of employees expected in the next 12 months.Note:If the applicant does not Agricultural Household Other expect to have any employees during the period,enter"-0-." W ► 5 14 Check one box that best describes the principal activity of your business. Health care&social assistance — Wholesale-agent/broker — Construction I I Rental&leasing _ Transportation&warehousing Accommodation&food service _ Wholesale-other 9 Retail Real estate Irll Manufacturing Finance&insurance Other(specify) 15 Indicate principal line of merchandise sold;specific construction work done;products produced;or services provided. BEER, WINE AND LIQUOR SALES 16a Has the applicant ever applied for an employer identification number for this or any other business? u Yes IA No Note:If"Yes,"please complete lines 16b and 16c. 166 If you checked"Yes"on line 16a,give applicant's legal name and trade name shown on prior application if different from line 1 or 2 above. Legal name Di Trade name► 16c Approximate date when,and city and state where,the application was filed.Enter previous employer identification number if known. Approximate date when filed(mo.,day,year) City and state where filed Previous EIN Complete this section only if you want to authorize the named Individual to receive the entity's EIN and answer questions about the completion of this form. Third Designee's name Designee's telephone number(include area code) Party J MICHAEL JOHANNES CPA 970-356-7994 Designee Address and 1770 25TH AVENUE STE 204 Designee's fax number(include area code) ZIP code GREELEY CO 80634 970-356-6128 Under penalties of perjury,I declare that I have examined this application,and to the best of my knowledge and belief, it is true,correct,and complete. Applicant's telephone number(include area code) Name and title (type or print clearly)► DEE ANN COSNER PRESIDENT Applicant's fax number(include area code) Signature► 1 u c �1r ft._ i(rc ,i. ,./ ..1._. �. 1 Date"' i-t,) For Privacy Act and Paperwork Reduction Act Notice,see separate Instructions. Form SS-4(Rev.12-2001) DAA RIA . CR 1OO(1u'/OO) ‘ Denver CO 261-OO13 COLORADO BUSINESS REGISTRATION 1 9 PLEASE PRESS FIRMLY AND PRINT CLEARLY INSTRUCTIONS FOR THIS FORM ARE IN THE PUBLICATION CR 101 sr. -„^ `IA 11cqtREASON FOR FILING THIS APPLICATION Z N O s� _ ' t ,exit Original Application O Change of Ownership 2 ♦If trade name registration with the Department of Y Do you have a Dept ofReleriue Account Number Oyes �no re Revenue Is required,the information marked with a IF YES,Account# u. diamond will become public record. Do you want this number assigned to new location? O yes O no Z ♦2.INDICATE TYPE OF ORGANIZATION K Individual O Limited Liability Limited Estate O Other Non-Profit = General Partnership Partnership(LLLP) Government W Limited Partnership Corporation Joint Venture ❑ Other O Limited Liability Company(LLC) 'S'Corporation Trust DO NOT WRITE IN THIS SPACE G Limited Liability Partnership(LLP) Association Non-profit 501(Cx3) � (Please enclose copy of the IRS letter of exemption.) , 1. Taxpayer Name(owner,partners or corporate name)(last,first,middle) " "' THE FORT 21 , LTD 2a.Trade Name/Domg Business As(8 applicable) 2b.Federal Employer Identification Number(FEIN) ♦ 02-0603177 3a.Street Address of Pnncipal Place of Business in Colorado City State LP ♦ 985 E 18TH STREET • GREELEY • CO • 80631 3b.County If business is within limits of a city,what city? telephone ♦ WELD • (( 970 )) 392-9109 4a.In Care Of(do) 4b.Mailing Address Of different from above)(include unit)r) z r City —State P Telephone et C ♦ ♦ ♦ ( ) O 5. Bank Name(if available) Bank Address Bank Account Number — LL Z Z 6. First Day of Payroll(MO/DAY/YR) Payroll Records Location(list address) THE FORT 21 LTD Payroll Records Telephone 07/30/02 985 E 18TH STREET GREELEY, CO 80631 ( 970 ) 392-9109 E 7. Whatprpductso�arRd/ppf�.,servjccgOss,,(1��yNi provide?