HomeMy WebLinkAbout820249.tiff RESOLUTION
RE : APPROVAL OF CHANGE OF OWNERSHIP REQUEST FOR FERMENTED MALT
BEVERAGE LICENSE FOR THE SALE OF FERMENTED MALT BEVERAGE
CONTAINING NOT MORE THAN 3. 2% OF ALCOHOL BY WEIGHT, FOR
CONSUMPTION ON AND OFF THE PREMISES ISSUED TO LILLIAN MEADS,
D/B/A CROW VALLEY CAFE, BRIGGSDALE, COLORADO 80611 - EXPIRES
FEBRUARY 23, 1983.
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, Lillian Meads, Crow Valley Cafe, Briggsdale,
Colorado 80611, ha5 presented an application for a County
Retail License for the sale of fermented malt beverages ,
containing not more than 3. 2% of alcohol by weight for con-
sumption on and off the premises, and
WHEREAS , pursuant to Weld County Ordinance No. 6 , Section
II . , C. , said applicant has paid the sum of $150. 00 to the
County of Weld for the change of ownership of the existing
license, and $7 . 50 for the County license fee, and
WHEREAS, said applicant has paid to the Dept. of Revenue
the sum of $67. 50 , pursuant to Section 12-46-117 (5) , CRS 1973,
as amended, of which sum, $42 . 50 has been paid over to the
State of Colorado, Department of Revenue for credit to the
Old Age Pension Fund pursuant to the requirements of Section
12-46-110, CRS 1973 , as amended, and said applicant has produced
a State Retail License for the sale of 3. 2% fermented malt
beverages for consumption both on or off the premises , outside
the corporate limits of any town or city in the County of Weld
at the location described as follows :
Section 20 , Township 8 North, Range 62 West
of the 6th P.M. , Weld County, Colorado
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 82-6 to said applicant to sell 3 . 2%
fermented malt beverages , only at retail at said location,
and does hereby authorize and direct the issuance of said
Page 2
RE : CROW VALLEY CAFE
license by the Chairman of the Board of County Commissioners
of Weld County, Colorado, attested to by the County Clerk and
Recorder of Weld County, Colorado, which license shall be in
effect from the 24th day of February, 1982 to the 23rd day of
February, 1983 , providing that said place where the licensee
is authorized to sell the 3 . 2% fermented malt beverages , for
consumption both on and off the premises shall be conducted
in strict conformity to all of the laws of the State of Colorado,
and any violation thereof shall be cause for revocation of the
license.
The above and foregoing Resolution was, on motion duly
made and seconded, adopted by the following vote on the 25th
day of January, A.D. , 1982 .
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
ATTEST: i r -
Join T. Martin, a rman
Weld County t lerk and Recorder / /J
and-tlyk to the Bard 4/ ' G
/ C ck Carlson, ro-Tem
-'D-eputy County Clem
Norman Carlson
APP VED AS TO FORM:
/7/27, tir
C`� c C W. Kirby /
County Attorney /
/faez,-2.7 c-,?2,e,/
e K. S einmark
DATE PRESENTED : MARCH 8, 1982
:4-,'.2.-.. 4t - •q'R Atr ^Ydy P 1
g
.).
,, ril 01 , ' , .3
I 1 5 r , ,t : .
, . . 4 , "..t....4...:;,:i.
V i!! .It
z: > DEPARTMENT OF REVENUE ,. .-
10 _
, tE A,
" 5 MEADS LILLIAN t'c`
0 �,,j £ r a cj " CROW VALLEY CAFE
r 7 _ %p s, SEC 20 T8R62W Efr
"' "P BRIGGSDALE CO 80611 ``
r" i •
--
I
3 . 2 % FERMENTED MALT BEVERAGE LICENSE f'
; k ``
YOUR LICENSE EXPIRES '� j
4, vy-�
3 {
..� USE LICENSE NUMREp FOR LIABILITY INFORMATION r" P •
0 • PEI
ALL REFERENCE CDUNiY CBA INDU4. R LIABIIO DAiE -�
r _
. % 14-214640-001 03 206 5411 1 022482 FEB 23, 1983 i;l't
T:li TYPE NAME AND DESCRIPTION OF LICENSE FEE -x +.i.K;t J 3.2 PERCENT BEER RETAIL LICENSE $ 25.00 , -
R COUNTY 85 PERCENT OAP FEE $ 42.50 . 3
-
%�
$ 67.50 < ,
3
4
EI TOTAL FEEIS)
3 THIS LICENSE IS ISSUED SUBJECT TO THE LAWS OF THE STATE OF
r COLORADO AND ESPECIALLY UNDER THE PROVISIONS OF TITLE 12, ddl.,;r.
>u ARTICLE 46, CRS 1973, AS AMENDED. '
S 1.'%• THIS LICENSE IS NON-TRANSFERABLE AND SHALL BE CONSPICU- � _(.)
:, ..e OUSLY POSTED IN THE PLACE ABOVE DESCRIBED. r
>}
IN TESTIMONY WHEREOF, I HAVE HEREUNTO SET MY HAND AND °
a
SEAL MAR 1 ICLL rIkt r
x •W -0
ii
...3:::t
4
DRL401 L (Rev9/79) EXECUTIVE DIRECTOR tl ..Q
rl 411.. I
/ ■J I11 y.s s"Tr 11r- •ti t E p.,..:•�F �w,�-.L;�EF..l.. f(�E��"�ti- �FF`��W�09— 1[� •O J ₹{l�EEELEb„-14et,0' 'VI".,W..m..?.
