HomeMy WebLinkAbout20050602.tiff RESOLUTION
RE: APPROVE APPLICATION FOR TRANSFER OF OWNERSHIP OF TAVERN LIQUOR
LICENSE FROM SHERRY LEE GEORGE, DBA GEORGE'S LUCKY STAR
RESTAURANT AND NITE CLUB,TO BAYOU HOUSE, LLC, DBA DOUG KERSHAW'S
BAYOU HOUSE AND AUTHORIZE CHAIR TO SIGN - EXPIRES MAY 18, 2006
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,Bayou House,LLC,dba Doug Kershaw's Bayou House,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 Sherry Lee George, dba George's Lucky Star Restaurant and Nite Club, 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:
33131 Highway 85
Lucerne, CO 80646
WHEREAS, at said hearing on the 23rd day of February, 2005 after review, the Board
deemed it advisable to approve the application.
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 2005-07 to said applicant to sell malt, vinous and spirituous
liquors for consumption by the drink on the premises only 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 May 18,
2006,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, subject to the following condition:
A. The Licensee has received a Certificate of Occupancy from the Weld County
Department of Planning Services.
2005-0602
LC0016
(10 So .9799e_
TRANSFER OWNERSHIP OF LIQUOR LICENSE - BAYOU HOUSE, LLC, DBA DOUG
KERSHAW'S BAYOU HOUSE
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 23rd day of February, A.D., 2005.
EL ♦ BOARD OF COUNTY COMMISSIONERS
®`� WELD COUNTY, COLORADO
1861 tlr:�
William H. J e, Chair
�u .?Clerk to the Board
,®QiWitt M. J. 'le, Pro- em
Deputy Clerk to t e Board '`
Davi . Long
APP AS •
Robe D. Masd
unty Attorney
Glenn Vaad
Date of signature: -O/t9,5—
2005-0602
LC0016
THIS LICENSE MUST BE POSTED IN PUBLIC VIEW
DR 8402102/03/04)
STATE OF COLORADO
DEPARTMENT OF REVENUE
Liquor Enforcement Division
1881 Pierce Street,Suite 108
Lakewood,Colorado 80214
BAYOU HOUSE LLC
DOUG KERSHAWS BAYOU
HOUSE
33165 HWY 85
LUCERNE CO 80646
ALCOHOLIC BEVERAGE LICENSE
Liability Information
Account Number County City Indust. Type Liability Date LICENSE EXPIRES AT MIDNIGHT
35-05569-0000 03 090 722410 B 051905 MAY 18, 2006
Type Name and Description of License Fee
2011 TAVERN LIQUOR LICENSE - $ 75.00
MALT, VINOUS, AND
SPIRITUOUS
2190 COUNTY 85 PERCENT OAP FEE $ 425.00
TOTALFEEIS) $ 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,CO80261.
In testimony whereof,I have hereunto set my hand.
d '-t MAY 2 0 2005 4 °Ece -
Division Director SW Executive Director
THIS LICENSE EXPIRES MAY 18 2006
.,a:q. '-` LICENSE FEE
X1'O - _,
STATE OF ,:r, I`�
t 4„_-1- COLORADO
COUNTY OF WELD
BY AUTHORITY OF THE BOARD OF COUNTY COMMISSIONERS
RETAIL LIQUOR LICENSE
FOR Tavern e'
SPECIFY: Retail Liquor Store,Liquor Licensed Drug Store,Hotel and Restaurant,Club,Tavern etc.
TO SELL AT RETAIL Malt, Vinous, and Spirituous LIQUOR
�i1
SPECIFY KINDS OF LIQUORS
TWO 10 to Certtfp, That Bayou House, LLC, dba Doug, Kershaw's Bayou House
of the State of Colorado,having applied for a License to sell Malt, Vinous, and Spirituous
Liquors,and having paid to the County Treasurer the sum of Seventy—five and no/100
($ 75.00 )Dollars therefor,the above applicant is hereby licensed to sell Malt, Vinous,
and Spirituous Liquors containing more than 3.2%Alcohol by weight
by the drink for consumption on the premises only
(Insert"by the drink for consumption on the premises"or"in sealed containers NOT for consumption at place where sold.")
as a Tavern at 33131 Highway 85, Lucerne, CO 80646 in the County of
Weld,for a period beginning on the 19th day of Nay —,20 05__,and ending on the 18th
day of May ,20_06 _,unless this License is revoked sooner as provided by law.
This License is issued subject to the Laws of the State of Colorado and especially under the provisions of Article 47 of Title 12,
Colorado Revised Statutes,as amended,
IN TESTIMONY WHEREOF,The Board of County Commissioners has hereunto subscribed its name by its officers
duly authorized this 23rd day of February , , _,20 05
ATTLT;
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,l T j The Board of County Commissioners
Nr
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/CA CI
By � �3L/ e
'
Deputy Clerk to the Board I f, +.: f) A > - '
� Chairman,Board of Courtly Commissioner
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OR 96011102&041 Page I 21 OEPARTMENT USE ONLY
COLORADO DEPARTMENT OF REVENUE
DONORENFoncEMENT DIVISION
COam DENVERCOLORADO LIQUOR
RETAIL LICENSE APPLICATION
[ll,NEN LICENSE lg TRANSFER OF OWNERSHIP ❑ LICENSE RENEWAL
• ALL ANSWERS MUST BE PRINTED IN BLACK INK OR TYPEWRITTEN
• APPLICANT MUST CHECK THE APPROPRIATE BOX(ES)
• LOCAL LICENSE FEE S
• APPLICANT SHOULD OBTAIN A COPY OF THE COLORADO UOUOR MD BEER CODE(Call 303.370.2165)
1. Applicant is applying as a ❑ Individual
❑ Corporation Limited Liability Company
❑ Partnership(includes Limited Liability and Husband and Wife Partnerships) Association or Other
2. App ant N an LLC,name of LLC:if partnership,at leas)2 partners names:it corporation,name of corporation Fein Number
A v?IA 1{F,tf�5c LL(. 89 /4A 885).
2a.Trade Namdof Establishment(DBA) Slate Sales Tax No. Business Telephone
D0MNc d, i2$jvA1a' 3Ae nv.- t,u.SL.• 35n 5569 <97D-3571- 0505
3. Address-4f remises[specify exact location of emises)
3313 {iW isi $c
—
City County State ZIP Code
1114r f.RNf lkr C 1 A 0n 6o b4h
4. Mailing Address (Number and Street) City or Town Statx ZIP Code
( 110 1\ Lv. SAA eh I 6,et(la,Z 1, f n 8oG3/
5. It the premises currently have a liquor or beer license,you MUST answer he following questions:
Present Trade Name of Establishment(DBA) • Present Slate License No. Present Class of License Present xpiration Dale
,/ tN
Gf$1xe9fS Lutl<lfc4,4+e KcsAnMA 3. tin -et II1-ooro raJuen) 3-7,75"
LAE SECTION A NONREFUNDABLE APPLICATION FEES LIAB SECTION B(CONT.) LIQUOR LICENSE FEES
2300 O Application Fee for New License $625.00 1985❑Resort Complex License(City) $500.00
2302 O Application Fee tor New License- 19860 Resort Complex License(County) $500.00
w/Concurrent Review $925 00 19880 Add Related Facility to Resort Complex...$ 75.00 X_Total_
2310 l0 Application Fee for Transfer $825.00 19900 Club License(City( $308.75
2312 O Application Fee for Transfer- 19910 Club License(County) $308.75
w/Concurrent Review $925.00 20100 Tavern License(City) $500.00
LIA@ SECTION B LIQUOR LICENSE FEES 20118 Tavern License(County) $500.00
1905 O Retail Gaming Tavern License(City) $500.00 20120Manager Registration-Tavern $ 75.00
1906 O Retail Gaming Tavern License(County) $500.00 20200 Arts License(City) $308.75
1940 O Retail Liquor Store License(City) . $227.50 2021❑RacetrackArta License(erase() . $300 00
1941 O Retail Liquor Store License(County).. $312.50 2030O License(City) $500.00
1950 O Liquor Licensed Drugstore(City) $227.50 2031❑Racetrack License(County) $500.00
1951 O Liquor Licensed Drugstore(County) $312.50 204000p5onal Premises License(City) $500.00
1960 O Beer and Wine License(City) $351.25 2041 DOptiona Premises License(County) $500.00
1961 O Beer and Wire License(County) $436.25 20450 Vintners Restaurant License(City) $750.00
1970 O Hotel and Restaurant License(City) $500.00 20460 Vintners Restaurant License(County) $750.00
1971 O Hotel and Restaurant License(County) $500.00 22200 Add Optional Premises to H 8 R $100.00 X_Total
1975 O Brew Pub License(City) $750.00 23]0❑Master File Location Fee $ 25.00%_Total
1976 O Brew Pub License(County) $750.00 23750 Maslen File Background .. $250.00 X_Total_
1980 O Hotel and Restaurant License w/opt premises(City)....$500.00
1981 O Hotel and Restaurant License w/opt premises(County) $500.00
1983 O Manager Registration-H 8 R $ 75.00
DO NOT WRITE IN THIS SPACE•FOR DEPARTMENT OF REVENUE USE ONLY
LIABILITY INFORMATION
County City Industry Type License Account Number Liability One License Awed Through
(Expiration Dale)
FROM TO
State City County Managers Reg
-750(999) 2160-100(999) 2190-100(999) •750(999)
Can rue h..Lam. cart NM r,.ee.L..,.. TOTAL
2300-100 2310-100
(999) (999)
DR 6004(10/28/041 Pape 2
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 correspondwith the name of the applicant exactly.All documents must be typed or legibly printed. Upon final State
approval the license wit 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 A. Applicant/Licensee identified.
Cr B. State sales tax license number listed or applied for at time of application.