(complete section'H') Do you sell motor vehicle tires? U Yes ' = • Dolt WIIVL Li ILUUK x1YI No < ' r Se you rent out items for l days or less? Nu Yes 8a.Owner/Partner/Corp.Officer Title Social Secury# Federal Employer Identification Number(FFJN) No DEE ANN COSNER ♦ PRES m eb.Address(residence or P.O.Box,street,city,state,ZIP) Telephone ♦ 2501 26TH STREET GREELEY, CO 80634 ( ) 9a.Owner/Partner/Corp.Officer Title Social Security# Federal Employer Identification Number(FEIN) ♦ ♦_9b.Address(residence or P.O.Box,street,city,state,ZIP) Telephone ) If you acquired the business in whole or In part,complete the following: — 1Oa.Prior Taxpayer Name Date of Acquisition Prior Taxpayer UI Tax Account Number • 1Ob.Address City State LP 1. ❑ If Seasonal,mark O JAN ❑APR ❑JULY ❑OCT - _• each business month. O FEB O MAY DAUG O NOV t `� O MAR O JUN ❑SFPT O CEC (0280- in 2a.FlUNG FREQUENCY: If sales tax collected Is: 12h.First Day of Sales(MO/DAY/YR) _ 750) Regiis rade Name (sec)$ W 1 O St 5.OO/month or less-Annually Q — (OO2O-State Sales Tax ❑ Under$3OO/month-Quarterly REVENUE REGISTRATION ACCOUNT NUMBER gut Deposit O ® $3OO/month or more-Monthly ) (355) $ 5D•DO rya n Wholesale only-Annually (0080• 750) License (999) 3. Indicate which applies to you: ❑ Wholesaler ❑SingleEvent-PerlodCwered (eee) $ 12.00 l — y?L�J ❑ Charitable Retail-Sales (MO/DAY/YR) (0100-Wholesale❑ Multiple Event Retailers-Use Event Location 750) License Iss9)$ $ Wae 1.FILING FREQUENCY:If wage withholding amount is 2. OIL/ ( GAS 1000- :�.$1 -$6,999/year-Quarterly ❑$50,000+/year-Weekly ❑ Withholding 750) withhdding lass)$ 0.00 e ❑$7,000-$49,999/year-Monthly Must file by Electronic Funds Transfer Make check payable to Colo.Dept.Of Revenue : BOTH WHITE PAGES MUST BE RETURNED. TOTAL $62- A00 23 I declare under penalty of perjury In the second degree that the statements made in this application are true and complete to the best of my knowledge. 1 SIGNATURE of Own Partner,or Co orate Officer REQUIRED Title Date ♦i-.)--C. _ v._ems �7c ;�C- —. PRESIDENT [ 5/22/02 OFFICE USE ONLY Account Type Sic Org LC LO OD SC IA. Sig❑ N TR-1 Date Tech Sig 1 Z0710 3.000 (continue on reverse side of this page.) nw rn 1. Has the taxpayer paid any individual that is considered contract or subcontract labor? O Yes ® No x "' CV 00 a. If YES,describe occupation(s) ' $�4E ,'. "11 2. Does your business activity consist of employee leasing or management of other businesses? ❑ Yes Q No O N/A F, S. If the taxpayer is a corporation,are any officers who perform services in Colorado paid wages7' ® Yes O No O N/A $ 4. If the taxpayer is an individual(sole proprietorship),does he/she have any employees other than the c individual, his/her spouse,and his/her children under the age of 21? O Yes O No :® N/A m 5. If the taxpayer is a partnership or any type of limited liability organization,does it have anyone performing vservices other than the partners or members of the limited liability organization? ❑ Yes O No gN/A LL 6. Has the taxpayer ever paid or expects to pay wages in the state of Colorado? M Yes O No O N/A ro If the answer is NO do not complete the remainder of section G.BE SI/RE TO SIGN IN SECTION"P c If YES,on what date? o *NOTE:Taxable wages include payments to corporate officers and"dividend?paid In lieu of wages to an officer who performs z services for a S corporation. m om 7a. Effective January 1, 1999,the requirement for unemployment insurance coverage for a business employer has changed from the first payroll date to the requirement listed below.The requirements for agricultural, household/domestic,and 501(c)(3)employers have not changed. nCheck the appropriate box and complete 7b. ® Business Employer. m A commercial, industrial,or professional organization who pays one or more workers a total of$1,500 gross m wages in a calendar quarter a (Jan.