-�e t ,RR. y WA orptli `NSP '^^y l:--r^WPn. WR'+�P`1G t , p aEY' ttirr-
1 - .9w wN I w � w'N / +A ': J1• wN. Y ".v�- w
is N
riS:.II . • I ! J ,,:-;'- t,::;--7.
M1 a�r • A :
M1 I a .,A IIr ,, : t r •'• ' • a Of rI rI K+�l tt Ii M1r t a
r •r y ,i' r ' , rif ' '
°h
jrill
s 1 9 ' '4. 47 7 �{ „�'I j� y• �
S " >., rX i
I c ° lf II 404 rl t
' t /�(11<i) T1 ti N .-ti o^ �'.wH �' ./ , , �.. ttic -
! l `\,f � _3 G O 4 co: I 'qtr'' \G - r.7
M1 ^• cif y co y O� .l • . g•a en N O '2Y .LI i
e . ,,e' a.) ) 0 ..8 -O4 O, res 0) >, °
` nii
H C acn
yfr fli ' •2 ° ��,yy
o c c
-, ti rd, <a u `o
J o G) t v 4 o b i
C NI O m 1 W �+( . s rte 5 rte.
' .Jstu E Q C o ° co rrG6
T
X k‘''. . I..". ILit m w o g O C N a au
1 t ^" �° CI)
k ( . r r w �`'� '' v P. a a Ul y O
W I } F O p c� o u x ' v C.J ry
Y V .-4' al N
mom . W � � w � � �_., , 0r:: � N
O Co ii
M' am.��-.!' Fa may ' - 114
`fir' i� "a q .C b .� , :34�L,',₹,, , .; .„."-:r:',:.,..
�•r v] w
V) 'f.r- : CD
C cd !"-IPIN
A w a� Fy � rj.�' yy.t1� 1 ` v :..r' Q C4
} �'� v o o U O 16.:Ni
,r ' _.▪ �-J "kelit1 m j W a ° �, W drysIZ azr ,._ y' 4,'u.,� a ° room a: ` x�t.W� � - ti₹ ' E'" (r.�cu i
l '�� � U r�' §_ M1F4
:!::,, k r , I OIL Z7 Q `O iv ; J 9 'fin;} �" ! iW• r e i !ls4' .C 6> {� by O uS { r r, `.b� ST• Pc1, > ✓ E � o � � 2��`I �
•:1•7-1)...,: >. G 1�'1 [— .G w 43 z JJ �"'� .� U ,1 4- r�.`' (ij•ro a �,
tR, r M .-. u, Pil N N QJ CO a+ �,d'.1.Nif Xc ,N,--":;,•••• ,,, �M�y
O cC rri Lo w 'O . w t,1 ik Q i :411.C...3i
I �' iz
—I� H C m N .i ° .-C 72 G E d i ' ti t,,,dr� -:•� V1
�Y t• e _ .�...,� m cu .G O E. O m •0 1-1 m p : i 7r'r i. r 0,,, :._.:
b w+a u �' r 11 W y w N O +-' cd .. r +b �•t
1 / Iii
l "�
i �c .ar1 l,.I,₹ ) w f,. ti.:rC,4 f r i\�3♦ i!
4 k,c t ti� , r₹. �,, utiA 44 4. / M1 , d-$ y
�r? a ,, •• Ir ti ti\\�vi�I r' 45,,4 'a••ii 'u• 4-r^ t3 :/ ₹ ° , ₹' r r d'
�t rr •a=11 er rr 1 ,r I ,r.I Y `Z•' I .t 1''I....1'.0:1:0.-5,::.;;;(
�. •M1 .- ✓₹ •..a e ₹ tq,,b:.;
1 ! ', -r 1. r r .
\4`L>"-�1J3�V.":...::; �, r- ~�,:..., ,5..i •ice • ,3' I' r ,r r i ``y(Y . II. u .4„:1--
STA T�OF COLORADO •
DEP.aRTMEN't•.OF REVENUE r
LIQUOR ENFORCEMENT SECTION
i7 Date of Issuance: 1 FMB License Number: Expiration Date:
APPLICATION FOR A FERMENTED MALT 3EVERAGE L CENSE .; i
This application,and all applicable fees and att'tchrnents, nvst!;= `' rl'Ai -r'hose tatail:i a:t;ai C;eccr't: t it,L.—dumn A.below,this application
the Colorado Department of Revenue.Lq ,or=r,iorrom,tnt Ul.•rsion, I :rust Fi'?Sl' ii! ';'...1 WITH A'1:l APPROVED ElY THE LOCAL
State Capitol Annex,1375 Sherman;;tree:, ^I•:1'•! iP:„; 1;+'.:'.'T'•�_
Denver,Colorado,80261, (3031830-3 741.
`•:1PORT:INT: • •.',:k ::i,:.1L';' ';r..:t.;rips t.+' I:rr type of licensefs)
Each applicant (including all generar and over!V•I•mited partners in
,..11.!.1pol•:,1.•i:. .:,;t:,r'r;i..., .r•l,:i'.i!it'in.;.:it a copy must be
partnership and all officers,directors arts:over stoc;;llolders of a
corporation)and managers must complete and file form i.)11L 404-r :pt in limn :.I(s or r erencr when.:npiy,nq for renewal licenses.You may
"Individual History Record" in nuplica:e,with trl'n application. • .tt-.;h'••Ttl'ir:it'!',ht",•ts r:'::r!dirior.:,l documents if necessary to fully complete
auptiitat:on.
