HomeMy WebLinkAbout20010436.tiff License Number License Type
DR 8400 (101951 LIQUOR OR 3.2 BEER LICENSE 24-85307-0000 2010
COLORADO DEPT OF REVENUE
LIQUOR ENFORCEMENT DIVISION RENEWAL APPLICATION Liability Information
1375 N ST
DENVER CO A 80261 03 206 005813 C 012299
Business Location
33131 HWY 85
ROMANCE INC LUCERNE CO
CLUB ROMANCE/LUCKY BAR Current License Expires
33131 HWY 85JAN 21 , 2001
LUCERNE CO 80646
PLEASE COPY FOR
YOUR RECORDS
❑ This renewal reflects no changes from the last Application for renewal must be filed with your LOCAL
application. Complete page 2 and file now! LICENSING AUTHORITY at least 45 DAYS PRIOR to the
❑ There are changes from the last application. expiration date of your current license
Complete and attach page 2 (DR 8401) and if a Exception: Wholesaler, manufacturer, importer, and public
corporation, DR 8177 - Corporate Report of transportation system license renewals do not need Local
Changes; or if a Limited Liability Company (DR Licensing Authority approval and must be returned directly to
8405). All other chances of ownership require a the Colorado Department of Revenue at least 30 days prior to
transfer of ownership application. See your Local me: cur;eni license exprra .on dale.
Licensing Authority immediately. FAILURE TO FILE THIS RENEWAL Al LtASI 4b
❑ Delivery Permit requested? Retail Liquor Store, DAYS PRIOR TO THE EXPIRATION DATE OF YOUR
Drug Store or 32% Beer - Combination On/Off LICENSE MAY RESULT IN YOUR LICENSE NOT
Premises Licenses ONLY. Check the box if you BEING RENEWED
want the permit to be issued
OATH OF gPPLICAIUT:::
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 Signat e Date I Business Phone
x � Ola/.t4-, yt
It IS 00 ��j'f(} 356-8a i
Title of Si ( rporation) Sales Tax Number
s t OkA -- tag-R C 30 1
REPORT AND APPROVAL OF LICENSING AUTHORITY
The foregoing application has been examined and the premises,business conducted and character of the applicant are satisfactory,
and we do hereby report that such license,if granted,will comply with the provisions of Title 12,Articles 46 and 47,C.R.S.
THEREFORE THIS APPLICATION IS APPROVED.
Local Licensing Authority for Date
❑ Town/City County
Signature I Title Attest
DO NOT DETACH DO NOT DETACH DO NOT DETACH
DR 8400 (08/951
COLORADO DEPT OF REVENUE LIQUOR OR 3.2 BEER LICENSE 21
L
1375 SHERMAN ST RENEWAL APPLICATION
DENVER CO 80261
Business Name LICENSE NUMBER(Use for an referencel RENEWED LICENSE EXPIRES AFTER
CLUB ROMANCE/LUCKY 24-85307-0000 01 -21 -02
TYPE OF LICENSE ISSUED CASH FUND STATE FEE
TAVERN LIQUOR LICENSE - COUNTY 85% OAP
MALT , VINOUS , AND 2320- 100( 999 ) 2010-750 ( 999 ) 2190- 100 ( 999 )
SPIRITUOUS
$ 25 . 00 $ 25 . 00 $ 425 . 00
SUB-TOTAL $ 475 . 00
ADD $75 . 00 TO RENEW RETAIL WAREHOUSE STORAGE PERMIT 2210- 100 ( 999 ) $
TOTAL AMOUNT DUE $
Make check payable to:Colorado Department of Revenue
X/-0`136 LC001
DR 8401 (0797)
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1881 PIERCE ATTACHMENT TO LIQUOR OR
LAKEWOOD,CO 80261
(303)2°5.23°° 3.2 BEER LICENSE RENEWAL APPLICATION
This page must be completed and attached to your signed renewal application form.
Failure to include this page with the application may result in your license not being renewed.