-Mar.,April-June,July-Sept.,Oct:Dec.)or em I y oemploys one or more workers in each of an 20 different calendar weeks in a calendar year. 15 O Agricultural Workers. m An agricultural employer who pays one or more employees a total of$20,000 gross wages in a calendar quarter(Jan.-Mar.,April-June, c July-Sept.,Oct.-Dec.)or has ten or more employees in each of any 20 calendar weeks in a calendar year. 0 w O Household/Domestic Workers. z A household/domestic employer who pays one or more employees a total of$1,000 gross wages in a calendar quarter(Jan.-Mar.,April-June, g July-Sept,Oct.-Dec.). z O 501(c)(3) Nonprofit Organization. WA 501(c)(3)nonprofit organization who has four or more employees in each of 20 weeks in a calendar year. 0 7b. On what date did or will you meet the above requirement? 7/30/02 J a. Total gross wages paid in the most recently completed calendar quarter: z N/A Z How many employees do you currentlyhave? • 0 • C! 1. Check the description that best describes your business activity in Colorado and explain in detail in box 2 below. ® Retail Trade(List what sold and to whom) GENERAL PUBLIC - Construction_General Contractor O Wholesale Trade(List what sold and to whom) n O Transportation,Communication&Public Utilities (List type) Residential Commercial Y O Service(Explain in detail) O Single O Other Industrial/Warehouse /Warehouse o O Finance,Insurance,Real Estate(Explain in detail) ❑ multi ❑Other than Contractor Industrial/Warehouse 12 O Agricultural(List crops,animals,&services provided) O Speculative Builder/For Sale by Contractor c❑ Manufacturing&Assembly(List products&materials used) O Subcontractor(List specialty trade below in 92)g ❑ Mining(List product extracted or service performed) Hea Construction z O Government(What type of agency) Highway&Steel Construction O ❑ Household/Domestic O Bridge,Tunnel&Elevated Highway Q ❑ Other(Give specific information) ❑Water,Sewer, Pipeline&Communication O Other Heavy Construction LL2 2.List SPECIFIC products or services and EXPLAIN IN DETAIL.If more than one activity,make ONE a PREDOMINANT percent.(e.g.51-49%) SALE OF ALCOHOLIC BEVERAGES z I— ID Y CC 4 3.Worksite Information-Complete the following for each physical location in COLORADO. For each additional location, copy Section rY H and complete.NOTE:If the employee works from home, list the resident address. m Worksite Physical Address(COLORADO BUSINESS OR RESIDENCE ADDRESS) (Do NOT list P.O. Box or accountant address) 4 Street City State —I 985 E 18TH STREET GREELEY CO ZIP 80634 I WELry D = Averaga Number of Monthly Employees Work ite Phone ork ile ont ct o Please Print 3 910 392-9109 �EE Rtoma GP(f aER LMI OFFICE USE ONLY CNTY OWN SIC AUX Acct. No. CNTY OWN SIC AUX 120711 2.000 DR 8404-I (02/94) COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION 1375 SHERMAN STREET DENVER CO 80261 INDIVIDUAL HISTORY RECORD To be completed by each individual applicant,all general partners of a partnership,all limited partners owning 10%(or more)of a partnership;all officers and directors of a corporation,all stockholders of a corporation owning 10%(or more)of the stock of such corporation;all limited