COLUMN A fate State
_er.al I .,;;LUMN I?
Fees Fees I Fees
❑RETAIL 3.2%BEER: FERMENTED MALT 546.25 3 3 75 I • •:WHOLESALE.L2';BEER I-;^,ENSF' ;100.00
BEVERAGE LICENSE-City I
BZRETA:L 3.2%BEER: FERMENTED MALT $67.50 $ 7.50 I _MANUFACTURER'S 3.2%BEER LICENSE' $100.00
BEVERAGE LICENSE—County I
•
❑CHANGE OF CORPORATE STRUCTURE OR LOCATION i
❑OTHER (Specify)
The undersigned hereby makes application for a state license as indicated airy!,under the.! vovisicrl:: Title 12,Article 46,CRS 1973,as
amended,and for that purpose makes the following answers to the questtnr,.container! In t:!:s;amulic.rt:cn. [Very aniliicahle question must
be answered. Any false answer or statement made by the applicant heroin:;r in :in a;thcilrrlrnt hereto constitutes periury and the person
making such false statements subjects any license issues: Ilereir: to rcyos,,iitir rs 1- ....
ALL ANSWERS MUST BE PRINTED IN SLACK INK for typewritten)
1.Name of Applicant(s): Social Security or Taxpayer I.D.Number:
2. Trade Name of Establishment: 1 E'usimess'Telepholie:
I
PO WV AL I, e u e �# f ,4/dA/e._
3. Address of Premises: (Exact location of pram es must be given.Give street arid number,when possible.If place to be licensed is located in a town or rural
district where it is impossible to give street and number,the lot and block number or part of section where located must he given.)
_Sed T2-O T-1 /7 4.2 lv
CIT COUNTY: i ..TA-1-tiL'P CC)DEr
. �- d eDLo,x,40v poh //
4. aili ddr ss: (Number J and Street)
C X Z — —
City : / I)gall: I....ip r.t i10,
V h ...
wq £o✓A Le ...- - (2 &,o RAD o I ka
5. Are these premi s/low licensed under the State Liquor or Seer Code? If answer is"yes",to whom is the license icsuen?
AYES ENO _ -
i
Trade Name of Establishment : State License No.: Tt,pe-f i-'cense:• /Red Expiration Da f/'�
crow V Id j d.4 f /y-/67.22- o '/ 3- fe, ,rocic�C�%%� /./A2,
6. Does the applicant have legal pr ession of the premises for which this application for license is made?If an sorer is'"no",explain in detail:
IKYES ENO
7. Are the p'smises owned or leased? I I'leased,from whom?
❑OWNED EASED
Attach copy of deed,lease or contract,and int rior plans and specifications of building,if built,or if not built,attach plot plan,interior sketch
nd architect's drawing of the building to be constructed.
8. If this is a transfer of location,on wriat date ao you plan to move?
9, Has the applicant filed a Form 11 waft the Internal Revenue Service?If answer is"nO",explain in"eiari.
EYES XNO t .0
_d: i.t- /414 4" L .' 'G.v /' L ' (r., e,v.c
10.ls applicant;or all over 5%partners;or officers,over 5%stockholders or directors of thekorporation;citizens of the United:,;sates? If answer is-no",give
name and Alien's Registration Card Number and Premanent Residency Card number.
DYES ENO
11.ls the applicant;or any of the over 5%partners;or officers,over 5%stockholders or directors of said applicant(if a corporation);or manager of applicant;
under the age of eighteen years?
EYES IXNO
12.Has the applicant;
any of the over 5% partners;or officers,over 5% stockholders or directors of said applicant(if a corporation);or employees of applicant
orsp
or persons lending assistance or financial support to the applicant;ever been convicted of a crime? If answer is"yes",explain in detail.
L2�IYES NO .(-.1) ha L. •N E• z
13.Has any person,as applicant,partner,officer, Difertor,stockh&er or employee,ever.
(a) been denied an alcoholic beverage license? V ES NO(b) Had an alcoholic beverage license suspended or revoked? EYES XtIO
If the answer is"yes"explain in detail; (Attach separate sheet if necessary.)
14.Does the applicant have a Colorado State Sales Tax Account?If answer is"yes",give the Account number.
E1Y ES [XIVD
15.Do the applicable zoning laws permit�( bee
the sale of alcoholic beverages on 16 n rFermtl within ted Malt
Beverage
erecedn one year?licensefo the same location pp��
the licensed premises? [r]J YES ❑NO LJ YES NO
17.Does or did the applicant;or any of the partners:or officers,directors or stockholders of said applicant(If a corporation),have a direct or indirect interest
in any Colorado Liquor or Fermented Malt Beverage License(include loans to or from any licensee,or interest in a loan to any licensee)? If the answer is
"yes" ,explain in detail.
flYES FNO
18. Identify the persons,firms or corporations who now or will have,a financial interest,evidenced either by loans or equity ownership in the business for which
this license is requested.State the names and addresses,and the amount and source of such financial interest expressed in donars or other items of value,such
as inventory,furniture or equipment.(Use separate sheet If necessary)
NAME: ADDRESS: INTEREST:
•
19. List the names and addresses of all businesses in which any of the persons in the previous question are materially Interested.(Use separate sheet if necessary):
NAME: BUSINESS: ADDRESS`.
Attach copy of all notes and security instruments,and any written agreement or details of any oral agreement,by which any person(including a corporation)
will share in the profit or gross proceeds of this establishment,and any agreement relating to the business which is contingent or cond.tional in any way by
volume,profit,sales,giving of advice or consultation.