Q' C. License type or other transaction identified.
❑ D. Return originals to local authority.
❑ .E. Additional information may be required by the local licensing authority.
II. DIAGRAM OF THE PREMISES
❑ A. No larger than 8 1/2'X 11'.
O 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
Er'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
O A. Individual History Record(s)(Form DR 8404-I).
[M'B. Fingerprints taken and submitted to local authority.(State authority for master file applicants.)
O 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 APPUCANT INFORMATION(H Applicable)
❑ A. Partnership Agreement(general or limited).Not needed if husband and wife.
VII. LIMBED LIABILITY COMPANY APPLICANT INFORMATION(B Applicable)
;MID
Copy of articles of organization(date stamped by Colorado Secretary of State's Office).
O 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(1028/04)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- Yea No
holders or directors if a corporation)or manager under the age of twenty-one years? ❑ M
7. Has the applicant(including any of the partners.if a partnership;members or manager it 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 alcohol beverage license? 0
(b) had an alcohol beverage license suspended or revoked? 0
531
(c) had interest in another entity that had an alcohol beverage license suspended or revoked? 50
If you answered yes to la,b or c,explain In detail on a separate sheet. 0IN
8. Has a liquor license application(same license class),that was located within 500 feet of the proposed premises,been denied within the
preceding Iwo years?It yes:explain in detail 0
51
9. Are the premises to be licensed within 500 feet of any public or private school that meets compulsory education requirements of
Colorado law,or the principal campus of any college,university or seminary? 0 X
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 it a corporation)?If yes,Idenlifyihe name 01 the business and list any
current or former financial interest in said business including any loans to or from a licensee. msms-Tic An VeAAy cq4 I 0 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?
Ownership 0 Lease 0 Other(Explain in Detail) Z1 0
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 or designate the area to be licensed(including dimensions)which shows the bars,brewery,walls,partitions,
entrances,exits and what each room shall be utilized for in this business.This diagram should be no larger than 8 1/2"X 11'.(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,lurniture or equipment to or for use in this business;or who will receive money frorntthis business.
Attach a separale sheet if necessary.
NAME DATE OF BIRTH FEIN OR SSN INTEREST
Jot T DE_Lc,.., Jo 6'/a
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
Has a local ordinance or resolution authorizing optional premises been adopted? 0
Number of separate Optional Premises areas requested.
(See License Fee Chan)
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. 0
15. Club Liquor License applicants answer the lotowing and attach:
(a) Is the applicant organization operated solely for a national,social,fraternal,patriotic,political or athletic purpose and o Ea
not for pecuniary gain?
(b) Is the applicant organization a regularly chartered branch,lodge or chapter of a national organization which is 0 at
operated solely for the object of a patriotic or fraternal organization or society,but not for pecuniary gain?
(c) How long has the dub been Incorporated? (d) How long has applicant occupied the premises
(Three years required) to be licensed as a dub?(Three years required) _
16. Brew•Pub License or Vintner Restaurant Applicants answer the following:
(a) Has the applicant received or applied for a Federal Permit? 0 51(Copy of permit or application must be attached)
17a. Name of Manager(for all on-premises applicants) Silt C,..4 '/ //J�f /y_ ,fill i Dale of Binh
application for a Hotel.Restaurant or Tavern License,the manager must also submit an Individual Hie ory Record(DR 8404-I).
170.Does this manager act as the manager of.or have a financial interest in,any other liquor Yes No
licensed establishment in the Stale of Colorado? If yes,provide name.type of license and account number. 0 to
18. Tax Distraint Information. Does the applicant or any other person listed on this application and including its partners,officers, q
directors,stockholders,members(LLC)or managing members(LLC)and any other persons with a 10%or greater finandal interest Yes No
in the applicant currently have an outstanding lax distraint issued to them by the Colorado Department of Revenue? ❑ SI
If yes,provide an explanation and include copies of any payment agreements.
DR 6404(1026/04)Page 4
' 19. 11 applicant is a corporation,partnership,association or limited liability company,applicant must list ALL OFFICERS.DIRECTORS,
GENERAL PARTNERS.AND MANAGING MEMBERS.In addition applicant must list any stockholders,partners,or members with OWNER-
•
SHIP OF 10%OR MORE IN THE APPLICANT.ALL PERSONS LISTED BELOW must also attach form DR 8400.1(Individual History record),
and submit finger print cards to their local licensing authority.
NAME HOME ADDRESS,CITY B STATE DOB POSITION %OWNED'
•
l -7/14-1/ 317/2- V:94 ftr/ Ali Aw/cy Cc,
r�4 my 30%
•
L y .
'I total ownership percentage disclosed here does not total 100%applicant must check this box
❑Applicant affirms that no individual other than these disclosed herein,owns 10%or more of the applicant
Additional Documents to be submitted by type of entity
❑ CORPORATION ❑ Can.of Incorp. ❑ Cen.of Good Standing(if more than 2 yrs.old) ❑ Cert.of Auth.(if a foreign corp.)
❑PARTNERSHIP ❑Partnership Agreement(General ar 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 Mach copy of agreements creating association or relationship between the parties
Registered Agent(if applicable) Address for Service
OATH OF APPLICANT
I declare under penalty of perjury in the second degree that this application end 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.
Aut odie nature Title Date
REPORT AND APPROVAL OF LOCAL LICENSING AUTHORITY(CITY/COUNTY)
Date application filed with local authority Dale of local authority hearing(for new license applicants;cannot be less
than 30 days from dale of application 1247-311(I))C.R.S.
THE LOCAL LICENSING AUTHORITY HEREBY AFFIRMS:
That each person required to file DR 0404-I(Individual History Record)has: Yes No
0 Been fingerprinted 0 0
❑ Been subject to background investigation,including NCICICCIC check for outstanding warrants 0 0
Thal the local authority has conducted,or Intends to conduct,an inspection of the proposed premises to ensure that the applicant is in
compliance with,and aware of liquor code provisions affecting their class of license 0 0
(Check One)
❑ Date of Inspection or Anticipated Date
❑ Upon approval of state licensing authority.
The foregoing application has been examined;and the premises,business to be conducted,and character of the applicant are satisfactory.
We do report that such license,if granted,wi auiuskr :.sonable requirementsofthe neighborhood and thedesires oftheadult inhabitants,
and will comply with the provisions of ,lr- A�p61�®V C.R.S. THEREFORE,THIS APPLICATION IS APPROVED.
Local Licensing Authority for {.. Telephone Number ❑ TOWN,CITY
Weld County, Colored) erg (970)356-4000 X4200 ® COUNTY
Signature •1161 :Ur�'S _'��
g ;�.flP H. Berke, Chair Date
r�� Board of Commitisioners 02/23/2005
` ' s � J\T Date
Signal -r s :v
"" � • ® lerk to e Boat 02/23/2005
Clerk to the Board
&COS-O64d
DR 8404-I (06/02)
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1881 PIERCE STREET RM 108A
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, Officers or other limited liability company members
with a 10% (or more)ownership interest In such company and all managers of a Hotel and Restaurant or a Tavern License.
NOTICE: This individual history record provides basic information which Is necessary for the licensing authority investigation.
All questions must be answered in their entirety or your application may be delayed or not processed. EVERY answer you give
will be checked for its truthfulness.A deliberate falsehood or omission will jeopardize the application as such falsehood
within Itself constitutes evidence regarding the character of the applicant.
1.Name of Business
1D .&& ktesL*t ) s L>4-y bw. 1-tn1.5E
2.Your Full Name(last,first,middle) / � 3.List any other names you have used.
1-IA 1 I T . 3 B ;II e- JAc.(- 13\ 11 s 1-I All
4.Mailing address(if different from residence) / G,2EL/FA, Home Telephone
3,2 71 X ti h4KE- .R063en 86-th 0170 -356- 5097
5.List all residence addresses below.Include current and previous addresses for the past five years.
STREET AND NUMBER CRY,STATE, ZIP FROM TO
Current
3.a4-1Ia- V/5.69 LA�AE /200,0 Gni/C7 CO 8063/ 12-03 Reesev/
Previous
a0 � �N� G�2ELlf�CL t4��3y (o-1V8 to- 03
6.Date of Birth Social Security Number(SSN) Place of Binh (ID 7.U.S.Citizen?
/ 62EEiC7 J024-9O X]Yes ❑No
If Naturalized,state where When Name of District Court
Naturalization Certificate Number Date of Certification 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?it so,give number 8 state
5'Bid bRr.4 ZieNI M G) Yes No
10.List the name(s)of relatives working in or holding a financial interest in the Colorado alcohol beverage Industry.
NAME OF RELATIVE RELATIONSHIP TO YOU POSITION HELD NAME OF EMPLOYER
11.Have you ever applied for,held,or had an interest in a Slate of Colorado Liquor or Beer License,or loaned money,furniture or fixtures,equipment or
inventory,to any liquor or beer licensee?If yes,answer in detail. ❑Yes ' No
12.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 or do you have any charges pending?(If yes,explain in detail.) Yes cg Na
13.Have you ever received a violation notice,suspension or revocation,for a liquor law violation,or have you applied for or been denied a liquor or beer
license anywhere In the U.S.?If yes,explain in detail. El Yes cs No
14.List all current and 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
51 / 1 /h r lnxl 6r ,kiptc Rs 4114,e
evettS,'lvw-Aon0hI "/ 4NAGAk inc 'w-1, 4ut &.t oltc �,
Fogs) WtsiotYf /957 Fkrsc..tt
aainit//IAN rA)1�t. 117-a I I A, /wt. SJC L.20 k c toy Otersi'oeltd
15.Financial Information. N
Total purchase price$�/4 41.10 (if buying an existing business)OR list the total amount of your investment in the new business,
including notes.loans,cash,ser6ices or equipment,and operating capital $
Provide details of Investment. You must account for the sources of ALL cash(how acquired).Attach a separate sheet If needed.