liability company MANAGING members,or other limited liability company members with a 10%(or more) ownership interest in such company and all managers of a Hotel and Restaurant license. NOTICE:This individual history record provides basic information which is necessary for the licensing authorities investigation.ALL questions must be answered in their entirety.EVERY answer you give will be checked for its truthfulness.A deliberate falsehood will jeopardize the application as such falsehood within itself constitutes evidence regarding the character of the applicant. 1.Name of Business Date Social Security Number(s) 71-\.e, <<r.? a 1 5-ac-Ca 2.Your Full Name(last,first,middle) pp 3.Also Known As(maiden name/nickname,etc.) 0osner1 lteeAr,rn i7ees0. CUJC1ICe 4.Mailing Address(if different from residence) Home Telephone 4s5 F , t -+), S'4 . C -ce\c.1 on RCCCc31 CI(7v - 3g1 -Slice 5.Residence Address(street and number,city,state,ZIP) r..SUI OR tiff- k 5 - eet tG'ree.le: l ,CCD `•3 C3 to.3LI 6.Date of Birth /' Place of Birth 7.U.S.Citizen? a .e.E. I eD [21-Yes No It Naturalized,state where When Name of U.S.District Court Naturalization Certificate Number Date of Certificate If an Alien,Give Alien's Registration Card Number Permanent Residence Card Number 8.Height Weight Hair Color Eye Color Sex Race 9.Do You Have a current Driver's License?If yes,give number,8,state rr 5'r /3Qt 2R1•3 C)` RN r coYes No � '� 10.Name of Present Employer 11.Type T of Business or Employment F'o4't a t 1 x)erI'`1 12.Address of Business Where Employed(street number,city,state,ZIP) Business Telephone 9s5 5 , I �-Ih5-t . czsc_may eo o(O-sj ci ?0 - 39 -ciicg 13.Present Position O LCne.Y 14.Marital Status 15.!,Name of Spouse(include maiden name if applicable) in-larrted- DoLr,o R. Ccaner 16.Spouse's Date of Birth Spouse's Place of Birth FI tn4 , linlen "gan 17.Spouse's residence address,if different than yours(street and number,city,state,ZIP) 18.Spouse's Present Employer Occupation Ur\ f 4asd `SKA-A-eS Q rY- Cor-ce m9' '4t i tan picam;n,SST0.4o-r 19.Address of Spouse's Present Employer 13 Oi-I-\ AN C A ..loos E, F'+kS Oi-I-\ -t-rcc-I Gree\e`{ C.d %O V3 I 20. List the name(s) of all relatives working in or having a financial interest in the liquor industry. NAME OF RELATIVE RELATIONSHIP TO YOU POSITION HELD NAME OF EMPLOYER LOCATION OF EMPLOYER 21.Do you now,or have you ever held a State of Colorado Liquor or Beer License,or loaned money,furniture,fixtures,equipment or inventory,to any Colorado Liquor or Beer Licensee?If yes,answer in detail CX Yes No 'lima SC'Y{ a( CONTINUED ON REVERSE SIDE OR 8404-1(2/94) Page 2 22.Have you ever been convicted of a crime,or received a suspended sentence,deferred sentence,or forfeited bail for any offense in criminal or military court?(Do not include traffic violations,unless they resulted in suspension or revocation of your driver's license,or you were convicted of driving under the influence of drugs or alcoholic beverages.)If yes, explain in detail. Li Yes �,No 23.Have you ever received a violation notice,suspension or revocation for a liquor law violation,or been denied a liquor or beer license anywhere in the U.S.?If yes,explain in detail. LJ Yes �.No 24.Military Service(branch) From To Serial Number Type of Discharge 25. List all addresses where you have lived for the past five years.(Attach separate sheet if necessary) STREET AND NUMBER I CITY,STATE, ZIP FROM TO • OCSC I Q tai-h S-i-1r e e,l C.91Z.`r�LE`t , �© (�� tk3-51-1 i 'irf S PJti . 