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Home My WebLink About20030417.tiff RESOLUTION RE: APPROVE APPLICATION FOR TRANSFER OF OWNERSHIP REQUEST FOR TAVERN LIQUOR LICENSE FROM ROMANCE, INC., DBA CLUB ROMANCE/LUCKY STAR, TO AFA, LLC, DBA ROMANCE NIGHT CLUB - EXPIRES FEBRUARY 17, 2004 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, AFA, LLC, dba Romance Night Club, P.O. Box 52, Lucerne, Colorado, 80646, 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 Romance, Inc., dba Club Romance/Lucky Star, 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, Colorado 80646 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 2003-03 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 February 17, 2004, 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 conditions: A. The Licensee shall prohibit minors from the night club area of the licensed premises whenever alcoholic beverages are being served. The Licensee shall initiate a system to identify patrons within the night club area of licensed premises. The new system shall include implementing a system of hand marking that utilizes different stamps and different colored inks changing nightly which so identifies the patrons within the night club area of the licensed premises. 2003-0417 00 : ROL) cj, LC0016 TRANSFER OWNERSHIP OF LIQUOR LICENSE - ROMANCE NIGHT CLUB PAGE 2 B. The Licensee shall require all persons who appear to be thirty years of age or younger to carry on their persons, adequate, currently valid identification of age, (those documents set forth in Colorado Liquor Code Regulation 47-128.3)while inside the night club area of the licensed premises. C. The Licensee shall call the Sheriff's Office to arrest any person whom the Licensee has reason to believe has violated the Colorado Liquor Code or other State law in the licensed premises or its parking lot. Furthermore, the Licensee shall meet weekly with Weld County Sheriff's Office personnel to discuss matters of concern regarding the operations of the tavern. D. The Sheriff's Office has agreed to design a flyer warning adults and minors that providing alcohol to minors and consumption of alcohol by minors is a violation of the Colorado Revised Statutes and of the possible penalties. The Licensee shall distribute the flyer to patrons of the tavern several times per month. Printing of the flyer shall be the responsibility of the Licensee. E. The Licensee shall post signs within the licensed premises, in English and in Spanish, warning adults and minors that providing alcohol to minors and consumption of alcohol by minors is a violation of the Colorado Revised Statutes and of the possible legal penalties for doing so. F. The Licensee shall ensure that the security guards working inside the licensed premises keep aisle and passageways clear at all times. No such security guards shall be required to take door receipts and/or tend bar. The Licensee shall provide to the Sheriffs Office and the Clerk to the Board's Office, on an ongoing basis, within thirty (30) days after hire or employment, copies of certificates of training for such security guards and copies of certificates permitting all armed security guards to carry weapons. G. The Licensee shall continue to hire two individuals to work in the parking lot of the licensed premises to ensure it is cleaned up after the close of business and that vehicles are parked properly. These individuals shall also provide security in the parking lot. Traffic cones shall be set up nightly to ensure that patrons park only in the tavern bar parking lot. These employees shall also pick up trash that is deposited on neighboring property by tavern patrons. H. The Licensee shall ensure that the two security guards working outside the licensed premises shall prohibit loitering from taking place in the parking lot of the licensed premises. The Licensee shall provide to the Sheriffs Office and the Clerk to the Board's Office, on an ongoing basis, within thirty (30) days after hire or employment, copies of certificates of training for the two outside security guards and copies of certificates permitting all armed security guards to carry weapons. 2003-0417 LC0016 TRANSFER OWNERSHIP OF LIQUOR LICENSE - ROMANCE NIGHT CLUB PAGE 3 The Licensee shall ensure that adequate lighting, to fully illuminate the parking lot of the licensed premises and thereby provide for the safety of all patrons and employees, shall be installed and operated. Space in the parking lot, close to the main door of the licensed premises, shall be kept open to allow emergency vehicles access. The Licensee shall post signs outside the licensed premises, in English and in Spanish, warning patrons that parking is only allowed in the parking lot of the licensed premises (not on the shoulder of U.S. Highway 85 or on the property located on the east side of Highway 85, nor in the lots located on properties to the north and south of the licensed premises). J. The Licensee shall provide one parking stall near the front entrance of the licensed premises that will be reserved for a Sheriffs Office vehicle. The Sheriff's Office has agreed to provide the signage for this parking stall. K. The Licensee shall ensure that its security personnel shall count each person coming into the licensed premises so that the number of persons occupying the bar and dance floor/sitting area shall not exceed the occupancy limits of that area as set by the Fire Marshall for the Eaton Fire Department. The Licensee shall also ensure that the area where alcohol is served and consumed does not exceed 5,000 square feet in size and that the requirements set forth in the letter of David Sprague, Building Official, Weld County Department of Building Inspection, dated October 30, 2000, a copy of which is attached hereto and is referred to herein as Exhibit "A," are complied with at all times. L. The Licensee shall ensure that all bartenders and wait staff, present and future, shall attend the T.I.P.S. program or similar training to learn when to stop serving alcoholic beverages to intoxicated patrons. The Licensee shall provide to the Sheriff's Office and the Clerk to the Board's Office, on an ongoing basis, within thirty (30) days after hire or employment, copies of certificates showing the successful completion of said training by the present bartenders and wait staff. M. The Licensee shall post its liquor and tobacco licenses in the proper location of the licensed premises at all times. N. The Licensee shall allow no readmittance to the licensed premises to patrons who leave prior to closing time. O. The Licensee shall comply with all of the requirements of the Colorado Liquor Code and with all of the conditions and requirements set forth in this Resolution. BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to sign said application. 2003-0417 LC0016 TRANSFER OWNERSHIP OF LIQUOR LICENSE - ROMANCE NIGHT CLUB PAGE 4 The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 12th day of February, A.D., 2003. BOARD OF COUNTY COMMISSIONERS �� WEL UNT i COLD O ATTEST: 4, /�'(/v ��I� % , c ,d,-., 42 spavid E. Long, Chair Weld County Clerk to the B r. rt; Y ..