Type:Cash,Services or Equipment Where Obtained(Savings,Checking,Account,etc.) Amount
Loan Information(attach copies of all notes or loans)
Name of Lender ��rr Address Term Security Amount
AA lcl�ai/ &fi INA-NO G7 oAI,4 , Afit lsrbtd)
Agif� �/f=/sl•,Wir (0, 04 o on! Pa4164 6-q155
16.Give name of bank where business account will be maintained;name the account will be maintained under;and the name or names of persons
authorized to draw thereon.
C/}GLne- BRni/c N�K P�Auss LL C — I3J/ /f �o� I
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 'gnat Title f/� //�� �®' Date:)-/‘")90-5-
ATTN: LLQ
ATTENTION: WELD CO SHERIFF
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: HALL, BILLIE JACK
PHYSICAL: W M 508 130 BRO/BRO SKIN:
DATE(S) OF BIRTH: 112853
PLACE(S) OF BIRTH: CO
CONTRIBUTOR / NAME / CHARGE /
ARREST# DATE DISPOSITION
WELD COUNTY SHERIFF HALL, LARCENY
(RECORDS) GREELEY BILLIE JACK
ARREST # 42661 DATE - 01/27/72 ITEM #001/001
---- END OF RECORD MEETING DISSEMINATION CRITERIA ----
03/10/05 0836MT
*** 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. ***
* FALSIFYING OR ALTERING THIS RECORD WITH THE INTENT TO MISREPRESENT THE *
* CONTENTS OF THE RECORD IS PROHIBITED BY LAW, AND MAY BE PUNISHABLE AS *
*** A FELONY WHEN DONE WITH THE INTENT TO INJURE OR DEFRAUD ANY PERSON.***
COLORADO DEPARTMENT OF REVENUE
Liquor Enforcement Division
1375 Sherman St
Denver,CO 80261
January,2005
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 Application are:
pi Paid in full. There are no outstanding accounts with any Colorado Wholesalers.
p 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: Q Licensee O Applicant
CI 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 day of 1-AA) , 200 S.
Seller: Buyer:
a004/-0,5- yD 9 j// i-. 0000 $ .you lgot.st /-LC.
Licensee & License Number Applicant
CQeocce I t'c ey %'r tt/l tL too J_tRSAws h,At .s�
Trade namo Trade`fi me
site
Signature Sign tur�
L, v 44a06/; PM/iwrt
Position Position ci
Berry 2. ae`'€fQ- 3;1. 1-1-A-1,1Print
Print Name Name
FINGERPRINT CARDS - INSTRUCTIONS
LIQUOR/BEER LICENSE APPLICATIONS
(For all New Applications or Transfer of Ownership Applications)
As part of the application process, each individual with financial interest in the
applicant is required to have fingerprints taken. Please follow the procedures carefully to
prevent delay in the application process:
1. Using a fingerprint card provided by the Clerk to the Board's Office, fill
out the top portion WITH BLACK INK, indicating your name, address,
aliases, date of birth, etc.
2. Take the fingerprint card to the Weld County Sheriffs Office, located at
2110 "O" Street, Greeley, CO, 80631, to be fingerprinted, along with a
cashier's check, money order, or business check made out to "Weld
County Sheriff's Office" in the amount of $10.00 per card.
3. Return the completed card to the Clerk to the Board's Office with a cashier's
check, money order, or business check made out to"Colorado Bureau of
Investigation" in the amount of$38.50 per card.
M:CAROL\OPMAN\PRINTS
11/06/2002
February 02, 2005
Weld County Commissioner's Office
Weld County, Colorado.
RE: Bill Hall
Applicant for Liquor License
It is with great pleasure I write this letter of recommendation for Bill Hall
and his associates as they apply for a liquor license in Weld County. I have
known Mr. Hall for the past 24 years. We received our airplane pilot's
license in the same month in 1.981. We also worked together in the
Wranglers for many years, the volunteer support group for the Greeley
Independence Stampede. Then we both were fortunate enough to be elected
to serve on the Greeley Independence Stampede Committee, as directors for
this major community event.
I have been a close personal friend and can attest to his integrity as an
upstanding citizen and a Weld County businessman. His business dealings
have always reflected his desire to make Weld County a better place live. He
has displayed high morals, respectfulness, and a willingness to meet
community desires and demands.
As you can ascertain, I highly recommend Mr. Hall and his associates for
their application for a liquor license in our great county.
If you have any questions or require further clarification, please do not
hesitate contacting me.
Respectfully submitted,
Jon D. Eastin
16359 Longs Peak Road
Greeley, CO 80631
970-353-0757
February 4, 2005
County Commissioners
915 10th Street
Greeley, CO 80631
Subject Bill Hall
Dear Sirs:
It is my understanding that Mr. Bill Hall has applied to the county for liquor and
other related licenses for operation of his new facility in Weld County. The
purpose of this letter is to serve as a personal reference relating to the
application.
I have had the pleasure of knowing and working with Mr. Hall over the past
several years in both a personal and professional capacity. I have found him to
be honest, straightforward and a person of high integrity. In addition, Mr. Hall is
currently a customer of our bank and has handled all transactions as agreed.
Please feel free to give me a call if you have questions or require additional
information. My direct line is 970-674-3604.
Sincerely,
Bob Hinderaker
President.
355 Eastman Park Drive • Windsor, CO 80550
Phone: (970) 674-3600 • Fox: (970) 674-3610 • www.signaturebanks.com
Farmers
BAN k
February 2,2005
Weld County Commissioners
Sirs,Madams,
This letter is to introduce Bill Hall to you. I have personally known Bill for the last 20
years. During the course of that time I have had the occasion to be involved in some of
Bill's business activities. All aspects of those activities that I have been associated with
have been handled in a business like manner.
I have also known Bill and his family on a personal level and can vouch for their honesty
and sincerity.
If you have further questions,please feel free to contact me.
S' cerely
auer
President
119 1st Street • P.O.Box 220 • Ault.Colorado 80610 • (970)834-2121 /Fax(970)834 1351
073 I�'I�III'1'�lII"illa!'V'I'IIIIl\rI�I:11151 � it Ir
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WARRANTY DEED "� $9.-kh(G
THLS DEED.Made this 24th day ofiunuary,2005 between $JZ'-I I Wb
Olga Galindo
of the County of Weld,State of Colorado,grantor and
Bayou House LLC,A Colorado limited liability company
whose legal address is:122011th Avenue,N201,Greeley,CO 80631
of the County of Weld,State of Colorado,grantee:
W ITNESSETH,'That the grantor for and in consideration of the sun of Five Hundred Sixty-Seven Thousand One
Hundred Dollars and NO/t00'S.(5567,100A0,the receipt and sufficiency of which is hereby acknowledged,has
granted,bargained,sold and conveyed,and by these presents does grant,bargain,sell,convey and corium],unto the
grantee,his heirs and assigns forever,all the real property together with improvements,if any,situate,lying and being in
the County of Weld,and State of COLORADO,described as follows:
The South 451.9 feet of the North 2,053.9 feel of that pan of the East''A of the Southeast''/.of Section 18,Township 6
North,Range 65 West of the 6h P.M.,lying West of U.S.Highway 85 as the same is now located,together with right
of ingress and egress over and across the prepetty lying South of the herein described property,
County of Weld,
Stale of Colorado.
also known by street and number as 33165 Highway 85,Lucerne,CO 80646
TOGETHER with all and singular the hereditannents and appurtenances thereunto belonging, or in anywise
appertaining,and the reversion and reversions,remainder and remainders,rents.issues and profits thereof,and all the
estate,right,title,interest,claim and demand whatsoever of the grantor.either in law or equity,of.in and to the above
bargained premises,with the herediamans and appurtenances.
TO HAVE AND TO HOLD the said premises above bargained and described,with the appurtenances,unto the grantee,his heirs
and assigms forever. And the grantor,for himself,his heirs,and personal representatives,does covenant,grant,bargain and agree
to and with the grantee,his heirs and assigns,that at the time of the caseating and delivery of these presents,he is well seized of
• the premises above conveyed,has good,sure,perfect,absolute and indefeasible estate of inheritance,In law,in fee simple,and has
good right,fill power and lawful authority to grurl,bargain,sell and convey the sante in manner and form as aforesaid,and that
the same arc free and clear from all former and other grants,bargains,sales,liens,taxes,assessments,encumbrances and
restrictions of whatever kind or nature soever,except all taxes and assessments for the current year.a lien but not yet due or
payable,the lien far the first and second instalments of 2004 taxes,and those specific Exceptions described by reference to
6' recorded documents as reflected in the Title Documents accepted by Buyer in accordance with section 83"Title Review",of the
contract dated January I h,2005.between the pathos.
cam!•
ry f The grantor shall and will WARRANT AND FOREVER DEFEND the above-bargained premises in the quiet and
C peaceable possession of the grantee his heir;and assigns,against all and every person or persons lawfully claiming the
9 = whole or any pan thereof. The singular number shall include the plural,the plural the singular,and the use of any gender
tcf shall be applicable to all genders.
hC IN WITNESS WHEREOF,the grantor has executed this deed on the date set forth above.
N—Cr SELLER:
,q O h Bali
S
El STATE OF COLORADO }SS:
C/ COUNTY OF Weldr \
The foregoing instrument was acknowledged before me this 24 day of Tatum ,21IUS,by Olga Galindo
•
Notary Publi
Witness my hand and official seal.