20. If the applicant is an individual or partnership,answer the following: (Attach separate sheet if necessary)
INDIVIDUAL PARTNERSHIP '
(a) Name of individual or name and class of each Home address and city:
Date of Birth: io of ownership:
partner:
(h) Name of Manager: Home address and city: Date of Birth:
(c) If partnership,when did said partnership commence doing business? (Attach a copy of the partnership agreement (except husband and wife) and trade name
affidavit)
21,If the applicant is a corporation,answer the following: • Date'
(a) Corporation is organized under the laws of the State of: '
Ibl Principal business is conducted at:
County of. State of.
(c) Date of tiling last annual corporate report to the secretary of state:
Id)Name of each officer listed below'.
HomeAddress and City: Date of Birth:
President:
Vice-President:
Treasurer:
Secretary.
Manager:
•
Page 2
g i 0
� a.
o PJ \____.________
1 CON .. _ _
(/--D w 5 4
CD Q 4-•1
� ` 7 Z z In U U y '.+U.1 wl:.TrL u U O N W
Z ' �O W W L , r r_iiF— Q.,o � rl i Z 'W w. F % rc 33IAU3S 1dI31.1I Min taH :.
C4
Q Z Z O r-I'r 3'r ;1,,
, I" S3VOiS 11046u i;
wc, ti r'I I:W 0'0 N U �- - ..
a () w•rl'¢ -1,o S••t g S33I B03 N?1SutkiSl$ .mcNr_'__ -
Ua,uiUaGp �-CC co
3 ,rte a E' V .73,rie4 u y u y y O O 4 4 y I
i
rv� y3"7, b Y' E4,
rd W O °1711 00 IA. i �
� � .a rbta • '-'1 ',1 i.... C] r� Jw N �4 3 u
oo : 3 3ch
g ,,qt�yO vy�� GsttIfli
ti LC W W J
0100DD 0
rI 6
3 r R a, a o a 3
a H O •H a
,I f i 6-I a
Ia U G4 M e L6 m
orm d , an. 09 RETURN RECEIPT,Fitt41STERED,INSURED AND CERTIFIED MAIL
(e) List all stockholders: Include actual owner or pledgee. (Use separate sheet if necessary)
Name of Stockholder: Home Address and City: %of stock; Date of Birth:
(f) Names of a”Directors or Trustees Home Address and City: I Date of Birth'.
of Corporal..on
-
IAttach a copy of the certificate of incorporation,the articles of incorporation,stock certificates,the authority to transact business in Colorado (if a foreign
corporation), and the corporate minutes authorizing the filing of this application and electing the current officers and directors,or trustees).
When did applicant purchase this business,or if new,when does applicant plan to begin operating this business? If purchased,from whom?
If the applicant is a manufacturer,or wholesaler,answer the following;
(a) Does applicant own,lease or operate any warehouse or storage plant in connection with its business? (If"yes",give full address)
HYES Li NO
(b) If the applicant is a manufacturer,does any owner,part owner,shareholder,director or officer have any direct or indirect financial interest in an importer,
manufacturer,wholesaler or retailer already licensed by the State of Colorado to self fermented malt,malt,vinuous or spirituous liquor? If answer is"yes"
attach explanation in detail.
nYES nNO
(c) If the applicant is a wholesaler,does any owner, part owner,shareholder,director or officer have any direct or indirect financial interest in a wholesaler,
retailer,manufacturer or importer already licensed by the State of Colorado to sell fermented malt,malt,vinuous or spirituous liquor? If answer is"yes"
attach explanation in detail.
'YES L.—NO
(d)If the applicant is a foreign wholesaler to what licensed wholesaler in Colorado does he intend to ship his merchandise?
(el Does the applicant have a valid Federal Basic Permit? If "yes",attach a copy of the permit; if"no",explain in detail.
nYES InNO
AFFIDAVIT
This affidavit is to be signed and acknowledged by individual,each general partner or partnership and by corporate applicants.
STATE OF COLORADO
COUNT SS
COUNTY OFCj
.i! ", � sr" AND
being by me first.duly sworn, if for himself, deposes and says: that he is the applicant above named, or a partner,or that he is
(title) of the above named corporation;that he has read the foregoing application and attachments, and
that he knows the contents thereof, and that all matters and things therein set forth are true of his own knowledge and he agrees to conform
to all the rules and regulations promulgated by the State Department of Revenue in connection therewith.
SUBSCRIBED AND SWORN TO ME INDIVIDUALS AND ALL GENERAL PARTNERS OF PARTNER-
SHIP MUST SIGN HERE:
This ,) ,f day of j�: ,h 11w19 1
Signature of Notary Public
(ATTACH SEAL)
f.
My commission expires: CORPORATION SIGN HERE: (Corporate Seal)
By:
(President,Vice-President,or Secretary)
REPORT AND APPROVAL OF LOCAL LICENSING AUTHORITY
(MANUFACTURERS AND WHOLESALERS DISREGARD THIS SECTION)
The foregoing application has been examined and the premises, business conducted and character of the applicant is satisfactory,and we
do report that such license, if granted, will meet the reasonable requirements of the neighborhood and the desires of the inhabitants, and
complies with the provisions of Title 12, Article 46, CRS 1973 as amended.
CRS 1973,as amended, 12-46-117 CHECK ONE
(1) (a) The local licensing authority shall restrict the use of said license to:
(I) Sales for consumption "off"the premises of the licensee;or
(III Sales for consumption "on"the premises of the licensee;or ❑
(III) Sales for consumption "both on and off"the premises of the licensee. ❑
(b) The provisions of paragraph (1) (a) shall not apply to any license issued or applied for under
this article prior to July 1, 1967, nor to any renewal or reissuance thereof.