-rt •. �asden, Pro-Tem BY: eA . Deputy Clerk to the Boa j Op 1,,„1/4-1;c.ckmac '/��=<. IVY♦ M. J. eile AP DAST ly}' 4(4424^41:40k4 Willierk� :, ounty %At l torne 4 lA Glenn Vaad Date of signature: 34 2003-0417 LC0016 THIS LICENSE MUST BE POSTED IN PUBLIC VIEW DR 8402(02/99) STATE OF COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division 1375 Sherman Street Denver,Colorado 80261 AFA LLC ROMANCE NIGHT CLUB 33131 HWY 85 LUCERNE CO 80646 ALCOHOL BEVERAGE LICENSE Liability Information Account Number County City Indust. Type Liability Date LICENSE EXPIRES AT MIDNIGHT 41-28224-0000 03 090 722410 B 021803 FEB 17, 2004 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 FEE(S) $ 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. QED C FEB 2 0 2003 Division Director I/Q Executive Director THIS LICENSE EXPIRES FEBRUARY 17 , 2004 LICENSE FEE e%. F STATE OF L :; COLORADO COUNTY OF WELD BY AUTHORITY OF THE BOARD OF COUNTY COMMISSIONERS RETAIL LIQUOR LICENSE FOR Tavern SPECIFY: Retail Liquor Store.Liquor Licensed Drug Store,Hotel and Restaurant,Club,Tavern etc. TO SELL AT RETAIL Malt, Vinous, and Spirituous LIQUOR SPECIFY KINDS OF LIQUORS nIg is to tGLerttfp, That AFA, LLC, dba Romance Night Club 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 00_1100 ($ 75.00 3 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 (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,fora period beginning on the 18th day of February ,20 03__,and ending on the 17th day of February ,2004_ 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 _day of Febru.r � _,20_03 _ j!c?ardofCount y Commissioners SITEST: ;, i¢_�SG.Q71 lr y "kJ Deputy Clerk to the Board I i f Choi nwq Board of County Comm4s' ( t / � DR 8404(06/02) 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 '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 $ • 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 ❑ 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 AF1 ° L_L II ', 3 2a.Trade N me of Establishment(DBA) State Sales Tax No. us essTelepJ� one �Knw1r(nr NIGri-F G vi of-asaaq q10-35Z- .-►uLo 3. Address of Premises(specify exact location of premises) 33131 USA }ku 1 965 City LU �� County State ZIP Code WELD ray3 PcccC-1 to 4. Mailing Address (Number and Street) City or Town State ZIP Code P. d- '&31 52 L4ACe&NE coc_.o (6:3la4Cs- 5. If the premises currently have a liquor or beer license,you MUST answer the following questions: Present Trade Name of Establishment(OBA) Present State License No. Present Class of License Present Expiration Date Rnmrtrlq: -kL r &th C-\ut o\-c lcAL v1-S53C`1 lave(v- .` x, ,a\ 3 LIAR SECTION A Nonrefundable APPLICATION FEES LIAB SECTION D . LIQUOR LICENSE FEES 2300 ❑ Application Fee for New License 900.00 1940 ❑Retail Liquor Store License (city) $227.50 2300 ❑ Application Fee-New License Concurrent Review.. 1000.00 1940 ❑Retail Liquor Store License(county) 312.50 2310 VApplication Fee for Transfer of Ownership 900.00 1950 ❑Liquor Licensed Drugstore (city) 227.50 SECTION B 3.2%BEER CICENSEFEES 1950 ❑Liquor Licensed Drugstore (county) 312.50 2121 ❑ Retail 3.2%Beer On Premises-(city) $96.25 1960 ❑Beer&Wine License (city) 351.25 2121 IDRetail 3.2%Beer On Premises-(county) 117.50 1960 ❑Beer&Wine License (county) 436.25 2122 ❑ Retail 3.2%Beer Off Premises-(city) 96.25 1970 ❑H & R License❑city❑county 500.00 2122 ❑ Retail 3.2%Beer Off Premises-(county) 117.50 1980 ❑H & R License w/opt Prem❑city❑county 500.00 2123 ❑ Retail 3.2%Beer On/Off Premises-(city) 96.25 1990 ❑Club License❑city❑county 308.75 2123 ❑ Retail 3.2%Beer On/Off Premises-(county) 117.50 2010 Vtavem License❑city❑county 500.00 SECTION C RELATED FEES AND I?ERMITS 2020 ❑Arts License❑city❑county 308.75 2030 ❑Racetrack License❑city❑county 500.00 1985-100(999)❑Addition of related Facility Permits to existing 2040 ❑Optional Premises License❑city❑county 500.00 Resort Complex license $50.00 x Total Fee 1905 ❑Retail Gaming Tavern Lic❑city❑county 500.00 2210-100(999)❑Retail Warehouse Storage Permit $100.00 1975 ❑Brew-Pub License 750.00 2220-100(999)❑Addition of Optional Premises to existing hotel/restaurant 1985 ❑Resort Complex License 500.00 $75.00 x Total Fee ❑H/R-Tavern Manager's Registration $75.00 DO NOT WRITE IN THIS SPACE-FOR DEPARTMENT OF REVENUE USE ONLY LIABILITY INFORMATION County City Industry Type License Account Number Liability Date License Issued Through (Expiration Date) FROM TO State City County Managers Reg -750(999) 2180-100(999) 2190-100(999) -750(999) % %/ CashCashFFundNow License G Fund CashTransfer License 2300-100 2310-100 TOTAL (999) (999) A 2003-0417 DR 8404(06/02)Page 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 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. Eli 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 V 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) V,/ B. Lease in the name of the Applicant ONLY. a3 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 E A. Individual History Record(s)(Form DR 8404-I). El B. Fingerprints taken and submitted to local authority. (State authority for master file applicants.) g` 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) a4. 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(06/02)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? ❑ V 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? ❑ LI (b) had an alcoholic beverage license suspended or revoked? ❑ I21 (c) had interest in another entity that had an alcoholic beverage license suspended or revoked? ❑ d 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. ❑ LI Bb. Has a 3.2 beer license for the premises to be licensed been denied within the preceding one year?If"yes,"explain in detail. ❑ V Eft 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? 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 a� the name of t busin ss and list any ❑ current financial interest in said business including any loans to or from a licensee.C 0 t�127.\((Z� Ox'(\ o. k,'i 1, \g0w0 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 beSsued by virtue of ownership,lease or other arrangement? 0"❑ ❑ Ownership a 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 1.4k AFA '' LLC, " zoos Attach a diagrarrf 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. NIA 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? ❑ ❑ (Copy of notice or application must be attached) 17a. Name of Manager (If this is an application for a Hotel, Date of Birth 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(06/02)Page 4 19. It applicant is a corporation,partnership,association or a limited liability company, it is required to list by position all 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 BIRTH i sil�l�l� t DD*RIC,UFtz. SPN AVE' U e,ntiS McM13eR It, co, 9O`Oi 20. Has the Applicant provided,or does the applicant intend to provide their staff with server training. Yes No Additional Documents to be submitted by type of entity ❑ CORPORATION ❑ Cert.of Incorp. ❑ Cert.of Good Standing(if more than 2 yrs.old) ❑ Cert.of Auth.(if a foreign corp.) ❑ PARTNERSHIP ❑ Partnership A Bement(General or Limited) E Husband and Wife partnership(no written agreement) LIMITED LIABILITY COMPANY Ivl 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) Addressor Service =sidro QLOCA .(3L1CZ S13 4-114 Ave Lcnc3inont Co) Q)OSOI OATH OF APPLICANT J 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. Aut rized Signature Title Date 0� Z_-5 Manctcjkg Ma bar' /ca R.0 -- V REPORT AND APPROVAL OF LOCAL LICENSING AUTHORITY (CITY/COUNTY) Date application tiled 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. I- ICI—4CO3 Each person required to file DR 8404-I: Yes No a.Has been fingerprinted 0b.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 g ❑ in compliance with,and aware of,liquor code provisions affecting their class of license. - (date of inspection) If not,does the authority want the state to conduct such an 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 dr 47,C.R.S. THEREFORE,THIS APPLICATION IS APPROVED. Local Licensing Authority for Telephone Number 0 TOWN,CITY Weld Coun (970)356-4000 X4200 ® COUNTY Signature A • . Long, Chair, Weld Count'pate citift ommissioners 02/12/2003 • • Signatur est) � Date r+y r ,� Deputy 02/12/2003 If premises are located within a town qty}t v ould be signed by the mayor and clerk,if in a county,then by the chairman of the board of county commissioners at&thgbfb9c Kto If,by ordinance or otherwise,the local licensing authority is some other official, then such approval should be given by such ' c 6'i• (, 1 6 s9W-s•Sr • ouct _ - I A ( X�.. anon r ' I 0. 1 m sr-c• 3 t- • 1; w • IIr f t--Ir_II.".... -1 a I -r 9�� JJ II 19W-6• l SCALE 1/8"=1'-0 `1 4-01 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 —ROM4 Ce- N terP1T C...LAwt3 2.Your Full Name(last,first, middle) 3. List any other names you have used. oDF,t i mO 4.Mailing address(if different from residence) Home Telephone 553 . 