My Commission expires:9/18N)5.-
t.PJUNEPEARSON
NOTARY PUBLIC
I STATE OF COLORADO
mpg
UP wimTO ^ Security Title
Wanuy Deed(For Photographic Bawd) File Na.50032665
OFFICE OF THE SECRETARY OF STATE
OF THE STATE OF COLORADO
CERTIFICATE
I, Donetta Davidson, as the Secretary of State of the State of Colorado, hereby certify that,
according to the records of this office,
Bayou House,LLC
is a
Limited Liability Company
formed or registered on 01/20/2005 under the law of Colorado, has complied with all applicable
requirements of this office, and is in good standing with this office. This entity has been
assigned entity identification number 20051031728 •
This certificate reflects facts established or disclosed by documents delivered to this office on
paper through 01/13/2005 that have been posted, and by documents delivered to this office
electronically through 01/20/2005 @ 13:25:49 •
I have affixed hereto the Great Seal of the State of Colorado and duly generated, executed,
authenticated, issued, delivered and communicated this official certificate at Denver, Colorado
on 01/20/2005 @ 13:25:49 pursuant to and in accordance with applicable law. This certificate is
assigned Confirmation Number 6131778 .
/--,-.......N..„_.,--- t
V
4.
xiv 4., rx f
�, r" .� _.
1876 Secretary of State of the State of Colorado
***********sat**************************End of Certificate****************************************
Notice.'A certificate issued electronically from the Colorado Secretary of State's Web site is fully and immediately valid and effective. However,
as an option,the issuance and validity of a certificate obtained electronically may be established by visiting the Certificate Confirmation Page of
the Secretary of State's Web site hap uuu..cos state so is BB t'er tfimreSearc ht'nter w(JO entering the certificate's confirmation number
displayed on the certificate, and following the instructions displayed. Confirming the issuance of a certificate is merely optional and is not
necessary to the valid and effective issuance of a certificate- For more information,visit our Web site, hap: Ii'.xos ouroco.zu click Business
Center and select "Frequently Asked Questions."
Colorado Secretary of State
-filed Date and Time: 01/20/2005 01:23 PM
Document Processing Fee Entity Id: 20051031728
If document is on paper: $50.00
If document is filed electronically: $ .99 Document number: 20051031728
Fees are subject to change.
For electronic filing and to obtain
copies of filed documents visit
v'ww.sos.state VOA'S
Deliver paper documents to:
Colorado Secretary of State
Business Division
1560 Broadway,Suite 200
Denver,CO 80202-5169
Paper documents must be typed or machine printed. ABOVE SPACE FOR OFFICE USE ONLY
Articles of Organization
filed pursuant to 7-90-301,et seq.and§7-80-204 of the Colorado Revised Statutes(C.R.S)
I. Entity name:
Bayou House, LLC
(The name of a limited liability company must contain the term or abbreviation"limited
liability company", "ltd.liability company" "limited liability co." "ltd.liability ca.".
"limited" "lie", "tic.",or"ltd."a7-90-601.C.R.S.)
2. Use of Restricted Words(if any of these
terms are contained in an entity name.true 0 "bank"or"cruse'or any derivative thereof
name of an entity,trade name or trademark O "credit union" O "savings and loan"
stated in this document,make the applicable O "insurance","casualty","mutual",or"surety"
selection):
3.Principal office street address: 1220 11th Avenue
(Street name and number)
Suite 201
Greeley CO 80631
(City) (State) (Postal/Zip Code)
United States
(Province-if applicable) (Country-if not US)
4. Principal office mailing address _
(if different from above): (Street name and number or Post Office Box information)
(City) (State) (Postal/Zip Code)
(Province-If applicable) (Country-if not US)
5.Registered agent name (if an individual): Hall Bill J.
(Last) (First) (Middle) (Suns)
OR(if a business organization):
6.The person identified above as registered agent has consented to being so appointed.
7. Registered agent street address: 1220 11th Avenue
(Street name and number)
Suite 201
Greeley CO 80631
Rev.a/14/2004
l of 3
(City) (State) (Postal/Zip Code)
8. Registered agent mailing address
(if different from above): (Street name and number or Post Office Box information)
(City) (State) (Postal/Zip Code)
(Province-If applicable) (Country-if not US)
9.Name(s)and mailing address(es)
of person(s)forming the limited
liability company:
(if an individual): Hall Bill J.
(Last) (First) (Middle) (Suffq
OR(if a business organization):
1220 11th Avenue
Suite 201(Street name and number or Post Office Box information)
Greeley COgy 80631
(City) unftet])StateS (Postal/Zip Code)
(Province-If applicable) (Country—if not US)
(if an individual) Delay John
(Last) (First) (Middle) (Selo
OR(if a business organization)
1220 11th Avenue
suite 201(Street name and number or Post Office Box information)
Greeley CO 80631
80631
(City) uniteCt States (Postal/Zip Code)
(Province—if applicable) (Country—if not US)
(if an individual)_
(Last) (First) (Middle) (Suffix)
OR(if a business organization)
(Street name and number or Post Office Box information)
(City) un(S9 elStateS (Postal/Zip Code)
(Province—(applicable) (Country—if not US)
(If more than three persons are forming the limited liability company,mark this box I and include an attachment stating the true
names and mailing addresses of all additional persons forming the limited liability company)
Rev.6/14/2004
2 of 3
10.The management of the limited liability company is vested in managers ID
OR is vested in the members C.
11.There is at least one member of the limited liability company.
12.(Optional) Delayed effective date:
(mm/dd/yyyy)
13.Additional information may be included pursuant to other organic statutes such as title 12,C.R.S. If
applicable,mark this box ❑ and include an attachment stating the additional information.
Notice:
Causing this document to be delivered to the secretary of state for filing shall constitute the affirmation or
acknowledgment of each individual causing such delivery,under penalties of perjury,that the document is the
individual's act and deed,or that the individual in good faith believes the document is the act and deed of the
person on whose behalf the individual is causing the document to be delivered for filing,taken in conformity
with the requirements of part 3 of article 90 of title 7,C.R.S.,the constituent documents,and the organic
statutes,and that the individual in good faith believes the facts stated in the document are true and the
document complies with the requirements of that Part,the constituent documents,and the organic statutes.
This perjury notice applies to each individual who causes this document to be delivered to the secretary of
state,whether or not such individual is named in the document as one who has caused it to be delivered.
14. Name(s)and address(es)of the
individual(s)causing the document Hall Bill J.
to be delivered for filing:
122011{fl5tAvenue (First) (Middle) (Suffix)
Suite 201(street name and number or Post Office Box information)
Greeley CO 60631
(C(ty) lJ raga States(PostallZip Code)
(Province—if applicable) (Country—if not US)
(The document need not state the true name and address of more than one individual. However,if you wish to state the name and address
of any additional individuals causing the document to be delivered for filing.mark this box •and include an attachment stating the name
and address of such individuals.)
Disclaimer:
This form,and any related instructions,are not intended to provide legal,business or tax advice,and are
offered as a public service without representation or warranty. While this form is believed to satisfy minimum
legal requirements as of its revision date,compliance with applicable law,as the same may be amended from
time to time,remains the responsibility of the user of this form. Questions should be addressed to the user's
attorney.
Rev.6/14/2004
3 of
NOTICE:
This "image"is merely a display of information that was filed electronically. It is not an image that was created by optically scanning
a paper document
No such paper document was filed. Consequently,no copy of a paper document is available regarding this document.
Questions?Contact the Business Division. For contact information,please visit the Secretary of State's web site.
DR 8404-I (06/02)
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1881 PIERCE STREET RM 108A
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, Officers or other limited liability company members
with a 10%(or more)ownership interest in such company and all managers of a Hotel and Restaurant or a Tavern License.
NOTICE:This individual history record provides basic Information which is necessary for the licensing authority investigation.
All questions must be answered in their entirety or your application may be delayed or not processed. EVERY answer you give
will be checked for its truthfulness.A deliberate falsehood or omission will Jeopardize the application as such falsehood
within Itself constitutes evidence regarding the character of the applicant.
1.Name of Business
l7o�i, ku sl,ar� s ' 4A but_ 14*c&st
2.Your Full Name(last,first,middle) 3.List any other names you have used.
$4411 Via. . 3 ;111 :TAcJ< 15 11 S MA /1
4.Mailing address(if different from residence) Gatti Home Telephone
_ in \lr's-# t,kL •RoaD Cx Fo l q -3s6- 5097
5.List all residence addresses below.Include current and previous addresses for the past five years.
STREET AND NUMBER CITY,STATE, ZIP FROM TO
Current
3.2'71a- Vis) LAA 12Oo.o G2£ticif £10 806.3/ 12-03 P,2Eszw/
Previous
' O 1 4 N1 G,ettlby cc 130631-/ -i i . - 03
6.Date of Birth Social Security Number(SSN) Place of Birth 7.U.S.Citizen?
GREElt4 (eh:IPA-6o Yes No
If Naturarzed,state where When / Name of District Court
Naturalization Certificate Number Date of Certification If an Alien,Give Allen'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 so,give number&state
5'Rrf binl 3' J Pt ( Yes ❑ND `
10.List the name(s)of relatives working in or holding a financial Interest In the Colorado alcohol beverage industry.
NAME OF RELATIVE RELATIONSHIP TO YOU POSITION HELD NAME OF EMPLOYER
11.Have you ever applied tor,held,or had an interest in a State of Colorado Liquor or Beer License,or loaned money,furniture or fixtures,equipment or
inventory,to any liquor or beer licensee?If yes,answer In detail. Yes No
DR 8404(10/28/04)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- yea No
holders or directors it a corporation)or manager under the age of twenty-one years?
7. Has the applicant(Including any of the partners,if a partnership;members or manager it a limited liability company;or officers,
stockholders or directors it a corporation)or manager ever(in Colorado or any other state);
(a) been denied an alcohol beverage license? Z
�(b) had an alcohol beverage license suspended or revoked?
o 181
to) had interest in another entity That had an alcohol beverage license suspended or revoked?
If you answered yes to 7a b or c.explain In detail on a separate sheet.