THEREFORE THIS APPLICATION IS HEREBY APPROVED.
•
J/,
DATED AT: I .Ci-fIC%A THIS ) DAY OF I '� (({�-iT/ ,A.D. 19 .7:
l 1
AT: 7/(1 7(.' r
(Name ikelwn,City and County)
BY: ,/ Z 2/LZ 4CT/
(M of;Chairman of Board of County Commissioners or other title t of the licensing authority.)
i i J/LC( 1 t �`_/ ,- i , �% , ( 0 ty County Clerk
ATTEST: 1 f
(Clerk, cretary or other officer haying the offici]I seal ch the licensing authority.)
If the premises are located within a town or city, the above approval should be signed by the mayor and clerk;if in a county,then by
the chairman of the board of county commissioners and the clerk to the board. If, by ordinance or otherwise,the local licensing authority
is some other official,then such approval should be given by such official.)
age 4
APPLICATION FOR 3. 2%
FERMENTED MALT BEVERAGE LICENSES
'9
Date
TO THE BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY, COLORADO :
The undersigned hereby makes application for a County Retail 3. 2% Be-:::7:age License.
1. Name of Applicant (s) L .'i kr A ..zZ____ A d ---------------
2. Home Address of Applicant (s) .3 O / 47 /L To A/ -S r - P e f -
3. Trade Name ( J r 0 ) V A L,[ e y (.¢f
4. Business Telephone r. r =%
5.. Home Telephone Number (s) Jay- .?.?"//
2
6. Business Address h ,' g :S S 14 4 e, L o ,L o SPA .E o
7. If Partnership, give names of partners; if a Corporation or Club give names of
principal officers
(Attach list if necessary)
8. Check the appropriate line for the type of retail license being applied for:
For Sales for consumption OFF the premises of license only.
For Sales for consumption ON the premises of licensee only.
For Sales for consumption ON and OFF the premises of licensee.
9. EXACT LOCATION OF PREMISES. Give street and number, lot and block number or range,
township and section (identify quarter section) .
Sic a 7-- z w
10. Do you have legal possession of the premises for which this application for license
is made? !/ S _
11. Are the premises owned or rented? If rented or leased, from whom?
',he/4 ty , cf
12. State nature of business conducted: ti/r ¢ 3 -4 ,fie_ e h
13. If restaurant, state whether other business is conducted except sale of food, meals,
drinks and tobaccos:
14. If club, state whether operating for a national, social, fraternal, patriotic, political
or athletic nature:
15. If club, state whether it is for pecuniary gain:
16. If club, state whether the property and advantages of club belong to members:
17. Is applicant(s) or all officers of the corporation a citizen(s) of the united States?
18. If applicant is not a citizen of the United States, specify which country:
19. Has applicant(s) a state license for the sale of 3.2% fermented malt beverage? /v40
20. Has applicant(s) ever been convicted of a felony? /110
Page 2
Application for 3. 2%
21. If answer to question 20 is "yes", give full details:
22. Has applicant been adjudged guilty by a court cf record of violating the laws covering
the prevention of gambling under Y/the laws of the State of Colorado, or under the laws
of the United States? / O
23. If answer to question 22 is "yes", give full details:
24. Will applicant(s) permit any wholesaler or manufacturer to be interested financially,
by loan or otherwise, in applicant' s business? A/
25. If answer to question 24 is "yes", give full details:
26. Will applicant(s) use any equipment, fixtures, chattles, decorations or furnishings
supplied or loaned by any manufacturer or wholesaler? N n
27. Is answer to question 26 is "yes", explain:
The applicant hereby agrees, if license is used for sale of 3.2% Fermented Malt Beverage
only, as herein requested, the place of business used therefor will be conducted in strict
conformity with all laws of the State of Colorado, and the rules and regulations of the
Board of County Commissoners of Weld County, Colorado, relating thereto, and any conviction
of violations of said laws, rules and/or regulations shall he cause for revocation of such
license, without further hearing thereon. The applicant(s) further agrees that he, she
(they) has/have full knowledge of the aforesaid state laws and Board rules and regulations
existing at the date of this application and agrees he, she (they) will keep advised as
to all subsequent state law, Board rules and regulations, that may be hereafter passed
relating thereto during the term of said license.
Applicant k)
STATE OF COLORADO )
COUNTY OF WELD ) ss.
Cd✓ ji�� c �✓ - �C being first duly sworn on oath, deposes and says:
'That he, she (they) is/are the applicant(s) above named: That he, she (they) has/have
read the above and foregoing application and the answers made thereto, and well knows the
contents hereof, and that the answers made to the interragatories therein set forth are
true to his, her (their) own knowledge.
Applicant(a;)
Subscribed and sworn to before me this
day of _`,�G, _.r 1 , A.D. 19 ,C'/
Deputy County,Clerk
Notary Public
DRk 404.1 (6/791
STATE OF COLORADO
DEPARTMENT OF REVENUE/LIQUOR ENFORCEMENT
INDIVIDUAL HISTORY RECORD
To be completed by each individual applicant,each general and over 5% limited partner of a partnership, each officer, director,and over 5%
stockholder of a corporation,and the manager of the applicant.