44-Th Ave LIDNI iY\CDkr- co, 2OSOi 303- Col (as 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 513 r . 4Th Pow t-.vNc rno v-c- coup <6oso 1 5 -q(-4 Previous 6.Date of Birth Social Security Number(SSN) Place of Birth '7. U. S. Citizen? ( �--� 14 IMe-m VYes No If Naturalized,state where Us in m i O n When Name of District Court ery X Colo. S2-rnbe r 'Poi Zoo/ Naturalization Certificate Number I Date of Certification If an Alien, Give Alien's Registration Card Number Permanent Residence Card Number gi90/ lO 1 8. Height Weight Hair Color Eye Color Sex Race 9. Do you have a current Driver's License? If so,give number&state 1IO broyA p4 Yes 7 N ( 10. List the name(s)of relatives working in or holding a financial interest in the Colorado alcohol beverage industry. NAME OF RELATIVE I RELATIONSHIP TO YOU POSITION HELD NAME OF EMPLOYER -RuteN T O t 4 Uf�Z_ 'A ER- oLJ��I~R P�m L. MA 4r v�l t u za st - 11. Have you ever applied for,held,or had an interest in a State of Coloraddo_Li uor or Beer License, or loaned money,furniture or fixtures,equipment or inventory,to any liquor or beer licensee?If yes, answer in detail. VYes C No EL N1-Ex.(c* O 1 4L1 ik tot U G1/4)0r2 CA C I- ki c tV ems±[ rld 5E A"f`TK}CH 1neir 12.Have you ever been convicted of a crime,or received a suspended sentence,deferred entente,or forfeited bail for any offense in criminal or military court or do you have any charges pending?(1f yes,explain in detail.) n Yes �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. O 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 1\Ot'nYht•l,c.c- - -t' C. 33131 OSA as U 1e co M+ANcecR 'LOD I Yr )tit k-+ s� N•c , `ISO .%71-11" , .1 ,c- ,r-N 1.4 ---fie ( ‘`1C-11 ZU0 tf\ex cc\yNs.-,, A\o5 C\°f\ 9 \CA'rk-`1 15.Financial Information. p� Total purchase price$ _ !Jr�00d • (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 opening ca ital $ 11,0) 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 oa fnc. t.�8 I Oi OCR va Cc&S11 i D,OOd -N17 E. I Il 4C\Ie) Thar kin C„) U)233 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 will be maintained under;and the name or names of persons authorized to draw thereon. //0- • AD Ye 1 N�1�.-vim �1 s* Lei rc'- (_`f\©too • 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 ATTACHMENT - FOR ANSWER# 11 ON INDIVIDUAL HISTORY RECORD ANSWER YES ISIDRO RODRIGUEZ WAS OWNER MANAGER AT EL MEXICANO PARRILLA BAR 4105 WADSWORTH BLVD. WHEAT RIDGE CO 80033-4618 ISIDRO OWNED EL MEXICANO PARRILLA BAR FROM NOVEMBER 1996, UNTIL DECEMBER 1997,. ISIDRO OWNED A HOTEL &RESTAURANT LIQUOR LICENSE, DURING THAT TIME THERE WERE NO INTERAPTIONS WITH THIS LICENSE, ISIDRO SURRENDED THE LICENE IN ABOUT DECEMBER 1997. SU,rccfnckl(k \ o& \-)sv\ssCSu * CommunityFhstCOMMIMitY Community First National Bank•Member FDIC December 18,2002 Re: Isidro Rodriguez To Whom It May Concern: - Please be advised that Isidro Rodriguiz has been a customer of Community First National Bank since 1992. Mr. Rodriguez has several deposit accounts with Community First all of which are in good standing and have been handled as agreed. Sincerely, J,.i •ettelman Retail Banking ger 720.652.6350 To whom it may concern, I have known Isidro Rodriguez for the last 7 years. In this time I have known him to be a honest, hardworking, upstanding person. I see him as being a man with ambition and integrity. His seems to have goals in his life and works hard to achieve them. I would, without hesitation, recommend him in any endeavor that he has set his sights on. Sincerly, 2 24-0-Ca /a, / l lAil Brook W. Koski -- 303-776-1329 FAX NO. i 7209299780 Dec. 18 2002 05:26PM P1 Luis A Thus 10690 12osalie Dr. Nort.liglenn, CO 80233 Ph.(303)236-8172 Vox(770)929-9780 December 17,2002 Re: Isidro Rodrigues To whom it may concern: As a brother of Isidro, I have known bin,all my life. Isidro is the kind of person everyone in the family a Mode!Father,a imam business nuurager and more important than anything a andadmires.H He is heart and soul of his family I've never seen such a dedicated father. Isidro has been ver religious all fhh He is the i very compassionate and has set and example that is tough to follow. Y tgious of his life. He is As a business manager I personally admire his courage and dedication as well as attention to detail. As a member of any family he has been on of the tuost respected characters and one of the most loved individuals I have ever known, by fancily and friends alike. To me he has been the friend everyone wishes to have;He has guided me in the right direction every time I needed it. His advice has helped me become a better Father and a better Citizen. Thus I do not hesitate to give Isidro my highest recouunendations. Feel free to contact me ifyou have any questions. • erelyrycouL Luis A Rios 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 iav day of -D cp 04212;t' , 2002.. ra4fAC.l7 --Date /,,2- ao -.o Q._ Li D eplicant (Buyer) Date PURCHASE AND SALE AGREEMENT Agreement made December 20, 2002, between Romance, Inc., of 33131 Hwy 85, Lucerne, Weld County, Colorado, referred to as "Seller", and A,F,A, L.L.C., of 513 E. Fourth Ave, Longmont, boulder County, Colorado, referred to as "Buyer." RECITALS The parties recite and declare A. Seller now owns and operates a restaurant and tavern business, known or designated as Club Romance/Lucky Star, at 33131 Hwy 85, Lucerne, Weld County, Colorado. B. Seller desires to sell and buyer desires to buy the restaurant and tavern business for the price and on the terms and conditions set forth below. In consideration of the mutual covenants and promises of the parties, seller and buyer covenant and agree: SECTION ONE AGREEMENT TO SELL AND BUY a. Restaurant and Tavern Business. Seller shall deliver to buyer and buyer shall purchase from seller the restaurant and tavern business located at 33131 Hwy 85, Lucerne, Weld County, Colorado including the goodwill of the business, the stock-in-trade, merchandise situated on the premises, and This Agreement also includes the trade name or business name, licenses, permits, insurance policies, and all contracts related to the business sold. b. Liquor License. Seller shall transfer to buyer and buyer shall purchase from seller Tavern Liquor License No. 24-85307-0000, issued by the Colorado Department of Revenue and Weld County for the premises located at 33131 Hwy 85, Lucerne, Weld County, Colorado, in accordance with the statutes, rules and regulations of the State of Colorado and the ordinances of Weld County. Seller shall execute all necessary papers and documents required to accomplish the transfer of the Tavern Liquor License. Buyer shall promptly apply to State and County Liquor license authorities for transfer of the Tavern Liquor License and temporary permit pursuant to 12-47-303, C.R.S. (2000). c. Purchase Price. The purchase price to be paid by the Buyer to the Seller shall be Fifteen Thousand Dollars ($15,000.00) business only. d. Effective Date. The purchase and sale of the restaurant and tavern business located at 33131 Hwy 85, Lucerne, Weld County, Colorado shall be effective upon the granting of a temporary liquor permit to the Buyer by the County Licensing authority. e. Operation of the Business. Pending approval of the Buyer's temporary permit, Isidro Rodriguez shall operate and maintain the restaurant and tavern business located at 33131 Hwy. 85, Lucerne, Weld County, Colorado. f. Bill of Sale. Upon approval of Buyer's temporary liquor permit, Seller shall deliver and execute bill of sale for the business, good will, and tavern liquor license to the Buyer. g. New Lease. Buyer must operate under a new lease with Landlord. h. Change of Possession. Upon approval of Buyer's temporary liquor permit, possession of the business. SECTION TWO MANNER OF PAYMENT The total purchase price of Fifteen Thousand Dollars ($15,000.00) shall be paid in the following manner: a. Seller owes Buyer Fifteen Thousand Dollars in back pay,Fifteen Thousand Dollars ($15,000.00) b. Buyer has worked for Seller for one year as a manager during that year the Buyer has not received any payment from Seller therefore as an exchange seller will