26.List all former employers or businesses engaged in within the last five years. (Attach separate sheet if necessary.) NAME OF EMPLOYER ; ADDRESS(STREET,NUMBER,CITY,STATE,ZIP) ' POSITION HELD FROM TO I _ 27.What is your relationship to the applicant?(sole owner,partner,corporate officer,director,stockholder,member or manager) ore )t" Y C!Y c c t e r ay-NCI C Y 28.If stockholder,number of shares owned beneficially or of record Percent of outstanding stock owned sOrC0 0 29.if partner,state whether ❑ General ❑ Limited Percent of Partnership Owned If Limited Liability Company(percent owned) 30.Total amount you will invest in this business,including notes,loans,cash,services or equipment,and operating capital.(Reg.46-106.1 and Reg.47-107.1) Amount$ 31. Identify the sources of all funds you will invest in this business as listed in 30 above. List all bank names, account numbers and the amount derived from such source.Also identify all persons authorized to sign on, or who are part owners of said account. (Attach copies of all your notes or loans used in or for this business.) Names on accounts or person who can Amounts Sources -Account Numbers sign on this account 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 Title ( Date 0_,QQ1"\Q.. . j`J dZS ��Jt . -ao-d ATTN: LIQ PAGE # 1 ATTENTION: WELD CTY SHERIFFS OFC COLORADO BUREAU OF INVESTIGATION - CRIME INFORMATION CENTER 690 KIPLING STREET, #3000, DENVER, COLORADO 80215 303/239-4208 THIS IDENTIFICATION RECORD, FOR LAWFUL USE ONLY, SUMMARIZES INFORMATION SENT TO THE CBI BY FINGERPRINT CONTRIBUTORS IN COLORADO. WHERE THE DISPOSITION IS NOT SHOWN OR FURTHER EXPLANATION OF A CHARGE OR DISPOSITION IS DESIRED, CONTACT THE AGENCY THAT FURNISHED THE FINGERPRINTS . ONLY THE COURT OR DISTRICT ATTORNEY IN WHOSE OFFICE A FINAL DISPOSITION OCCURRED CAN PROVIDE A CERTIFIED COPY OF THAT DISPOSITION. STATE LAW GOVERNS ACCESS TO SEALED RECORDS . UNLESS FINGERPRINTS ACCOMPANIED YOUR INQUIRY, WE CANNOT GUARANTEE THIS RECORD RELATES TO THE PERSON IN WHOM YOU HAVE AN INTEREST. BECAUSE ADDITIONS AND DELETIONS MAY BE MADE AT ANY TIME, A NEW COPY SHOULD BE REQUESTED WHEN NEEDED FOR SUBSEQUENT USE . NAME (S) USED: WOELK, DEE A WILHELM, DEEANN WOELK, DEENA WILHELM, DEENA COSNER, DEEANN WOLFE, DEENA PHYSICAL: W F 507 125 BRO/BRO SKIN: DATE (S) OF BIRTH: PLACE (S) OF BIRTH: CO CONTRIBUTOR / NAME / CHARGE / ARREST# DATE DISPOSITION --- END OF PAGE # 1 --- ---- END OF RECORD MEETING DISSEMINATION CRITERIA ---- 06/04/02 1540MT *** CRIMINAL JUSTICE AGENCIES MAY NOT HAVE PROVIDED ALL ARRESTS, *** *** CHARGES OR DISPOSITIONS TO THE CBI . THIS RECORD SHOWS ALL *** *** ARRESTS, CHARGES & DISPOSITIONS THAT WERE PROVIDED, UNLESS *** *** ACCESS TO THEM HAS BEEN LIMITED BY COURT ORDER. *** June 1, 2002 Weld County Liquor Board Greeley, Colorado 80634 Re: Letter of Reference for Dee Ann Cosner Dee Ann is a person who has worked very hard to become a successful business owner. She has put many hours into making the Fort 21 a unique place in this city. She has basically built the business from the ground up, and through much adversity has kept the high quality that she has strived for. Not only has she made it more attractive and cleaner, but also she has eliminated the undesirable clientele of the previous owner. Dee Ann has supported and raised two daughters on her own that have turned out to be very responsible women. Dee Ann annually raises money for St. Jude Children's Hospital. Through her efforts this last year, she raised over$5000. Being the number one money-raising event in the state, Coors brewery matched her amount for a total of$10000 donated on behalf of the Fort 21. The Fort not only received recognition from Coors brewery, but a commendation from St. Jude