NOTICE
This Individual History Record provides basic information which is necessary for the licensing authorities' investigation.ALL questions must be
answered in their entirety. EVERY answer you give will be checked for its truthfulness.A deliberate falsehood will jeopardize the application
as such falsehood within itself constitutes evidence regarding the character and reputation of the applicant.
1.Name of Business: Date: Social Security Number:
h c w U ,4- 41- ,4 e -5:;&-41.2-
2. Your Full Name' (last/first/middle) 3.Also Known As: (maiden name/nickname/etc-)
1,•c- 4/ 41. 1A A/ %f e,4 s 1 , ,`4 4' /Me Ad S
4. Height: Weg!ti: ;Hair Color: Eye Color: Sex: Race: �^ 5. Do you have a Colorado
Colorado Drivers License?if"YES",give number:
• I.L±o v 2i,d id/Y ie./1?.L@ kA /Pr WtYES ONO _ 7 .1/0 2.
6. Your Relationship to Applicant: (sole owner/partnef/corporate ofticer/director/stockholder or manager)
1. If Stockholder, Number of Shares Owned Beneficially or of Record: Percent of Outstanding Stock Owned:
8. If Partner State Whether: Percent of Partnership Beneficially Owned:
OGENERAL LIMITED
9. Residence Address: (street and number/city/state/zip) r�
?a Z/i/ 4-7o it1 ,S Th e iii b 6 (Po s�//
10. Is your residence: If rented,from whom?
OWNED RENTED
11.Mailing Address, If Different From Residence:
/if
12. Name of Present Employer: 13. Type of Business of Employment:
/Lic 'C\ �
14- Address of Business Where Employed: (street and number/city/state/zip)
{� o jL e- Lt;; f e-
15.Present Position: 16. Home Telephone: Business Telephone:
f3/- .23y
17. Date of Birth: Place of Birth:
18. U.S.Citizen?: If naturalized,state where: /7^ When: Name of U.S. District Court:
KYES ONO
Naturalization Certificate No.: Date of Certificate: If an alien,give Alien's Registration Card No.: Permanent Residence Card No.:
•
19.Marital Status: 20. If spouse is a wife,wife's full maiden name:
/AHrreci
21.Spouse's Date of Birth: Place of Birth:
A Gt'k r icy
22. If spouse's residence address is different than yours,list here,. (street and number/city/state/zip)
23. It spouse works,state name of present employer: Occupation:
�/J9 yLO) / 141- Met- A4 /lc II t?
Address of present employer:
•'1! _ A'
24. List the name(s) of all relatives working in the liquor industry,giving their:
Name of Relative: Relationship to you: Position held: Name of employer: Location of employer:
�vcrQ.
Name of Relative: Relationship to you: Position held: Name of employer: Location of employer:
25. Do you now,or have you ever held a direct or Indirect interest in a State of Colorado Liquor or Beer License? If"YES",answer in detail.
DYES pi,NO
X16, Do you now,or have you ever had a direct or Indirect interest in a liquor or beer license,or been employed in a liquor or beer related business outside ofthe
State of Colorado?If"YES",describe in detail.
OYES ANO
27. Have you ever been convicted of a crime,fined,imprisoned,placed on probation,received a suspended sentence or forfeited ball for any offense in criminal or
military court?(Do not enclude traffic violations,unless they resulted in suspension or revocation of your driver's license,or you were convicted of driving
under the influence of alcoholic beverages.) If"YES",explain in detail.
DYES ❑N O —c h s p 1...•1 ! ,'iv &.:" - h?k h.
28. Have you ever received a violation notice,suspension or revocation for a liquor law violation,or been denied a liquor or beer license anywhere in the U.S.?
If"YES",explain in detail.
OYES ISNO
29. Have you ever held a gambling or gaming license or owned a Federal Gambling Stamp? If"YES",explain in detail.
DYES c,NO
State/Federal: Year: City: State:
State/Federal: Year: City: State:
30. Military Service: branch: 'From: 'To: Serial No.. Type of Discharge:
31. List all addresses where you have lived for the last five years.(Attech separate sheet if necessary)
Street and Number: City/State/Zip: From: To:
r'L 7 in..L t D AJ -S 1"-N e 7" h,'1 L c d 1 A ti le ��c// /775;5- /fi'e
Street and Number: ity/Star b ip: From:
To:
1 !_* Y.
32. List all former employers or businesses engaged in within the last five vears: (Attach additional sheets if necessary)
Name of Employer: Adoress: (street and number) (city/state/zip) Position Held: From: To:
3r,yj.sd.,� 0%A.I, L�. R a J 2 3 ir';ff.(ci A kg i.g c. �E� a,KKeodA ch !r -4 /r/75-'
Name of mployer: Address: (street and number) (city/st t /zip) Position Hel From: To: ,73
t_a)tS e.d �'6// // e7•u•v e. 6
�h. cdq`v 'AFa j%5'/�' A .v V1Te St,iII,ceiA o 1 oi-cRA00 ["ooK t !fd, IIda/
33,/Kist the nags and attach letters of recommendation from three persoris/who can vouch for your good character and fitness in connection with this application.
Name of Reference: Address: (street and number) (city/state/zip) No.Years Known:
,. /L/.1J /' •,
)L t. j 1-
' ,1-4".‘C" 0:"."-'4:4,;i�.tr—rte .C.-, -�-4; '4 - 4.8 _.5 r
Name of Reference: Address: (street and number) (city/a e/zip) No.Years Known:
f03/1.) Lii'c`plA t- S R • x / G /�y 4t.i",:G; er4Aki' ' I.t.. .i-.,c11 , ' 0
Name a Reference:
Address: (street and nLm1ler) (city/state/zip) ' No.Years Known:
L.—
'.-.I I` I— L' 4 Ina Ai 1)r r 4'6' S 1),4 L;, ;. :L v i'?cJ/ ,-"L4--
. -,
STATE OF - ''Wit .--" h
SS.