assign his Business Romance, Inc, to A,F,A, L.L.C and Isidro Rodriguez as new owner .at the time e signing of this agreement. REPRESENTATIONS The parties represent and acknowledge as follows: a. Ownership, Seller represents that it is the unconditional owner of the restaurant and tavern Business, and the above mentioned liquor license. b. Equipment and fixtures, Seller represents that the establishment is fully equipped and all equipment and fixtures are in good working condition. c. d. Liquor License. Buyer acknowledges that it has been adequately advised that the Seller's Tavern Liquor License was renewed by the local Liquor Licensing Authority in January 2001. and Z002 . e. Manuel Manriquez acknowledges that he is the President and Director of the Romance, Inc., and is authorized to bind Romance,Inc.,to this agreement. f. Isidro Rodriguez Warrants that he is manager and member of A,F,A, LLC, and authorized to bind A,F,A, LLC to this agreement. AGREED TO THIS 20 DAY OF DECEMBER, 2002. ROMANCE, INC. BY: V7a/Pkvd917 MANUEL MANRIQUEZ P� ?2. IDe►.1T ' DWNc9- A,F,A, L.L.C. "r BY; I3IDRO RODRIG Z MANAGER/MEMBER BILL OF SALE Agreement made December 20, 2002, between Romance, Inc., of 33131 Hwy 85, Lucerne, Weld County, Colorado, referred to as"Seller", and A,F,A, L.L.C., of 513 E. Fourth Ave, Longmont, boulder County, Colorado, referred to as "Buyer." a. Purchase Price. The purchase price to be paid by the Buyer to the Seller shall be Fifteen Thousand Dollars ($15,000.00) business including Liquor, beer, food, Maintance Fixtures, Paper, cleaning supplies, food and vegetables.. b. Effective Date. The purchase and sale of the restaurant and tavern business located at 33131 Hwy 85, Lucerne, Weld County, Colorado shall be effective upon the granting of a temporary liquor permit to the Buyer by the County Licensing authority. c. Operation of the Business. Pending approval of the Buyer's temporary permit, Isidro Rodriguez shall operate and maintain the restaurant and tavern business located at 33131 Hwy. 85, Lucerne, Weld County, Colorado. d. New Lease. Buyer must operate under a new lease with Landlord. e. Change of Possession. Upon approval of Buyer's temporary liquor permit, possession of the business. f. Buyer's will not take responsibility on any outstanding payments due by Romance, Inc,. MANNER OF PAYMENT The total purchase price of Fifteen Thousand Dollars ($15,000.00) shall be paid in the following manner: a. Seller owes Buyer Fifteen Thousand Dollars in back pay, Fifteen Thousand Dollars ($15,000.00) The parties represent and acknowledge as follows: a. Ownership, Seller represents that it is the unconditional owner of the restaurant and tavern Business, and the above mentioned liquor license. b. Equipment and fixtures, Seller represents that the establishment is fully equipped and all equipment and fixtures are in good working condition. AGREED TO Tins 20 DAY OF DECEMBER, 2002. ROMANCE, INC. BY: MANUEL MANRIQUEZ PSSIPEEN b.Esitawr/owNtt. A,F,A, L.L.C. BY; I IDRO RODRIG Z MANAGER/MEMBER REAL ESTATE LEASE This Lease Agreement(this "Lease")is dated December 20, 2002,by and between LilLy,LLC ("Landlord"), and AFA "LLC" ("Tenant"). The parties agree as follows: PREMISES. Landlord, in consideration of the lease payments provided in this Lease,leases to Tenant AFA"LLC" (the "Premises")located at 33131 USA HWY 85, LUCERNE, CO 80646. LEGAL DESCRIPTION. The legal description for the premises is: The south 451.9 feet of the north 2,053.9 feet of that part of the East Half of the Southeast Quarter of Section 18,Towship 6 North,Range 65 West of the 6th P.M, TERM. The lease term will begin onDecember 20,2002 and will terminate on December 19, 2005. LEASE PAYMENTS. Tenant shall pay to Landlord monthly installments of$5,000.00, payable in advance on the first day of each month, for a total lease payment of $180,000.00. Lease payments shall be made to the Landlord at 232 Elizabeth Cr, Ft Lupton, CO 80621,which address may be changed from time to time by the Landlord. POSSESSION. Tenant shall be entitled to possession on the first day of the term of this Lease, and shall yield possession to Landlord on the last day of the term of this Lease,unless otherwise agreed by both parties in writing. At the expiration of the term,Tenant shall remove its goods and effects and peaceably yield up the Premises to Landlord in as good a condition as when delivered to Tenant, ordinary wear and tear excepted. USE OF PREMISES. Tenant may use the Premises only for Restaurant and Bar. The Premises may be used for any other purpose only with the prior written consent of Landlord,which shall not be unreasonably withheld. Tenant shallnotify Landlord of any anticipated extended absence from the Premises not later than the first day of the extended absence. FURNISHINGS. The lease of the Premises includes the furnishings listed on the attached exhibit. Tenant shall return all such items at the end of the lease term in a condition as good as the condition at the beginning of the lease term,except for such deterioration that might result from normal use of the furnishings. PARKING. Tenant shall be entitled to use 250 parking space(s)for the parking of the Tenant's customers'/guests'motor vehicle(s). STORAGE. Tenant shall be entitled to store items of personal property in Storage Trailer located with in the property and Storage shed located on the North side of parking lot. during the term of this Lease. Landlord shall not be liable for loss of, or damage to, such stored items. PROPERTY INSURANCE. Tenant shall maintain casualty insurance on the Premises in an amount not less than$1,000,000.00. Landlord shall be named as an additional insured in such policies. Tenant shall deliver appropriate evidence to Landlord as proof that adequate insurance is in force issued by companies reasonably satisfactory to Landlord. Landlord shall receive advance written notice from the insurer prior to any termination of such insurance policies. Tenant shall also maintain any other insurance which Landlord may reasonably require for the protection of Landlord's interest in the Premises. Tenant is responsible for maintaining casualty insurance on its own property. LIABILITY INSURANCE. Tenant shall maintain liability insurance on the Premisesn a total aggregate sum of at least $1,000,000.00. Tenant shall deliver appropriate evidence to Landlord as proof that adequate insurance is in force issued by companies reasonably satisfactory to Landlord. Landlord shall receive advance written notice from the insurer prior to any termination of such insurance policies. MAINTENANCE. Tenant shall have the responsibility to maintain the Premises in good repair at all times during the term of this Lease. UTILITIES AND SERVICES. Tenant shall be responsible for all utilities and services incurred in connection with the Premises. TAXES. Taxes attributable to the Premises or the use of the Premises shall be allocated as follows: REAL ESTATE TAXES. Tenant shall pay all real estate taxes and assessments which are assessed against the Premises during the time of this Lease. PERSONAL TAXES. Landlord shall pay all personal taxes and any other charges which may be levied against the Premises and which are attributable to Tenant's use of the Premises, along with all sales and/or use taxes(if any)that may be due in connection with lease payments. TERMINATION UPON SALE OF PREMISES. Notwithstanding any other provision of this Lease,Landlord may terminate this lease upon 90 days'written notice to Tenant that the Premises have been sold. DEFAULTS. Tenant shall be indefault of this Lease if Tenant fails to fulfill any leaseobligation or term by which Tenant is bound. Subject to any governing provisions of law to the contrary, if Tenant fails to cure any financial obligation withinl5 days (or any other obligation within 30 -2 - days)after written notice of such default is provided by Landlord to Tenant,Landlord may take possession of the Premises without further notice (to the extent permitted by law),and without prejudicing Landlord's rights