Trade Name of Establishment State License Number
1RDvrYY\CL) L chart C,u.6 Cel to ./btakl S+tr aU-R5307-0000
1.Operating Manager I Home Address Date of Birth� ` C,.. i&u OD X6651�lrt�tt�l 6�1u��rtgt.tvz � N r�Urd�vt Pll1 t
2. Do you have legal possession of the premises for which this application for license is made? Yes No
Are the premises owned or rented: 'e V\-C.Pt If rented,expiration date of lease: I3I 2003 '1
3. Has there been any change in financial interest(new notes,loans,owners,etc.)since the last annual application?If yes,explain in Yes No
detail and attach a listing of all liquor businesses in which these new lenders or owners,(other than licensed financial institutions)are
materially interested.
4. Since the date of filing of the last annual application,has the applicant,or any of its agents,owners,managers,principals,or lenders Yes No
No
(other than licensed financial institutions),been convicted of a crime?If yes,attach a detailed explanation.
5. Since the date of filing of the last annual application,has the applicant,or any of its agents,owners,managers,principals,or lenders
(other than licensed financial institutions),been denied an alcoholic beverage license,had an alcoholic beverage license suspended or Yes No
revoked,or had interest in any entity that had an alcoholic beverage license denied,suspended or revoked?If yes,attach a detailed
explanation.
6. Does the applicant,or any of its agents,owners,managers,principals,or lenders(other than licensed financial institutions),have a Yes No
direct or indirect interest in any other Colorado liquor license(include loans to or from any licensee,or interest in a loan to any
licensee)?If yes,attach a detailed explanation.
7. Ole owners or husband-wife partnerships answer this question.Since the date of filing of the last annual license application:
1�(\` Has ownership changed in whole or in part,from a sole owner to any other person,partnership,corporation,or limited liability Yes No
company other than the licensee listed on your state liquor license? If yes,this license must be transferred to the new owner and IA
\\\\\ �y may not be renewed.Contact your Local Authority immediately.
8.\'rtnership applicants must answer this question.Since the date of filing of the last annual license application: Yes No
„��\\17 a) Are there,or have there been any general partners added to,or deleted from the partnership?If yes,this license must be
transferred to the new partnership and may not be renewed.Contact your Local Authority immediately.
(b) Are there,or have there been any limited partners with a 10%or more interest,added or deleted from the partnership?If yes,this I,,{
license must be transferred to the new partnership and may not be renewed.Contact your Local Authority immediately.
9. Corporate applicants must answer this question.Since the date of filing of the last annual license application: Yes No
(a) Are there,or have there been any officers or directors added to,or deleted from the corporation?If yes,complete and attach
DR 8177 and submit tc your Local Authority immediately.
(b) Ale these,or have tiles been any siockhulders with 10%or n,ore of ii,e issueu sioek,added to,or Jeieted lion!the corporation?
If yes,complete and attach DR 8177 and submit to your Local Authority immediately. ❑ F I
(c) Date of filing last annual corporate report with the Colorado Secretary of State: .
1 mated Liability Company applicants must answer this question.Since the date of filing of the last annual license application: Yes No
\ a Are there,or have there been any managing members added to,or deleted from the company?If yes,complete and attach ❑
DR 8177 and submit to your Local Authority immediately.
(b) Are there,or have there been any members with 10%or more membership interest,added to,or deleted from the company?
If yes,complete and attach DR 8177 and submit to your Local Authority immediately.
(c) Date of filing last annual LLCO report with the Colorado Secretary of State: .
11` ri and Breakfast applicants must answer this question and certify compliance with 12-47-118.5 C.R.S.,to the state licensing
k\authority by initialing the following listed questions:
That it has no more than 20 sleeping rooms,and
That it provides at least 1 meal per day at no charge other than for overnight lodging,and
That it does not sell alcoholic beverages by the drink or in sealed containers,and
That it shall not serve alcoholic beverages for more than 4 hours in any one day,as follows:
MONDAY HOURS/1 TUESDAY HOURS WEDNESDAY HOURS THURSDAY HOURS FRIDAY HOURS SATURDAY OURS SUNDAY HOURS
From: 5'00 11. From:5100 Am. From:5-tr tom. From:5' m. From,Wp 11.11,,. From:5,00 From: 5'.(3:94M.To:1,00 Pm. To:,,yt)D\ m. To:--(ion`gym. To:l 10-0em. To V) '� 1n. To fl erd m. To: �,`(k)'t-Ph.
` c Lt laR r{-Eau( s 12. us cu 4it us S� '1'xtc- (-AC Lt.i S 2eveKsc_
'. (Avg \ i 30 fl
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