COUNTY OF -'"/ C'(s."—
—
I understand that a false answer to any of the foregoing can subject the application to denial or a license to revocation. I certify that all of the
information in this Individual History Record is complete and correct to the best of my knowledge and belief.
Subscribed and sworn to me
this E' __ day of -s r C`ti•k ..1-''`• i9 'C./ . ._,Z2,Z. ,Z.,2, - ajlorf (/��
sigrature
WITNESS my hand and official seal.
(ATTACH SEAL)
My commission,expires: •'v ,-�''• ' ' , y '(:
• ie- •L._ez-c— .• .,y-GG vc..t..e./
• )i -
Notary Public
/ - 7`1.
,---11/6
It L 7 6 ,)2.1
) . , _3, 2Cirkni-
I /
1":712 � �
r i,' o ' - ., plea .
, r I a�<.l<<� J� cr.,-, c. (7)4,,ry C
c Zr z ( C,1/4 (.c �e c
ps! z
/� 1 att Gic9 4D
4 / %e f/
<(5--‘i 3 5---f � 1� L f�rzti C�
A1/4 1/4y±:-:
i
Awe -_.,{, `9--z L -il a z/,
„ .Cti /.cwt
/
G��9 4/ 1
G,� 3 ya'cd,47 .6/74 %,,s-07
adie As, 471., ,,a4
47t
IA - 4# 4,/ 1
A 4 dfrafee
40v . / -evatoyii-eit "ad
,hie "Isar
.b�v" A'� r ad
4 A/di ,7„1
id/zia at, A #
d .zt,e, le
#07, may^
No. 990. Denver Reel Estate Exchange Pi,..a. Short Perm
—Bradford Publishing Co..162416 Stout Street,Denver.Colorado --8-77 Denver Insulates torn of lease
Subtentdaliy as adopted by
The D Real Estate Exchange and
The D Building Owners and Managers Aseeelatis
BUSINESS LEASE
THIS LEASE, Made and entered into this 18th day of November , A. D. 19 81 , between
MARY MAXINE VIEFHAUS hereinafter called the
Landlord, and._......_.. _ LILLIAN MEADS hereinafter called the Tenant.
Wherever the words "Landlord" and "Tenant" are used in this indenture, they shall include Landlords and Tenants
and shall apply to persons, both men and women, companies, co-partnerships and corporations, and in reading said
indenture the necessary grammatical changes required to make the provisions hereof mean and apply as aforesaid, shall be
made in the same manner as if written into said indenture.
WITNESSETH, That, in consideration of the payment of the rent hereinafter provided and the keeping and dI
performance of each of the covenants and agreements of the said Tenant hereinafter set forth, said Lapol rd has and does le I V
hereby lease unto the said Tenant the following described premises situate in the_Gligsrod County of D Merin the State of \\\\\\
Colorado to-wit. Part of the SE1/4SEq Sec. 20, Township-_8North, Range 62 West of the
6th P.M., Weld County, Colorado, known as the Crow Valley Cafe at Hwy 14 $
County Road 77 Bri sdale Colorado
z ....
the r
TO HAVE AND TO HOLD the same with all the appurtenances unto the said Tenant from twelve o'clock noon on the
15th day of January , A. D. 19.....8-3.... for, during and until twelve o'clock noon the
15th day of January , A. D. 19 83 at and for a rental, for the full term afore-
said of Nine Hundred and No/100 ($900.00) dollars payable in
monthly installments of seventy-five and no./100 ($75.00) dollars per month,in advance,on or before
twelve o'clock on the 15th day of each calendar month during said term,at the office of
Mary Maxine Viefhausa Briggsdale Haifa Colorado, without notice.
This lease is subject to the condition,however, that the Lessor].Lau and will cause to be paid
promptly all assessments for water rents that may be levied upon said premises during the continuance of this lease•
This lease shall include all equipment presently on the premises, the repair of
which shall be the responsibility of the Lessee-Tenant.
FOR AND IN CONSIDERATION of the leasing of said premises as aforesaid, the said Tenant does covenant and
agree as follows,to-wit:
To pay the rent for said premises as hereinabove provided promptly when due and payable; to pay any and all charges
for heating and lighting said premises; to keep all the improvements upon said premises, including all sewer connections,
plumbing,heating appliances,wiring and glass,in good order and repair at the expense of said Tenant, to order no repairs
at the expense of the Landlord, to.keep said glass insured at the expense of said Tenant; and, at the expiration of this
lease, to surrender and deliver up said premises, including all heating appliances, plumbing, sewer connections, wiring
and glass,in as good order and condition as when the same were entered upon, loss by fire, inevitable accident or ordinary
wear excepted; to sublet no part of said premises, nor assign this lease or any interest herein, without the written
consent of the Landlord first being obtained; to use said premises for no purpose prohibited by the laws of the United
States,the State of Colorado,or the ordinances of t1iR3tx7aYltX�pn> X&atteacc now in force,pr. hereafter enacted, and
Gown o ri sae 4 County of Weld
for no improper or questionable purpose whatsoever, o occupy the s as a......._......-.....-......._..............------......_......_.....