to damages. In the alternative,Landlord may elect to cure any default and the cost of such action shall be added to Tenant's financial obligations under this Lease. Tenant shall pay all costs, damages,and expenses(including reasonable attorney fees and expenses) suffered by Landlord by reason of Tenant's defaults. All sums of money or charges required to be paid by Tenant under this Lease shall be additionalrent,whether or not such sums or charges are designated as "additional rent". The rights provided by this paragraph are cumulative in nature and are in addition to any other rights afforded by law. LATE PAYMENTS. For each payment that is not paid within per day after the 7th day days after its due date, Tenant shall pay a late fee equal to 0.01 %of the required payment. CUMULATIVE RIGHTS. The rights of the parties under this Lease are cumulative, and shall not be construed as exclusive unless otherwise required by law. NON-SUFFICIENT FUNDS. Tenant shall be charged$20.00 for each check that is returned to Landlord for lack of sufficient funds. - REMODELING OR STRUCTURAL IMPROVEMENTS. Tenant shall have the obligation to conduct any construction or remodeling(at Tenant's expense)that may be required to use the Premises as specified above. Tenant may also construct such fixtures on the Premises(at Tenant's expense)that appropriately facilitate its use for such purposes. Such construction shall be undertaken and such fixtures may be erected only with the prior written consent of the Landlord which shall not be unreasonably withheld. Tenant shall not install awnings or advertisements on any part of the Premises without Landlord's prior written consent. At the end of the lease term, Tenant shall be entitled to remove (or at the request of Landlord shall remove)such fixtures,and shall restore the Premises to substantially the same condition of the Premises at the commencement of this Lease. ACCESS BY LANDLORD TO PREMISES. Subject to Tenant's consent(which shall not be unreasonably withheld), Landlord shall have the right to enter the Premises to make inspections, provide necessary services, or show the unit to prospective buyers,mortgagees,tenants or workers. However,Landlord does not assume any liability for the care or supervision of the Premises. As provided by law, in the case of an emergency,Landlord may enter the Premises without Tenant's consent. During the last three months of this Lease,or any extension of this Lease,Landlord shall be allowed to display the usual "To Let" signs and show the Premises to prospective tenants. INDEMNITY REGARDING USE OF PREMISES. To the extent permitted by law,Tenant agrees to indemnify hold harmless, and defend Landlord from and against any and all losses, claims,liabilities, and expenses, including reasonable attorney fees, if any,which Landlord may - 3 - suffer or incur in connection with Tenant's possession,use or misuse of the Premises, except Landlord's act or negligence. MECHANICS LIENS. Neither the Tenant nor anyone claiming through the Tenant shall have the right to file mechanics liens or any other kind of lien on the Premises and the filing of this Lease constitutes notice that such liens are invalid. Further, Tenant agrees to (1)give actual advance notice to any contractors, subcontractors or suppliers of goods, labor, or services that such liens will not be valid,and(2)take whatever additional steps that are necessary in order to keep the premises free of all liens resulting from construction done by or for the Tenant. NOTICE. Notices under this Lease shall not be deemed valid unless given or served in writing and forwarded by mail,postage prepaid, addressed as follows: LANDLORD: LilLy, LLC 232 Elizabeth CT Ft Lupton, CO 80621 TENANT: AFA"LLC" 513 E.4th Ave Longmont, CO 80501 Such addresses may be changed from time to time by either party by providing notice as set forth above. Notices mailed in accordance with the above provisions shall be deemed received on the third day after posting. ' GOVERNING LAW. This Lease shall be construed in accordance with the laws of the State of Colorado. ENTIRE AGREEMENT/AMENDMENT. This Lease Agreement contains the entire agreement of the parties and there are no other promises,conditions,understandings or other agreements,whether oral or written,relating to the subject matter of this Lease. This Lease may be modified or amended in writing,if the writing is signed by the party obligated under the amendment. SEVERABILITY. If any portion of this Lease shall be held to be invalid or unenforceable for any reason,the remaining provisions shall continue to bevalid and enforceable. If a court finds that any provision of this Lease is invalid or unenforceable,but that by limiting such provision, it would become valid and enforceable,then such provision shall be deemed to be written, construed,and enforced as so limited. -4 - The failure of either party to enforce any provisions of this Lease shall not be construed as a waiver or limitation of that party's right to subsequently enforce and compel strict compliance with every provision of this Lease. BINDING EFFECT. The provisions of this Lease shall be binding upon and inure to the benefit of both parties and their respective legal representatives, successors and assigns. LANDLORD: LilLy,LLC By , 7�G2 C J Date: December 20,2002 Olga M e in TENANT: AFA "LLC" By: tCz, Date: December 20, 2002 Isfdro Rodriguez, Manager _5 _ I JIM ff11111111 III!!liii! III 1111!ID 11111 D[ III EMS 11/12/1002 01:80P Weld Rowdy,Ca 1 of 1 II 6.00 006.87 d.A."EuWn TRdalmotO Warranty Deed THIS DEED Is a conveyance of the real property daadbed below, Including soy improvements sad other mminaaca(the "properly') from mthe Dtnd and a.ca �a(O,putnenhlpp),or other emlt(lee)named below u GRANTOR a the individud(t) or Po I)AM The GRANTOR y tells and conveys the property to the GRANTER end Me GRANTOR*cants the title to the property,except peril property tun for the yar of ti deed,aka the GRAMEE will bey(2)aty cements and riRhne!- way Mawr of cord(3)nay pact reannetlonm and arapdoa(4)any wWrtlW mlnerU Intends.Mwn of record(5)any Wectiecovtav bm and hlti M �km.shown of record Enmay addition!'marten dawn below under'Additional Wamnty Exception D P. t coning raplukm. 565.37 The Sped&s Tame ants Died An, Caren ttlM cus(s)sad puNe)of reddest if h.apoa oft.owwmtnem Is joking in this Dowd to Side banes*N.MSG maronr bat aed when) HADI TEHRANIAN AND FATMEH SOHRABI Grano Nine•••a(0 and mantes);swan et Sam.leadrp awaaw red or meet mate.) LILLY,LLC 232 ELIZABETH COURT,FT LUPI'ON,CO 80621 Form et C..Onreldp Otte.two or maw mite tend.dry win mmedid to ma N rune in met,wsp du weeds'Spit wooer or won*of the tum m.Wns ma added S the was Edna Property Dalerlpdea (inAd.warn eat sot) The South North, 1S West ofd North6th P.M.,53.9�t otthat h 8�of the E1/2 of the SE1/4 of Section 18,Towmhip 6 right of Ingram and egress ova and across the property lying south of tthheYhe�re�scrii�property together with Properly*Atom 33131 HIGHWAY 85 LUCERNE COLORADO 80646 Caedderdlat (I',.aim=oh done mum Is apbW,deMa maaNMon for et deed will be Praneud Was dt maveynem h SSfld r.dl la my cue.1.mnvelme N able.not re uemddmal.) SIX HUNDRED FIFTY THREE THOUSAND SIX HUNDRED THIRTY EIGHT AND 69/!00 Rrerndes.Rmatfi_, MeeOMNOR Web tswam my base In On pgew or to.m.a lag that N owed,ore On GAMMA is ,mrie of th.GRANTEE'S r0ee in die many,cab Mpoptlne ISlat,) Adam!Wander Pa.Pttcar (gelds deeds itwee below sand and dm.hems not mead dot) DEED OF TRUST IN FAVOR OF MICHAEL H.BRANAND,IN WHICH GRANTEE(S)HEREBY AGREE TO ASSUME AND PAY. Exanued by the Gramr a VBMBER 8.2002 1peen for er Aseedl a for lat,WssIGE Nam of Gnaw: Carpondoa.PumenMp or Association l TSHRAmAN by4A.Fneouo TERRAN 12nuse as Attorney N Put Ry M ... .' PAH 0HITARI by MAIw OUD TE iRANL .s W Alto ss Annoy In Pea Ana STATE OF COLORADO COUNTY pdOFF WELDTbs r. of NOVEMBER,2002 BB MA UD A Swaim NN AS ATTORNEedged Y NEY IN FACT FOR HADI re me tlis Ids URANIAN AND MMAI(MOUD TEHRANIAN AS ATTORNEY IN PACT FOR PATNRH SONRADI wnt4t Smy bad Nw�ayw�I�ry r i�/�'i';',l. �� a A _. MP euWee ady6tb2.0. ,'�;;,t?