8. Has a liquor license application(same license class),that was located within 500 feet of the proposed premises,been denied within the
preceding Iwo years?If yes:explain in detail. 0 Z
9. Are the premises to be licensed within 500 feet of any public or private school that meets compulsory education requirements of
Colorado law.or the principal campus of any college.university or seminary? X
10. Has a liquor or beer license ever been issued to the applicant(including any of the partners,if a partnership;members or manager 8 a
limited tiabilily company;or officers,stockholders or directors it a corporation)?If yes,denlify he name of the
?bbusi7nes;sl�and list any pl
current or former financial inleresl in said business including any bans to cr from a licensee.jJg�M S'3' 71.Y Pd c,44jf" �
II, 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 +l
This license will be issued by virtue of ownership,lease or other arrangement?
Z Ownership 0 Lease 0 Other(Explain in Detail) 5 0
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 or designate the area to be licensed(Including dimensions)which shows the bars,brewery,walls.panitions,
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 Ironythis business.
Attach a separate sheet it necessary.
NAME DATE OF BIRTH FEIN OR SSN INTEREST
J0IA.J -T DR-Lai 30 %
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
Has a local ordinance or resolution authorizing optional premises been adopted?
Number of separate Optional Premises areas requested. (See License Fee Chan)
14. Liquor Licensed Drug Store applicants,answer the following:
(a) Does the applicant for a Liquor Licensed Drug Slore have a license issued by the Colorado Board of Yes No
Pharmacy?COPY MUST BE ATTACHED. rgl
15. Club Liquor License applicants answer the following and attach:
(a) la the applicant organization operated solely for a national,social,fraternal.patriotic,political or athletic purpose and g
not for pecuniary gain?
(b) Is the applicant organization a regularly chartered branch,lodge or chapter of a national organization which is t�.
operated solely for the object of a patriotic or Iralernal 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 dub?(Three years required)
16. Brew•pub License or Vintner Restaurant Applicants answer the following:
(a) Has the applicant received or applied for a Federal Permit? al(Copy of permit or application must be attached)) r� 2
17a. Name of Manager(for all on•premiass applicants) )t�f— l�w/�i� ,Cmil/trig_i,Tlt UMW
Date of Binh
application for a Hotel,Reslaurant or Tavern License,the manager must also submit an Individual Hi ory Record(DR 84041).�/-
17b.Does this manager act as the manager of,or have a financial interest in,any other liquor Yea No
licensed establishment in the Stale of Colorado? II yes,provide name,type of license and account number, o of
16. Tax Distraint Information. Does the applicant or any other person listed on this application and including its partners,officers, No
directors,stockholders,members(LLC)or managing members(LLC)and any other persons with a 10%or greater financial inleresl Yes Na
in the applicant currently have an outstanding tar distraint issued to them by the Colorado Department of Revenue? ❑ ig
If yes.provide an explanation and include copies of any payment agreements.
CIVIL APPLICANT RESPONSE
ICN IFCS0001000000745908 CIDN OCA et" O4z-C<''
HALL,BILLIE JACK W 508 1953/11/28
MNU SOC SEX M
FPC
HENRY CLASS API
OO0620000 SHERIFF' S OFFICE DATE FP
GREELEY CO 2005/02/01
CC COCBI0000 COLORADO B OF I
DENVER CO
A SEARCH OF THE FINGERPRINTS ON THE ABOVE
INDIVIDUAL HAS FAILED TO DISCLOSE PRIOR ARREST
DATA. CJIS DIVISION
2005/03/29 FEDERAL BUREAU OF INVESTIGATION
IliglilllllllIIIIIIIIII,I,,I,IIIulIluuIlIuIlIluIluII
COCBI0000
CO BUREAU OF INVEST
COLORADO CRIME INFO CTR
STE 3000
690 KIPLING ST
DENVER, CO 80215-5825
,7731 Pic
rice
FAX TRANSMISSION
COLORADO
Weld County
Clerk to the Board
PO Box 758
Greeley,CO 80632
Fax: 970.352-0242
Phone:970-336-7215,ext.4217
4
To: Sabrina Date: May'( 2005
Fax: (303) 825-9061 Pages: 10+Cover
From: Carol Harding,
Deputy Clerk to the Board
Subject: Liquor License Application-Bayou House, LLC, dba Doug Kershaw's Bayou House
COMMENTS: Per your request last week,I have attached a copy of the Local Licensing authority section
of the application form,as well as a corrected diagram of the premises,completion of#15 on the Individual
History Record for Bill Hall, and a copy of his Promissory Note.
The other item requested was an Individual History form for John Delay. Mr.Delay called your office,and
Sheila told him a new DR8404 will not be necessary,since you have one on file for him. You will find that
with the license for the Pegasus at Castle Rock. If you have any questions regarding his involvement,you
may call him direct at(720) 217-5706. Of course, I am available to answer any questions or forward any
other information to you which you require. Hopefully, this will complete the information needed for the
application.
CONFIDENTIAL
This facsimile is intended only for the use of the individual or entity to which it is addressed and may contain information that is
privileged, confidential, and exempt from disclosure under applicable law. If the reader of this facsimile is not the intended recipient nor
the employee or agent ts. nsible for delivering the facsimile to the intended recipient, you are hereby notified that any dissemination,
distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us
immediately by telephone and return the original message to us at the above address via the U.S.Postal Service. Thank you.
PROMISSORY NOTE
I ktopal kaaft Data kostwitrmt t+an f GtiN f a6 ceoutrt officorAatissa
4e0.000.00` : ..0'1:2.4-2005:: 01-24-2006. s.«9 1010749m goggsmattm mittikim
References in the shaded area are for Lender's use only and do not limit the applicability of this document to any particular loan or item.
Any item above containing has been omitted due to text length limitations.
Borrower: BILL J. HALL Lender: SIGNATURE BANK
32712 VISTA LAKE ROAD WINDSOR BRANCH
O p
GREELEY,CO 80631 355 EASTMAN PARK
�11�
WINDSOR,CO 80550
(970)674.3600
Principal Amount: $50,000.00 Initial Rate: 7.250% Date of Note: January 24, 2005
PROMISE TO PAY. BILL J. HALL("Borrower") promises to pay to SIGNATURE BANK("Lender"), or order,in lawful money of the United States
of America,the principal amount of Fifty Thousand&00/100 Dollars(850,000.00)or so much as may be outstanding,together with interest on
the unpaid outstanding principal balance of each advance. Interest shall be calculated from the date of each advance until repayment of each
advance. •
PAYMENT. Borrower will pay this loan in full immediately upon Lender's demand. If no demand is made, Borrower will pay this loan In one
payment of all outstanding principal plus all accrued unpaid interest on January 24, 2006. In addition, Borrower will pay regular monthly
payments of all accrued unpaid Interest due as of each payment date, beginning February 24, 2005,with all subsequent interest payments to be
due on the same day of each month after that. Unless otherwise agreed or required by applicable law, payments will be applied first to any
accrued unpaid interest;then to principal;then to any late charges;and then to any unpaid collection costs. Interest on this Note is computed
on a 365/365 simple interest basis;that Is, by applying the ratio of the annual interest rate over the number of days in a year, multiplied by the
outstanding principal balance, multiplied by the actual number of days the principal balance is outstanding. Borrower will pay Lender at Lender's
address shown above or at such other place as Lender may designate in writing.
VARIABLE INTEREST RATE. The interest rate on this Note is subject to change from time to time based on changes in an independent index
which is the WALL STREET PRIME (the "Index"). The Index is not necessarily the lowest rate charged by Lender on its loans. If the Index
becomes unavailable during the term of this loan, Lender may designate a substitute index after notice to Borrower. Lender will tell Borrower
the current Index rate upon Borrower's request. The interest rate change will not occur more often than each DAY. Borrower understands that
Lender may make loans based on other rates as well. The Index currently is 5.250% per annum. The interest rate to be applied to the unpaid
principal balance of this Note will be at a rate of 2.000 percentage points over the Index, resulting in an initial rate of 7.250% per annum.
NOTICE: Under no circumstances will the interest rate on this Note be more than the maximum rate allowed by applicable law.
PREPAYMENT; MINIMUM INTEREST CHARGE. Borrower agrees that all loan fees and other prepaid finance charges are earned fully as of the
date of the loan and will not be subject to refund upon early payment(whether voluntary or as a result of default), except as otherwise required
by law. In any event, even upon full prepayment of this Note, Borrower understands that Lender is entitled to a minimum interest charge of
$100.00. Other than Borrower's obligation to pay any minimum interest charge, Borrower may pay without penalty all or a portion of the
amount owed earlier than it is due. Early payments will not, unless agreed to by Lender in writing, relieve Borrower of Borrower's obligation to
continue to make payments of accrued unpaid interest. Rather, early payments will reduce the principal balance due. Borrower agrees not to
send Lender payments marked "paid in full", "without recourse", or similar language. If Borrower sends such a payment, Lender may accept it
without losing any of Lender's rights under this Note, and Borrower will remain obligated to pay any further amount owed to Lender. All written
communications concerning disputed amounts, including any check or other payment instrument that indicates that the payment constitutes
"payment in full" of the amount owed or that is tendered with other conditions or limitations or as full satisfaction of a disputed amount must be
mailed or delivered to: SIGNATURE BANK,WINDSOR BRANCH, 355 EASTMAN PARK DRIVE, WINDSOR, CO 80550.
LATE CHARGE. If a payment is 15 days or more late, Borrower will be charged 5.000%of the regularly scheduled payment.
INTEREST AFTER DEFAULT. Upon default, including failure to pay upon final maturity, Lender, at its option, may, if permitted under applicable
law, increase the variable interest rate on this Note to 6.000 percentage points over the Index. The interest rate will not exceed the maximum
rate permitted by applicable law.