Children's Research Hospital. Dee Ann's employees are all conscientious and responsible. She asks only that they follow her rules, and never asks them to do anything that she herself would not. She maintains a good working relationship with them, attends training classes with them, and is on call for them 24 hours a day. Sincerely, Virgil Price Mohrlang Custom Feeders 200 37th Street Evans, Colorado 80620 970-330-6362 Letter of reference for Dee Ann Cosner I have been acquainted with Dee Ann for approximately 10 years both professionally and personally. I have found her to be a person of high moral standards and an employer who demands the same of people who work for her. When Dee Ann took over ownership of the Fort 21 she immediately began the task of eliminating problem patrons. Although it cost her business, she wanted to run a clean establishment free from trouble makers. Dee Ann encouraged frequent checks by the Sheriff's Office and made it clear to her employees that Deputies were to be welcomed. Dee Ann keeps up on liquor laws and requires all employees to attend liquor training classes. She and her people keep a watchful eye on liquor consumption and do not hesitate to refuse service if someone becomes intoxicated. In October of 2001 Dee Ann's bar participated in a St Judes fund-raiser. Over the three day weekend the Fort 21 raised over $5000.00 for St Judes and was number one in the State of Colorado in this Coors sponsored event. There are many social events at the Fort 21 including Darts, Cribbage, Pool and miniature Nascar racing to mention a few. Since Dee Ann has taken over the Fort 21, the bar is no longer a drain on services for the Sheriffs Office and instead she has become proactive in problem solving and in working with us. 4d1-7 Dan Cooch Deputy Sheriff Weld County Sheriff's Office MAY 30, 2002 TO WHOM IT MAY CONCERN: I HAVE KNOWN DEE ANN COSNER FOR APPROXIMATELY 18 YEARS. SHE HAS WORKED SEVERAL YEARS TO GET THE BUSINESS SHE WANTS, AND TO HAVE TILE BUSINESS BE WIIERE IT IS TODAY. DEE ANN HAS WORKED PHYSICALLY MANY HOURS BEHIND THE BAR TO MAKE IT BE EFFICIENT, CLEAN AND SAFE FOR HER CUSTOMERS. DEE ANN STRIVES TO MANAGE THE EMPLOYEES TO FOLLOW HER EXAMPLE. DEE ANN I IAS DETERRED SOME CUSTOMERS TI LAT CONTINUOUSLY ARE NOT GOOD TO HAVE IN HER BUSINESS. SHE WORKS HARD TO KEEP IT A FRIENDLY PLACE TO BE IN. SINCERELY, pry MARY HUFF 1511 E. 16111 STREET GREELEY, COLORADO 80631 970-352-0800 LIQUOR/BEER RENEWAL REVIEW FORM Date: June 12, 2002 TO: Deputy Rob Otterstatter FROM: Kim Fliethman 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: JUNE 26, 2002 ESTABLISHMENT: THE FORT 21, LTD. DBA THE FORT 21 985 EAST 18TH STREET GREELEY, CO 80631 Current license expires: NEW APPLICATION FOR TRANSFER OF OWNERSHIP ......................******.......»............................... w,. ,r. ************............****** No concerns `+^ `is'r1 Deputy's nitials 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 P. �a"r-al z- at Extension q 13 t of the date and time of the Board of Commissioner's renewal hearing. Kett‘-- MEMORANDUM To: Esther Gesick, Deputy Clerk to the Board June 25, 2002 !Elk From: Bethany Salzman, Zoning Compliance Officer, Dept. of Planning Services COLORADO Subject: LC0034 Review of the following liquor license renewal by the Department of Planning Services shows the following: Dee Ann Wolfe dba Fort 21 985 East 18th Street Greeley, CO 80631-6135 Zone District: I-1 (Industrial-1) This use is allowed through a Nonconforming Use (NCU-199). No violations are occurring on the property at this time. SERVICE,TEAMWORK,INTEGRITY,QUALITY Hello