• C aldII..11ddF,h__dd��— SI'ATH OP i; t u. 1721 St ave. QUEUE CO 50031 The J 6i.o r•i .. � COVNfY OF ft 3 teem* tchMWm n:willanowSdg before me bib day of rase �C� c/f k co sins (1m WaY.Ft )ofaermeralw or ocu aaaan,h*c(t)ee ouoxlad limn la plWdeumvkep.eeeaWaanee,y m a,Wumeamy of' 4rtls!iierP)oT petmue64:mbammimd ss.mrr(0otsssoclstlon) WITNESS we bad mad otRdd r E My ssmldd s apron Notary Pubic p 1951 UPDATE LEGAL FORMS WCTC No.201-L em's We 0Lt0T 2002-60-Nat JAN-08-2003 03 :07 PM P. 03 La Lass, a.a.', 232 ELIZABETH COURT, FT LUPTON, CO 80621 Form of Co-Owner:rip: (If there are two or more trustees named,they will be comideted to take as tesares In con nn twice the words'injdnt tenancy"or words of the serve meaning are added in the space below.) Property Daseelption (Include county and state.) The South 451.9 feet of the North 2,053.9 feet of that part of the E112 of the SEI/4 of Section 18, Township 6 North,Range 65 West of the 6th P.M.,lying west of U.S.Highway No.85 as the same is now located,together with right of ingress and egress over and across the property lying south of the herein described property. Property Address: 33131 HIGHWAY 85 LUCERNE COLORADO 80646 Consideration: (The natement of a dollar amount to optional,adequate conrideretion for this deed wda be presumed unless this conveyance Is identified u a gift, N any case this conveyance Is absolute,final and unconditional.) SIX HUNDRED NIFTY THREE THOUSAND SIX HUNDRED THIRTY EIGHT AND 69/100 ReservatiturReslrktloos: (If the GRANTOR intends to serve any interest in the property or to convey less than h awned.or If the GRANTOR Is restricting the GRANTEE'S right in the property,note appropriate Ind(catlon.) Additional Warranty ExeepUonm (Include deed.of net being assumed and other natters nos covered above.) DEED OF TRUST IN FAVOR OF MICHAEL E. BRANAND,IN WHICH GRANTEE(S)HEREBY AGREE TO ASSUME AND PAY. Executed by the Grantor on NOVEMBER 8. 2002 Sigeamre for Corporation,Parfneraklp or Aanclaaan: tore for In tilvldwl(sh Name of Grantor. Corporation,Partnership or Association HADI TEANIAN by AMMO EHRANIAN Grantor as Attorney in Fact By c �,n FATMEH SOHRABI by MAHMOUD TBHRANIAN es Attorney in Fact Attest STATE OP COLORADO e COUNTY OP WELD The foregoing instrument was acknowledged before me ' 8th day of NOVEMBER, 2002 By° MAHMOUD TEHRANIAN AS ATTORNEY TN FACT FOR HADI TEHRANIAN AND MAHMOUD TEHRANIAN AS ATTORNEY IN FACT FOR FATMEH SOHRABI • WITNESS my hand and.. _ p 0 tl� my commisslen axp(reae w O5 STATE OP `T \\\ 1221 8th eve, GREELEY CO 80631 COUNTY OF f(1, U. 1 The foregoing iWurent wpr eelfl awlddgf before me this day of By c +, (*name individual Gr i r f Grantor iacorporation,Partnership or Association,then Identify signers as president or vice president end secretary or assistant soo a ary of elation(or;up,Nner(q of partnership;or as authorised reemhar(s)of emaciation,) • ...'ter WITNESS my hand and official seal. Notary FPh6c My dommlaslon expires: p 1981 UPDATE LEGAL POEMS WCTC No.201•L Ferro W-9 Request for Taxpayer Give form to the (Rev.December 1996) Identification Number and Certification requester. Do NOT Department of the Treasury send to the IRS. lrternai i,levenue Service Name(If a joint account or you changed your name, see Specific Instructions on page 2.) Isidrio Rodriguez Business name,if different from above.(See Specific Instructions on page 2.) Please ! AFA "LLC" - or nt 'Cheek appropriate box: Individual/Sole proprietor Corporation Partnership [X Other ID. LLC type Address(number,street, and apt.or suite no.) Requester's nerve and address(optional) 513 E. 4TH AVE Isidrio Rodriguez City,state, and ZIP code LONGMONT CO 80501 513 E. 4TH AVE 1;i: z' Taxpayer Identification Number (TIN) List account number(s)here(optional) Enter your TIN in the appropriate box.For individuals,this is your social security number —! (SSN). However,if you are a resident alien OR a {Social security number sole proprietor,see the instructions on page 2. _ For other entities,it is your employer Y r identification number(EIN). If you do not have a OR •= " 'F' For Payees Exempt From Backup number, see How To Get a TIN on page 2. Withholding(See the instructions on page 2.) Note: If the account is in more than one name, Employer identification number see the chart on page 2 for guidelines on whose number to enter. `" Certification Under penalties of perjury,I certify that: 1. The number shown on this form is my correct taxpayer identification number(or I am waiting for a number to be issued to me), and 2. I am not subject to backup withholding because (a)I am exempt from backup withholding,or (b)I have not been notified by the Internal Revenue Seivice(IRS)that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c)the IRS has notified me that I am no longer subject to backup withholding. Certification Instructions. -- You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup withholding because you have failed to report all interest and dividends on your tax return.For real estate transactions, item 2 does not apply. For mortgage interest paid, acquisition or abandonment of secured property,cancellation of debt.contributions to an individual retirement arrangement(IRA), and generally,payments other than interest and dividends,you are not required to sign the Certification, but you must provide your correct TIN. (See the instructions on page 2.) Sign 1 Here Signature I► Ir Date > f ate-- d..N2 +Z Purpose of Foram.--A person who is include interest,dividends, broker and 5. You do not certify your TIN when required to file an information return with barter exchange transactions, rente, required. See the Part III instructions on the IRS must get your correct taxpayer royalties,nonempioyee pay, and certain page 2 for details. identification number(TIN)to report,for payments from fishing boat operators. Real Certain payed and payments are example,income paid to you,real estate estate transactions are not subject to exempt from backup withholding.See the transactions,mortgage interest you paid, backup withholding. Part II instructions and the separate acquisition or abandonment of secured If you give the requester your correct Instructions for the Requester of Form property,cancellation of debt,or TIN,make the proper certifications, and W-9. contributions you made to an IRA. report all your taxable interest and Use Form W-9 to give your correct TIN dividends on your tax return,payments Penalties to the person requesting it(the requester) you receive will not be subject to backup and,when applicable,to: withholding. Payments you receive will be Failure To Furnish TIN.-- If you fail to 1. Certify the TIN you are giving is subject to backup withholding if: furnish your correct TIN to a requester,you are subject to a penalty of$50 for each correct(or you are waiting for a number to 1. You do not furnish your TIN to the such failure unless your failure is duo to be issued), requester,or reasonable cause and not to willful neglect. 2. Certify you are not subject to backup 2, The IRS tells the requester that you Civil Penalty for False Information With withholding,or furnished an incorrect TIN,or Respect to Withholding .g.-- if you make a 3. Claim exemption from backup 3. The IRS tells you that you are subject false statement with no reasonable basis withholding if you are an exempt payee. to backup withholding because you did not that results in no backup withholding,you Note: If a requester gives you a form other report all your interest and dividends on are subject to a$500 penalty. than a W-9 to request your TIN,you must your tax return(for reportable interest and Criminal Penalty for Falsifying use the requester's form if it is substantially dividends only),or Information. --Willfully falsifying similar to this Form W-9. 4. You do not'certify to the requester certifications or affirmations may subject Is Backup Withholding? Persons that you are not subject to backup you to criminal penalties including fines What aking Bak payments you--must withholding under 3 above(for reportable and/or imprisonment minterest and dividend accounts opened Misuse of TINS.