DEFAULT. Each of the following shall constitute an event of default("Event of Default") under this Note:
Payment Default: Borrower fails to make any payment when due under this Note.
Other Defaults. Borrower fails to comply with or to perform any other term, obligation, covenant or condition contained in this Note or in
any of the related documents or to comply with or to perform any term, obligation, covenant or condition contained in any other agreement
between Lender and Borrower.
Default in Favor of Third Parties. Borrower or any Grantor defaults under any loan, extension of credit, security agreement, purchase or
sales agreement, or any other agreement, in favor of any other creditor or person that may materially affect any of Borrower's property or
Borrower's ability to repay this Note or perform Borrower's obligations under this Note or any of the related documents.
False Statements. Any warranty, representation or statement made or furnished to Lender by Borrower or on Borrower's behalf under this
Note or the related documents is false or misleading in any material respect, either now or at the time made or furnished or becomes false
or misleading at any time thereafter.
Death or Insolvency. The death of Borrower or the dissolution or termination of Borrower's existence as a going business, the insolvency
of Borrower, the appointment of a receiver for any part of Borrower's property, any assignment for the benefit of creditors, any type of
creditor workout, or the commencement of any proceeding under any bankruptcy or insolvency laws by or against Borrower.
Creditor or Forfeiture Proceedings. Commencement of foreclosure or forfeiture proceedings, whether by judicial proceeding, self-help,
repossession or any other method, by any creditor of Borrower or by any governmental agency against any collateral securing the loan.
This includes a garnishment of any of Borrower's accounts, including deposit accounts, with Lender. However, this Event of Default shall
not apply if there is a good faith dispute by Borrower as to the validity or reasonableness of the claim which is the basis of the creditor or
forfeiture proceeding and if Borrower gives Lender written notice of the creditor or forfeiture proceeding and deposits with Lender monies or
a surety bond for the creditor or forfeiture proceeding, in an amount determined by Lender, in its sole discretion, as being an adequate
reserve or bond for the dispute.
Events Affecting Guarantor. Any of the preceding events occurs with respect to any guarantor, endorser, surety, or accommodation party
of any of the indebtedness or any guarantor, endorser, surety, or accommodation party dies or becomes incompetent, or revokes or
disputes the validity of, or liability under, any guaranty of the indebtedness evidenced by this Note. In the event of a death, Lender, at its
option, may, but shall not be required to, permit the guarantor's estate to assume unconditionally the obligations arising under the guaranty
in a manner satisfactory to Lender, and, in doing so, cure any Event of Default.
Adverse Change. A material adverse change occurs in Borrower's financial condition, or Lender believes the prospect of payment or
performance of this Note is impaired.
Insecurity. Lender in good faith believes itself insecure.
LENDER'S RIGHTS. Upon default, Lender may declare the entire unpaid principal balance on this Note and all accrued unpaid interest
immediately due, and then Borrower will pay that amount.
ATTORNEYS' FEES; EXPENSES. Lender may hire or pay someone else to help collect this Note if Borrower does not pay. Borrower will pay
Lender the reasonable costs of such collection. This Includes, subject to any limits under applicable law, Lender's attorneys' fees and Lender's
legal expenses, whether or not there is a lawsuit, including without limitation attorneys' fees and legal expenses for bankruptcy proceedings
(including efforts to modify or vacate any automatic stay or injunction), and appeals. If not prohibited by applicable law, Borrower also will pay
any court costs, in addition to all other sums provided by law.
JURY WAIVER. Lender and Borrower hereby waive the right to any Jury trial In any action, proceeding,or counterclaim brought by either Lender
or Borrower against the other.
GOVERNING LAW. This Note will be g d by federal law applicable to Lender and,to the extent not preempted by federal law,the laws of
the State of Colorado without regard to its conflicts of law provisions. This Note has been accepted by Lender in the State of Colorado.
CHOICE OF VENUE. If there is a lawsuit, Borrower agrees upon Lender's request to submit to the jurisdiction of the courts of WELD County,
State of Colorado.
DISHONORED ITEM FEE. Borrower will pay a fee to Lender of $25.00 if Borrower makes a payment on Borrower's loan and the check or
preauthorized charge with whir.h Borrower pays is later dishonored.
PROMISSOrlY No'rE
Loan No: 1000107-01 (Continued) Page
RIGHT OF SETOFF. To the extent permitted by applicable law, Lender reserves a right of setoff in all Borrower's accounts with Lender(whether
checking, savings, or some other account). This includes all accounts Borrower holds jointly with someone else and all accounts Borrower may.
open in the future. However, this does not include any IRA or Keogh accounts, or any trust accounts for which setoff would be prohibited by...,
law. Borrower authorizes Lender, to the extent permitted by applicable law, to charge or setoff all sums owing on the debt against any and all '?,
such accounts, and, at Lender's option, to administratively freeze all such accounts to allow Lender to protect Lender's charge and setoff rights
provided in this paragraph.
COLLATERAL. Borrower acknowledges this Note is secured by UNSECURED.
LINE OF CREDIT. This Note evidences a revolving line of credit. Advances under this Note, as well as directions for payment from Borrower's tf
accounts, may be requested orally or in writing by Borrower or by an authorized person. Lender may, but need not, require that all oral requests
be confirmed in writing. Borrower agrees to be liable for all sums either: (A) advanced in accordance with the instructions of an authorized +.,,.1j
person or (B) credited to any of Borrower's accounts with Lender. The unpaid principal balance owing on this Note at any time may be
evidenced by endorsements on this Note or by Lender's internal records, including daily computer print-outs. Lender will have no obligation to
advance funds under this Note if: (A) Borrower or any guarantor is in default under the terms of this Note or any agreement that Borrower or
any guarantor has with Lender, including any agreement made in connection with the signing of this Note; (B) Borrower or any guarantor
ceases doing business or is insolvent; (C) any guarantor seeks, claims or otherwise attempts to limit, modify or revoke such guarantor's
guarantee of this Note or any other loan with Lender; (D) Borrower has applied funds provided pursuant to this Note for purposes other than
those authorized by Lender;or (E) Lender in good faith believes itself insecure.
SUCCESSOR INTERESTS. The terms of this Note shall be binding upon Borrower, and upon Borrower's heirs, personal representatives,
successors and assigns, and shall inure to the benefit of Lender and its successors and assigns.
GENERAL PROVISIONS. This Note is payable on demand. The inclusion of specific default provisions or rights of Lender shall not preclude
Lender's right to declare payment of this Note on its demand. Lender may delay Cr forgo enforcing any of its rights or remedies under this Note
without losing them. Borrower and any other person who signs, guarantees or endorses this Note, to the extent allowed by law, waive
presentment, demand for payment, and notice of dishonor. Upon any change in the terms of this Note, and unless otherwise expressly stated in
writing, no party who signs this Note, whether as maker, guarantor, accommodation maker or endorser, shall be released from liability. All such
parties agree that Lender may renew or extend (repeatedly and for any lencth of tune) this loan or release any party or guarantor or collateral; or
impair, fail to realize upon or perfect Lender's security interest in the collateral; and take any other action deemed necessary by Lender without
the consent of or notice to anyone. All such parties also agree that Lender may modify this loan without the consent of or notice to anyone
other than the party with whom the modification is made. The obligations under this Note are joint and several.
PRIOR TO SIGNING THIS NOTE, BORROWER READ AND UUU:CERST00D ALL THE PROVISIONS OF THIS NOTE, INCLUDING THE VARIABLE
INTEREST RATE PROVISIONS. BORROWER AGREES TO Tl lb TERMS OF THE NOTE.
BORROWER ACKNOWLEDGES RECEIPT OF A COMPLETED COP? OF THIS PPOM SSOnY NOTE.
BORROWER:
X COPY
BILL J. HALL
LASER FAO landing.Ye.5.15 00.000 Copt.W,,d,nm.b 6:Fn M!!l._ate ,I, t'0'e.S..Q. -COtKFlLL0.1D]O.FC TOIE PR
DR 8404(t Ot2I1/04)Page 4
19. If applicant is a corporation,partnership,association or limited liability company,applicant must list ALL OFFICERS.DIRECTORS,
�I. GENERAL PARTNERS,AND MANAGING MEMBERS.In addition applicant must list any stockholders,partners,or members with OWNER-
SHIP OF 1a%OR MORE IN THE APPLICANT.ALL PERSONS LISTED BELOW must also attach form DR 8404-I(Individual History record).
and submit finger print cards to their local licensing authority.
NAME HOME ADDRESS.CITY STATE DOB POSITION %OWNED'
/ T/.lr�// 317/, ✓sits/r .� Aw4en
w+-+mac— 30%
$�f y .
•
'It total ownershp percentage disclosed here does not total 100%applicant must check this box
❑Applicant affirms that no Individual other than these disclosed herein.owns 10%or more of the applicant
Additional Documents to be submitted by type of entity
❑ CORPORATION 0 Cen.of tncory. 0 Cert.of Good Standing(if more than 2 yrs.old) 0 Cen.of Audi.(if a foreign mrp.)
0 PARTNERSHIP 0 Partnership Agreement(General or Limited) 0 Husband and Wde partnership(no written agreement)
®LIMITED LIABILITY COMPANY 0 Articles of Organization 0 Cen.of Authority(9 foreign company) 0 Operating Agrmt.
❑ASSOCIATION OR OTHER Attach copy of agreements creating association or relationship between the parties
Registered Agent(d 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 o/my agents and employees
to comply with the provisions of the Colorado Liquor or Beer Code which affect my license.
riz nature Title
,,//aa�� �.r I Dale
REPORT AND APPROVAL OF LOCAL LICENSING AUTHORITY(CITY/COUNTY)
Date application tiled with local authority Date of local authority hearing(for now license applicants;cannot be less
than 30 days from dale of application 1247411(1))C.R.S.