--If the requester withhold and pay to the IRS 31%of such after 1983 only),or q payments under certain conditions.This is discloses or uses TINS in violation of called*backup withholding.'Payments Federal law, the requester may be subject that may be subject to backup withholding to civil and criminal penalties CAA 8 CW91 NTF8S55 Form W-9(Rev. 12-96) Copyright Forma Software Only,15ga Nalco Form W-9(Rev. 12-96) Page 2 Specific instructions Part II--For Payees Exempt From and certain other income paid to you, Backup Withholding mortgage interest you paid,the acquisition Name.-- If you are an individual,you must Individuals(including sole proprietors)are or abandonment of secured property, generally enter the name shown on your - cancellation of debt,or contributions you not exempt from backup withholding. social security card. However,if you have Corporations are exempt from backup made to an IRA.The IRS uses the nhtrrtgera your lest name,for instenr;ct,rasp withholding for certain payments,such as numbers for identification purposes and to to loo riiege,without informing the Social help verify the accuracy of your tax return. interest and dividends. For more Security Administration of the name information on exempt payees,see the The IRS may also provide this information change, enter your first name,the last separate Instructions for the Requester of to the Department of Justice for civil and name shown on your social security card, Form W-9. criminal litigation and to cities, states, and and your new last name. the District of Columbia to carry out their If the account is in joint names,list first If you are exempt from backup tax laws and then circle the name of the person or withholding,you should still complete this form to avoid possible erroneous backup You must provide your TIN whether or entity whose number you enter in Pert I of withholding.Enter your correct TIN in Part not you are required to file a tax return. the form. I,write"Exempt"in Part II,and sign and Payers must generally withhold 31%of Sole Proprietor. --You must enter your date the form. taxable interest,dividend,and certain other individual Footle as Si*Wit on your w riial payments to a payee who does not give a if you are a nonresident alien or a foreign TIN to a payer.Certainpenalties may also :.Irity card.You may enter your entity not subject to backup withholding, pat business.trade.or"doing business as" apply give the requester a completed Form W-8, name on the business name line. • Certificate of Foreign Statue. Other Entities.--Enter the business name What Name and Number To as shown on required Federal tax Part HI --Certification documents.Thee name should mooch the For a joint account,only the person whose Give the Requester nomc shown on the charter or other legal TIN is shown in Part I should sign(when For this type of account: 1 Give name and SSN of: document creating the entity.You may required). Theindivid al enter any business,trade,or"doing 1. Individual I business as"name on the business name 1. interest,Dividend,and Barter 2. Two or more The actual owner of the line Exchange Accounts Opened Before 1984 individuals(joint account or,if combined and Broker Accounts Considered Active account) funds,the first individual During 1883.You must give your correct on the account 1 Part 1 --Taxpayer Identification Number 3. Custodian account of The minor 2 (TIN) TIN, but you do not have to sign the a minor(Uniform Gift certification. to Minors Act) You must enter your TIN in the appropriate 2.interest,Dividend,Broker,and 4. a The usual The grantor-trustee 1 box.If you are a resident alien and you do revocable savings not have and are not eligible to get an garter Exchange Accounts Opened After trust(grantor is SSN,your TIN is your IRS individual 1983 and Broker Accounts Considered also trustee) eyer idieiiiir iueiiun number(i T iN).Et Fier inactive During 1983.You must sign the b. So-called trust The actual owner 1 it in the social security number box. II you certification or backup withholding will account that is not a legal or valid do not have a i,TIN,eee How To{seta apply.If you ere subject to backup trust under state TIN below. withholding and you are merely providing law your correct TIN to the requester,you must 5. Sole proprietorship The owner 3 It you are a sole proprietor and you have cross out item 2 in the certification before For this type of account: Give name and SIN of: an EIN,you may enter either your SSN or signing the form. 3 EIN. However,using your EIN may result in 6. Sole proprietorship The owner tinnoco:car/noticos to the requester. 3.Rest Estate Transactions.You must 7. A valid trust,estate, Legal entity Q sign the certification.You may cross out or pension trust Note:See the chart on this page for further item 2 of the certification. 8. Corporate Ths corporation rlerification of name and TIN combinations. 4.vµvr oc.r.» 9. Association,club, The organization How To Get a TIN.--If you do not have a �•-olio.You must give your 9� rerigioue,charitable, correct TIN, but you de not have to sign educational,or other TIN,apply for one immediately.To apply the certification unless you have been tax-exempt for an SSN,get Form SS-5 from your local notified that you have previously given an organization Social Security Administration.office.Get incorrect TIN.'Other payments"include 10. Partnership The partnership Form W-7 to apply for an MN or Form payments made in the course of the 11. A broker or The broker or nominee SS-4 to apply for an EIN.You can get requester's trade or bl teiness for rents, registered nominee Forms W 7 and SS-4 from the IRS by 12. Account with the The public entity royalties,goods(other than bills for Department of calling 1-800-TAX-FORM merchandise), medical and health care Agriculture in name of (1-800-829-3978). services(including payments to a public entity(such It you do not have a TIN,write"Applied corporations),payments to a nonemployee as state or local govt. school For"in the space for the TIN,sign and for services(including attorney and or prison)tha district, (fate the form,and give it to the requester. ;czu tin^y foes), and payments to certain receives agricultural For interest and dividend payments,and fishing boat crew members. program payments certain payments made with respect to 1 List first and circle the name of the person whose ��n S.(Mortgage interest Paid by You, number you furnish.It only one person on a joint readily tradob! instruments,you will a „ono r A�ondo ,.t of S„ ,r` r ,terrtEly have IV days to net a TIN end r'�'— �� Scoured account has an SSN,that person's number must be �` Property,Cancellation of Debt,or IRA furnished. give it to the requester.Other payments Contributions.You must give your correct 2 Circle the minor's name and furnish the minor's SSN. are subject to backup withholding. TIN, but you do not have to sign the 3 you must show your individual name,but you may also Note:Witting"Applied For"means that certification. enter your business or"doing business as"name.You may use either your SSN or EIN(if you have one)• you have already applied for a TIN OR that a you intend to apply for one soon. Privacy Act Notice List sfi onst tut,nd too the name of the legal e estate, or pension trust.