,t -9-or 1 - a 3-os
THE LOCAL LICENSING AUTHORITY HEREBY AFFIRMS:
That person required to tits DR 6404-I(tndivdual History Record)has: Yes No
Been fingerprinted �❑
aitgen subject to background imesllgatlon,Including NC IC/CCIC check for outstanding warrants (�❑
Thal the local authority has conducted.or Intends to conduct,an inspection of the proposed premises to ensure that the applicant is In
compliance with,and aware of,liquor code provisions affecting their class of license IVO
(C One) \\
L7,{Ipte of Inspection or Anticipated Date 7 ft? —f� C (PKre4 I Ni/A a'n'�l/� S A ( Gbh-44'161
_1a •_�a,17
[1'.o.,approval of stale licensing authority.—"Q 1 � i fr4.i»4 o'f tits J -IF) Weer Hi rrt€-(a't4.OQ '�l%hJA'�O'a
The foregoing application has been examined;and the premises,business to be conducted,and character of the applicant are satisfactory.
Wedoreport thatsuch Gcense,if granted,wi,..iitsonable requirements of the neighborhoodardthedesiresof theadult inhabitants,
and will comply with the provisions of .P .I.. . 7,C.R.S. THEREFORE,THIS APPLICATION IS APPROVED.
/
Local Licensing Authority for ` Telephone Number 0 TOWN.CITY
Weld County, Colored? I• „t1/43 (970)356-4000 X4200 ® COUNTY
Signature ( g'i,fg.� H. Jerks. Chair Date
�/V/}�.� �� �/�/,/1� '(°i�taT_nIl Board o Commigsionere 02/23/2005
Signal a.•.ssiv /U'"��u-^'rs'rl ,</ �._�dte Milk) Date
` ( %! O ark to e Board 02/23/2005
Clerk to the Board e
OW05-064°1
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Coster f A.
E, Qu1/49A AREA-
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12.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 or do you have any charges pending?(If yes,explain in detail.) Yea No
19.Have you ever received a violation notice,suspension or revocation,for a liquor law violation,or have you applied for or been denied a liquor or beer
ISlicense anywhere in the U.S.?If yes,explain In detail. �Yes No
14,List all current and 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
S la 11 lxfife) Eig-Ckmzc Rsslilh#
c;/vu ,,, 01I MANA6r,s ` t .11-13t *L Out S;,SL...1o1 60631 Ps;Die d /987 "Mc At
TIt//uil/� CC.4,21„44' n-Id 1I4-1, kvt5t tL2010,iebte Ven;DEN/
1nanciai Information. iffenii
Total purchase price$0 77),iff0 (if buying an existing business)OR list the total amount of your investment in the new business,
including notes,loans,cash,serfices or equipment,and operating capital $
Provide details of Investment. You must account for the sources of ALL cash(how acquired).Attach a separate sheet If needed.
Type:Cash,Services or Equipment Where Obtained(Savings,Checking,Account,etc.) Amount
LIAL CA 1.402 71a kesanenl gAnk &awl saio t,
13
Domino/ ens: M,ic14.1,) Boma) - s w- - gaival ! S4s75s
I4 P oc e c.,s a�0rd
��► _
Loan Information(attach copies of all notes or loans)
Name of Lender Address Term Security Amount
41g4Inggirr&—Sse
�
AA l 441/ C g/24N.4N0 (DWO/V 4t, Af4
140 rift i, H43ycy9 6s-ta on A6rs11$s
16.Give name of bank where business account will be maintained;name the account will be maintained under;and the name or names of persons
authorized to draw thereon. /
l Ci}cA , '$4/VA — ' 1 D 4busc LL C — 8,7/ 161/ -oIti,,, bP/4y
Oath of Applicant
I declare under penalty of perjury in the second degree that this application and all attachments are true,correct,and complete to the best of
my knowledge.
Authorized gnat a Title Date
The printed portions of this form,except differentiated additions,have been approved by the Colorado Real Estate
I
Commission.(NTD 81-5-04)
IF THIS FORM IS USED IN A CONSUMER CREDIT TRANSACTION,CONSULT LEGAL COUNSEL.
THIS IS A LEGAL INSTRUMENT.IF NOT.UNDERSTOOD,LEGAL,TAX OR OTHER COUNSEL SHOULD BE
CONSULTED BEFORE SIGNING.
PROMISSORY NOTE
U.S.$ 515,785.83 Greeley ,Colorado
Date January 24, 2005
I. FOR VALUE RECEIVED,the undersigned(Borrower)promise(s)to pay to the order of Michael E. Branand
at 6740 N. Highway AlA, Fort Pierce, Florida 34949
or order,(Note Holder)the principal sum of $515.785.83
U.S. Dollars. with interest on the unpaid principal balance from 1/24/05 , until paid.at the rate of 9%
percent per annum. Principal and interest shall be payable at Lender's address above shown
or such other place as the Note Holder may designate,in monthly payments of Five Thousand Dollars
(U.S.$ 5,000.00 ),due on the first day of each month
beginning 1/1 /05 . Such payments shall continue until the entire indebtedness evidenced by
this Note is fully paid: provided, however, if not sooner paid, the entire principal amount outstanding and accrued interest
thereon,shall be due and payable on 7/1/05
2.Borrower shall pay to the Note Holder a late charge of 4 % of any payment not received by the Note Holder within
5 days after the payment is due. The late charge shall be in addition to the default •
rate of interest.
3.Payments received for application to this Note shall be applied first to the payment of late charges, if any,second to the payment
of accrued interest specified above,and the balance applied in reduction of the principal amount hereof
4. If any payment required by this Note is not paid when due,or if any default under any Deed of Trust securing this Note occurs,
the entire principal amount outstanding and accrued interest[heron shall at once become due and payable at the option of the Note
Holder(Acceleration);and the indebtedness shall bear interest at the rate of 15 percent per annum from the date of
default. The Note Holder shall be entitled to collect all reasonable costs and expense of collection and/or suit, including, but not
limited to reasonable attorneys'fees.
5. Borrower may prepay the principal amount outstanding under this Note, in whole or in part, at any time without penalty except
Any partial prepayment shall be applied against the principal amount outstanding and shall not postpone the due date of any
subsequent payments or change the amount of such payments.
6. Borrower and all other makers, sureties, guarantors, and endorsers hereby waive presentment, notice of dishonor and
protest, and they hereby agree to any extensions of time of payment and partial payments before, at, or after maturity.
This Note shall be the joint and several obligation of Borrower and all other makers, sureties, guarantors and endorsers,
and their successors and assigns.
7. Any notice to Borrower provided for in this Note shall be in writing and shall be given and be effective upon (1)
delivery to Borrower or(2)mailing such notice by first-class U. S.mail, addressed to Borrower at the Borrower's address
NTD 81-5-04 PROMISSORY NOTE Page 1 oft
•
stated below, or to such other address as Borrower may designate by notice to the Note Holder Any notice to the Note
Holder shall be in writing and shall be given and be effective upon( I) delivery to Note Holder or(2)by mailing such
notice by first-class U.S.mail.to the Note Holder at the address stated in the first paragraph of this Note,or to such other
address as Note Holder may designate by notice to Borrower.
8.The indebtedness evidenced by this Note is secured by a Deed of Trust dated 1/24/05 and until released
said Deed of Trust contains additional rights of the Note Holder. Such rights may cause Acceleration of the indebtedness
evidenced by this Note. Reference is made to said Deed of Trust for such additional terms. Said Deed of Trust grants
rights in the property identified as follows:
Property address: 33131 Highway 85
Lucerne Colorado 80646
(CAUTION: SIGN ORIGINAL NOTE ONLY/RETAIN COPY)
IF BORROWER NA RAL PERSON(S): � �\� t
/Fait- oc `
Bill Hall ( John Delay
doing business as
IF BORROWER IS CORPORATION:
ATTEST:
Name of Corporation
by
Secretary President
(SEAL)
LIMITED LIABILITY COMPANY:
IF BORROWER IS Bayou House, LLC
ameo LLC
111-05
*immt. IJ� �cc mW14 K Manager/Member
A,Borrower's address: I ') fl O I I -h.l.� D- 3
G f1 £ill conC-3/
KEEP THIS NOTE IN A SAFE PLACE.THE ORIGINAL OF THIS NOTE MUST BE EXHIBITED TO THE PUBLIC TRUSTEE IN ORDER TO
RELEASE A DEED OF TRUST SECURING THIS NOTE.
NTD 81-5-04 PROMISSORY NOTE Page 2 of 2
NOTICE OF FINAL AGREEMENT
SOPOntAttalina AKf:811 Oats : I196t1ITlt(t < S*00041,10: :::No caglCetl i 00gLttTt f hcer ' 1Mi N 1S
References in the shaded area are for Lender's use only and do not limit the applicability of this document to any particular loan or item.
Any item above containing has been omitted due to text length limitations.
Borrower: BILL J. HALL Lender: SIGNATURE BANK
32712 VISTA LAKE ROAD WINDSOR BRANCH
GREELEY. CO 80631 355 EASTMAN PARK DRIVE
WINDSOR,CO 80550
(970)674-3600
BY SIGNING THIS DOCUMENT EACH PARTY REPRESENTS AND AGREES THAT: (A1 THE WRITTEN LOAN
AGREEMENT REPRESENTS THE FINAL AGREEMENT BETWEEN THE PARTIES, (B) THERE ARE NO
UNWRITTEN ORAL AGREEMENTS BETWEEN THE PARTIES, AND (C) THE WRITTEN LOAN AGREEMENT
MAY NOT BE CONTRADICTED BY EVIDENCE OF ANY PRIOR, CONTEMPORANEOUS, OR SUBSEQUENT
ORAL AGREEMENTS OR UNDERSTANDINGS OF THE PARTIES.