(Do not furnish the TIN of the Section 6108 of the Internal Revenue Code personal representative or trusts,unless the legal entity itself is nut aesignatea;n the account title.) requires you to give your correct TIN t0 pores who must file information returns Note:If no name is circled when more than with the IRS to report interest,dividends, one name is listed, the number will be .,one doled to be that of the first name listed. CAA 7 W92 NTF 855ei Copyright Forme Software Only,1997 Nalco Page l of 1 • ----- ; —1 rt '' .;.2...4'; .1-,) p —1----:"--1IIMIONOMOSIIIIIIIIIIIIIIIII s STATE �. ;45411it bR.A►DO • DEPARTMENT OF STATE CERTIFICATE 1,DONETTA DAVIDS0N,Secretary of State of the State of Colorado, hereby certify that,ac coding to the records of this office, AFA"LLC" (Colorado LLMITED LIABILITY COMPANY ) File/t 20011058465 was filed in this office on March 20.2001 and has complied with the applicable provisions of the laws of the State of Colorado and on this date is in good standing and authorized and competent to transact business or to conduct its affairs within this state. Dated:December 19.2002 • • Ay Validation: Cel a ate 1D: 6116110: To volktotorWs oertt cats,vfee the folkiwing wets sill,;anew Ma outtOOSds ID.thee Wow MO. hilt uctiOni dI Isy : .:... :www.aomistit•no uWtdld.1. .rtMosto <4 1 �►"' c•1 re.w...e. : r fink2-' ...4.4.4„,tez- .6;' i,SECRETARYSTATE ' http://www.sos.state.co.us/forte/corporation/images/docstmp/GS_20011058465.gif 12/31/2002 Mail to: Secretary of State For office use only Corporations Section - 04 1560 Broadway, Suite 200 Denver, CO 80202tu L`f r (303) 894-2251 MUST BE TYPED Fax (303) 894-2242 • `'Ftisrer FILING FEE: 510.00 MUST SUBMIT TWO COPIES Please include a typed self-addressed envelope CERTIFICATE OF ASSUMED OR TRADE NAME AFA , a corporation , limited partnership or limited liability company under the laws of being desirous of transacting a portion of its business under an assumed or trade name as permittec by 7-71-101, Colorado Revised Statutes, hereby certifies: 1 . The location of its principal office is: 33131 USA HWY 85 LUCERNE COLORADO 80646 (Include city, state, zip) 2. The name, other than its own, under which the business is carried on is: CLUB ROMANCE 3. A brief description of the kind of business transacted under such assumed or trade name is: Restaurant, food, dance, live music and entertainment. Limited Partnership or Limited Liability Corporations complete this section Companies complete this section. AFAL�LLC'' Name of Entity Name of Corporation byl �� dd �v �.. by Signature Signature • PRESIDENT / MANAGER Its Title, General Partner, or Manager Title Revised 7/95 • ARTICLES OF ORGANIZATION Form 7.80.204.1 revised 11/29/2000 Filing fee: $50.00 This document must be typed or machine printed. AS%b-Cusronr Cony If more space is required, continue on an 81/4"x11" attachment. oOLORA DosEa DONE ET A DAVIDSONAVIDSODeliver 2 copies to: Colorado Secretary of State, Business Division, - ' YOFsTA7` 1560 Broadway, Suite 200, Denver, CO 80202-5169 Please include a typed or machine printed,self-addressed, envelope. For filing requirements,see §§ 7-90-301 and 7-80-204, Colorado Revised Statutes:St... For more information, see the Citizen's Guide to the Business Division on our � _'•:AR`!' OF y Web site, http://www.sos.state.co.us Questions? Contact the Business Division: i_s` , 15 voice 303 894 2251, fax 303 8942242 ore-mailsos.business@state.co.us ABOVESPACEFOROFFICEUSEONLY The undersigned, a natural person eighteen years of age or older, intending to organize a limited liability company pursuant to §§ 7-80-203, Colorado Revised Statutes (C.R.S.), delivers these Articles of Organization to the Colorado Secretary of State for filing, and states as follows: 1. The name of the limited liability company is AFAIFLLC" The name of a limited liability company must contain the term "limited liability company", "ltd. liability company", • "limited liability co.", or"ltd. liability co."or the abbreviation "LLC"or"L.L.C."§7-90-60l(3)(c). C.R.S. 2. If known,The principal place of business of the limited liability company is 33131 USA HWY 85 Lucerne Colorado 80646 3. The name, and the business address, of the registered agent for service of process on the limited liability company are: Name Isidro Rodriguez ; Business Address(must be a street or other physical address in Colorado) 513 E. Fourth Ave Longmont Co, 80501 If mail is undeliverable to this address,ALSO include a post office box address: 4. a. If the management of the limited liability company is vested in managers, mark the box 0 "The management of the limited liability company is vested in managers rather than members." The name(s).and business address(es) of the initial manager(s) is(are): Name(s) Ts; guez Business Address(es) 33131 USA HWY 85 Lucerne Colorado 80646 or b. If management of the limited liability company is not vested in managers rather than members. The name(s) and business address(es) of the initial member(s) is(are): Name(s) Business Address(es) • 5. 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 //Isidro Rodriguez 51.3 E. Fourth Ave Longmont Colorado 80501 Organizer to + Signer's Name-printed Isidro Rodriguez vvvv (individual' signature) 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 Isidro Rodriguez address 331.31 USA HWY 85 Lucerne Co, 80646 voice 970-352-4203 fax e-mail Bia'41mer This Sued lmMbnt.rtm'mended n provide YFl.dein et um'dyke.is ire sftn a..e.Llk mice"iS.npmanlmloe censuring. WSI,IFi,ram i,baked u u:i,h nAm,mi, legal"q.imnml.a a retudon dm mppis.awith sppllabk WE...iM om may te amended from:Ism to 1is,.rtmu,u:e..wV.Uiill,of the taw of in.form, Quaib.OMWE Ie ad:®E Ia IM m.,,soon., LIQUOR/BEER RENEWAL REVIEW FORM Date: January 16, 2003 TO: Deputy 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: JANUARY 29, 2003 ESTABLISHMENT: AFA, LLC DBA ROMANCE NIGHT CLUB 33131 HIGHWAY 85 LUCERNE, CO 80646 Current license expires: JANUARY 23, 2003 No concerns =� a . 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 at Extension of the date and time of the Board of Commissioner's renewal hearing-h- MEMORANDUM To: Esther Gesick, Deputy Clerk to the Board February 3, 2003 wineFrom: Bethany Salzman, Zoning Compliance Officer, Dept. of Planning Services COLORADO Subject: LC0016 PIO Review of the following liquor license renewal by the Department of Planning Services shows the following: AFA, LLC dba Romance Night Club 33131 Highway 85 Lucerne, Colorado 80646 Zone District: C-3 This use is allowed through the zone district and existed prior to zoning. A "Nonconforming Use" (NCU) case file has not yet been initiated. No violations are occurring on the property at this time. �1 LV w r �-. -n Ls, lJ Co SERVICE,TEAMWORK INTEGRITY.QUALITY viki�.'T ('��Y 4 y•,....,,,„.:A. ',$.ti,,„.,...',:. 4 �,' r r,r 7 u r>L�5 '3f i's.°'4 IFE)clEc. 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Phone(v[�3)i )5- r7?3 e marc'cnOremioN rcade, �~ a.rnialebetl.nnPcodes , o�nrnidd Mends*rokh ord Nibmrr r� looslions Deis this shipment cesiSM ampere=pods? to allot 2 ,�r / • tine boa must o clucked.' Company a�o r`udo Oet riirwil! e 1 ?- 're/1IIE ❑No ❑Yes ❑ Yes El a lbnp.r,D I. Isto.no.u.son ,,°,1,12.c,:,...4 b Shippers Declaration netwrpied p/� OangeusdooMcann b.shipped'nRelspaekapnp. ❑ Cargo AircraROnly Address Are// h eri e $f rt e1 � '/YI /A? 7 Payment Bill to w.cannot&loorb-.boaasorP0.2IPcodes Oeptrflm—silseloom ----.-..... rni•rMedt:vkm:No orCre s ntNo.below------ Senderla Sorkin ❑Recipient ❑ Party Ill Per Credit Card ❑Cash/Check Acn,Nosi bs biad T daldn htornaon, Ras Am Ns , OMSe �/5 /y /� (y�,y /'/� � Oob I City LI e "ooze/ State (l/ I ZIP al /1•`c . • Toad Packages Total Weight Total Declared Valuer NEW Peel and Stick FedEx USA Airbill S AO See back for application instructions. taus Mry a NNW to OM A unless you doctorsa highervalos See back los details. FWD(Pee Only Questions?Call 1.800•Go•FedExe (800-463-3339} S Release Signature ,ntieaedb ,,,wp.ne.. Vick our Web site at www.fedsx.con3 By usingg lhiE Airbill yet Dproe m die Service conditions on the back dlga3 Airbill By Siplerp yet authoriee us to deMmfile shilmemuearout ohbnnq a eipnaWro 359 stud m our Curren Service Guide,including 1e1m5 fist liml our liablRy and woe to indemnity and hold us hornless trom soy resulting claims. 0095378134 SOS 359•IYr Dm r VSB•Pss nOee13s•o199s-i SisC•rreiilo IN US A ;�,.. � .. • • ISIDRO RODRIGUEZ 821a��°48 070 212 7 LUCILA A. IGLESIAS 4321126320 513 E. 4TH AVE. PH. 303-678-5125 J-�- LONGMONT, CO 80501 daeei f -.All� ' ROER OF: : O f 'O�ei $ 1 a4 1/ led-' fOwY I ‘0'. `1/4'//#�'�1.' 0#----- �fe 8 sae CO Community First doling•imenarr•Inwtrosm•Wealth Meugetaee Telephone Banking:1-800-414-2265 www.Com mu n ityF rst.com ' 'fv lip 6cQ-,,...e_. �, Hello