As used In this Notice,the following terms have the following meanings:
Loan. The term "Loan" means the following described loan: a Variable Rate Nondisclosable Revolving Line of Credit Loan to an
Individual for $50,000.00 due on January 24, 2006. The reference rate (WALL STREET PRIME, currently 5.250%) is added to the
margin of 2.000%, resulting in an initial rate of 7.250.
Loan Agreement. The term "Loan Agreement" means one or more promises, promissory notes, agreements, undertakings, security
agreements, deeds of trust or other documents, or commitments, or any combination of those actions or documents, relating to the
Loan, including without limitation the following:
LOAN DOCUMENTS
Customer Information Profile: BILL J. HALL Promissory Note
Disbursement Request and Authorization Notice of Final Agreement
W-9 Request for Taxpayer ID Number and Certification: BILL
J. HALL
Parties. The term "Parties' means SIGNATURE BANK and any and all entities or individuals who are obligated to repay the loan or
have pledged property as security for the Loan, including without limitation the following:
Borrower: BILL J. HALL
Each Party who signs below, other than SIGNATURE BANK, acknowledges, represents, and warrants to SIGNATURE BANK that It has
received,read and understood this Notice of Final Agreement. This Notice Is dated January 24, 2005.
BORROWER:
X CoP�
BILL J. HALL
LENDER:
SIGNATURE BANK
X
Bob Hinderaker,President
LAM,PO L'dmu.V .e.a.OPW Cop,.Monona reww NYYm,.w..,n7.]0.O. AP MMu IYVM. .CO L:1C,NIWi1 IC 1W75 MA
•
DISBURSEMENT REQUEST AND AUTHORIZATION
♦Pt Ry5�R. Losrt Date ABttHrllY i Bel ikp eaa'F coil .. �Sccourlk :E:11999196717
:::Y5�x00G0O 41:-242005.<>0142442006gimE4000I0741ME EMEMEEMitena ENESSENESEMms
References in the shaded area are for Lender's use only and do not limit the applicability of this document to any particular loan or item.
Any item above containing has been omitted due to text length limitations.
Borrower: BILL J. HALL Lender: SIGNATURE BANK
32712 VISTA LAKE ROAD WINDSOR BRANCH
GREELEY, CO 80631 355 EASTMAN PARK DRIVE
WINDSOR, CO 80650
(970)674-3600
LOAN TYPE. This is a Variable Rate Nondisclosable Revolving Line of Credit Loan to an Individual for 950,000.00 due on January 24, 2006.
The reference rate (WALL STREET PRIME,currently 5.250%) is added to the margin of 2.000%, resulting in an initial rate of 7.250.
PRIMARY PURPOSE OF LOAN. The primary purpose of this loan is for:
0 Personal,Family,or Household Purposes or Personal Investment. O r,..�1[\/�
® Business(Including Real Estate Investment). �LJ� V
SPECIFIC PURPOSE. The specific purpose of this loan is: COMMERCIAL.
DISBURSEMENT INSTRUCTIONS. Borrower understands that no loan proceeds will be disbursed until all of Lender's conditions for making the
loan have been satisfied. Please disburse the loan proceeds of $50,000.00 as follows:
Undisbursed Funds: $50,000.00
•
Note Principal: $50,000.00
CHARGES PAID IN CASH. Borrower has paid or will pay in cash as agreed the following charges:
Prepaid Finance Charges Paid in Cash: $100.00
$100.00 Loan Fee
•
Total Charges Paid in Cash: $100.00
FINANCIAL CONDITION. BY SIGNING THIS AUTHORIZATION, BORROWER REPRESENTS AND WARRANTS TO LENDER THAT THE
INFORMATION PROVIDED ABOVE IS TRUE AND CORRECT AND THAT THERE HAS BEEN NO MATERIAL ADVERSE CHANGE IN BORROWER'S
FINANCIAL CONDITION AS DISCLOSED IN BORROWER'S MOST RECENT FINANCIAL STATEMENT TO LENDER. THIS AUTHORIZATION IS
DATED JANUARY 24,2005.
BORROWER:
X COPY
BILL J. HALL
wtS POO..Sb..Va.1.20.00.000 Cw.Hein,FMa+MWYn.w.U557,CON. 4 MOM R1\S5. -CO LCEN0.SO.FC 15-75 51,5
•
utI S` Zcr
WELD t:0MMUN I TY FEDERAL CREDIT UNION
Teller: :YPr' P,rt lh��i11bC 2�,+y %.4 ,bs 2Ce f3 329
4 of 1 07
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** **NEED EXTRA HOLIDAY MONEY?***** rig 118'`.CY' ! op t.ASKABOUT OUR HOLIDAY LOAN WITH �'E 1 14, 127. 82
AS REPAY.LOW AS 9.99% & A 1—YR. , Nets' r?„1 �;et a 14,cc1.OS. , DON' T
ICOMMI
SILVERADO OIL-MANAGEMENT
BILL HALL, PRES
1220 11TH AVE SUITE 201
GREELEY CO 80631
SIGNATURE •
Total. Cash,To Member:
C FAX TRANSMISSION
COLORADO
Weld County
Clerk to the Board
PO Box 758
Greeley,CO 80632
Fax: 970-352-0242
Phone:970-336-7215,ext.4217
To: Sabrina Date: May 18, 2005
Fax: (303) 205-2341 Pages: 1 +Cover
From: Carol Harding,
Deputy Clerk to the Board
Subject: Bayou House
COMMENTS: Attached is the addition of#16 to John Delay's Individual History Record.
CONFIDENTIAL
This facsimile is intended only for the use of the individual or entity to which it is addressed and may contain information that is
privileged,confidential, and exempt from disclosure under applicable law. If the reader of this facsimile is not the intended recipient nor
the employee or agent responsible for delivering the facsimile to the intended recipient, you are hereby notified that any dissemination,
distribution, or copying of this communication is strictly prohibited. If you have received this communication in en-or, please notify us
immediately by telephone and return the original message to us at the above address via the U.S.Postal Service. Thank you.
9-€L1f-L..„(..r ; —��Q). ,3��.1,4 �,`;,1�, ,,� f � �7� -4 ;
12. 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 or do you have any charges pending?(If yes,explain in detail.) Yes U NO
13. Have you ever received a violation notice,suspension or revocation,for a liquor law violation,or have you applied for or been denied a liquor or beer
license anywhere in the U.S.?If yes,explain in detail. Yes No
14.List all current and 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) I POSITION HELD I FROM I TO
15. Financial Information.
Total purchase price$ (if buying an existing business)OR list the total amount of your investment in the new business,
including notes,loans,cash,services or equipment,and operating capita! $
Provide details of Investment. You must account for the sources of ALL cash(how acquired).Attach a separate sheet if needed.
Type: Cash,Services or Equipment Where Obtained(Savings,Checking,Account,etc.) Amount
Loan Information(attach copies of all notes or loans)
Name of Lender — Address Term Security Amount
16.Give name of bank where business account will be maintained;name the account wit be maintained under;and the name or names of persons
authorized to draw thereon.
Cyr c 0., -- c- — << -‘
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
FAX TRANSMISSION
COLORADO
Weld County
Clerk to the Board
PO Box 758
Greeley,CO 80632
Fax: 970-352-0242
Phone:970-336-7215,ext.4217
To: John Delay Date: May 10, 2005
Fax: (720) 733-6960 Pages: 2 +Cover
From: Carol Harding,
Deputy Clerk to the Board
Subject: Individual History Record
COMMENTS: You may fax the document back to me;however,I do need your original signature in my
file, so please mail the original to me after you fax it. Thanks.
CONFIDENTIAL
This facsimile is intended only for the use of the individual or entity to which it is addressed and may contain information that is
privileged, confidential,and exempt from disclosure under applicable law. If the reader of this facsimile is not the intended recipient nor
the employee or agent responsible for delivering the facsimile to the intended recipient, you are hereby notified that any dissemination,
distribution, or copying of this communication is strictly prohibited. If you have received this communication in error, please notify us
immediately by telephone and return the original message to us at the above address via the U.S.Postal Service. Thank you.
I
0
th LC/r TEMPORARY CERTIFICATE OF
I icir k\
wage OCCUPANCY
COLORADO WELD COUNTY, COLORADO
DEPARTMENT P OF BUILDING INSPECTION
,, I ISSUED TO: QU {A - •
I
I
THIS CERTIFICATE IS ISSUED PURSUANT TO THE REQUIREMENTS OF SECTION 29.3-280 OF THE WELD COUNTY CODE. IT
i CERTIFIES THAT AT THE TIME OF ISSUANCE NO MAJOR CODE VIOLATIONS WERE OBSERVED AT THE FINAL INSPECTION;
I AND MINOR ITEMS ARE TO BE CORRECTED BY THE CONTRACTOR. THIS BUILDING APPEARS TO CONFORM WITH THE WELD
COUNTY CODE REGULATING BUILDING CONSTRUCTION AND USE. ITEMS TO BE CORRECTED ARE AS FOLLOWS:
I �.� corn' g Ole..deti ''12,3 ICC L-&- B rOS-a 2$ t t r-
I DESCRIPTION OF BUILDING OR PORTION OF BUILDING: _1w-re-zioie /11n c)P..J
I I
I USE CLASSIFICATION: 11•-f fat- /6 BUILDING PERMIT NO: g� Uj2
TYPE OF CONSTRUCTION: ZONING DISTRICT: C -3
?. i LEGAL DESCRIPTION: SECTION , TOWNSHIP N, RANGE WEST OF THE 6" P.M. WELDCOUNTY, COLORADO
h I SUBDIVISION: LOT: BLOCK:
I BUILD AA DRESS: 1331b' 4i4wrtt Fc5
f, 1 6 \,k4, ' Le4t6-
WELSC0UNTY BUILDING INSPECTOR DATE
to
POST IN A CONSPICUOUS PLACE
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