Cafe ....; keep the sidewalks in front of and around said premises free from ice and
snow, d said sidewalks s a d free•
and said and premises free from all litter, dirt, debris, and obstructions; to keep said premises clean and in
the sanitary condition required by the ordinances and the health, sanitary and police regulations of the City and County of
Denver; to neither permit nor suffer any disorderly conduct, noise or nuisance, whatever, about said premises having a
tendency to annoy or disturb any persons occupying adjacent premises; to neither hold nor attempt to hold the Landlord
liable for any injury or damage either proximate or remote occurring through or caused by any repairs, alterations, injury
ur accident to above demised premises, to adjacent premises or other parts of the above premises not herein demised,
or by reason of the negligence or default of the owners or occupants thereof or any other person, nor liable for any injury
or damage occasioned by defective electric wiring, or the breaking or stoppage of the plumbing or sewerage upon said
premises or upon adjacent premises, whether said breaking or stoppage results from freezing or otherwise; to neither
permit nor suffer said premises,or the walls or floors thereof to be endangered by overloading,nor said premises to be used
for any purpose which would render the insurance thereon void or the insurance risk more hazardous, nor make any
alteration or change in,upon or about said premises without first obtaining written consent therefor; to place no signs on
exterior of demised premises without first securing written consent therefor; to permit the Landlord to place a "For Rent"
card upon said premises at any time thirty days before the end of this lease; that, in case said premises shall become
untenantable by reason of fire or other casualty, the rent shall cease while the same are being repaired, but that nothing
herein contained shall be construed so as to compel the Landlord to rebuild or repair said premises in case of destruction
unless Lessor/Landlord._-..---_.._...so desire-.5 ; that no assent, expressed or implied, to any breach of any one
or more of the covenants and agreements hereof, shall be deemed or taken to be a waiver of any succeeding or other
breach; to permit the said Landlord, at any reasonable hour of the day. to enter into or upon and go through and view
said premises; to surrender and deliver up the possession of said premises promptly at the expiration of this lease, or, in
case of the termination of this lease on account of a breach in the keeping of any one or more of the covenants or
agreements hereof, upon three days' notice...%i)en._by Lessor/Land),Q.Fd__≥:,Q•-,Le,$s-te/.t iiait...at
The Crow Valley Cafe, Briggsdale, CO.
And the said Tenant further covenants and agrees that if the rent above reserved, or any part thereof, shall be in
default, or in case of a breach of any of the covenants or agreements herein, the said Landlord may declare this lease
terminated, and after the expiration of three days from the date of the service of a written notice to that effect, be
entitled to the possession of said premises without any further notice or demand; and further, that in case the Landlord
shall become entitled to the possession of said premises either by the expiration of this lease or by any termination of said
term as herein provided for, and the said Tenant shall refuse to surrender and deliver up the possession of said premises,
after the service of said notice as aforesaid, then and in that event the said Landlord may. without further notice or
demand,enter into and upon said premises, or any part thereof, and take possession thereof and repossess the same as of
the Landlord's former estate,and expel, remove and put out of possession the Tenant,using such help, assistance and force
in so doing as may be needful and proper,without being liable for prosecution or damages therefor, and without prejudice
to any remedy allowed by law, available in such cases.
The Tenant hereby declares that in entering into this lease he or she relied solely upon the statements contained in
this lease and fully understands that no agent or representative of the Landlord has authority to in any manner change,
add to or detract from the terms of this lease.
IT IS MUTUALLY AGREED,that if after the expiration of this lease the Tenant shall remain in possession of said
premises and continue to pay rent, without any express agreement as to such holding, then such holding over shall be
deemed and taken to be a holding upon a tenancy from month to month,and the party holding be regarded as a tenant from
month to month,at a monthly rental equivalent to the monthly installments hereinabove provided for, payable in advance
on the same day of each calendar month.
IT IS FURTHER MUTUALLY AGREED, that in case said premises are left vacant and any part of the rent herein
reserved be due and unpaid, then the Landlord may, without in anywise being obliged so to do, and without terminating
this lease, retake possession of said premises and rent the same for such rent, and upon such conditions as the Landlord
may think best,making such changes and repairs as may be required, giving credit for the amount of rent so received less
all expenses of such changes and repairs, and said Tenant shall be liable for the balance of the rent herein reserved until
the expiration of this lease.
FURTHER,that all the covenants and agreements in this lease contained shall be binding upon and apply to the heirs,
assigns and legal representatives of said Landlord and said Tenant or any person claiming by, through or under either of
them or their agents or attorneys.
IN WITNESS WHEREOF, the parties hereto have hereunto set their hands and seals the day and year first above
written.
/U
M r xi e lefhau Landlord (SEAL)
(SEAL)
r-27
(SEAL)
G i inn ears, enant
N Ni
c0 c
C (n eti r-1
O
$o W In ' CN-1 O °
I
Z al Z
Q b 5 s 1,1 I
k H
a
URER'S OFFICE, WELD COUNT`" N° 3 3
•
yyJ Greeley, Colorado lt„ . . , 19 , . 0 4.RECEIVED OF :-egL.et,/C--' !,(. /v as,21 K2-9 $
Y c
FOR
CREDIT
County General Fund � ��ra
Health Department
Human Resources
I. G. S.
Payroll
Road & Bridge Fund
Weld County General Hospital Fund
County Clerk Cash Escrow
Fee Fund
School District Gen Fund
School District C R F
School District Bond Fund``
FRANCIS M. LOUSTALET \lI"t` i > I TOTAL AMOUNT
County Treasurer Cler A1-7
1 .ASURER'S OFFICE, WELD COUNT\ N 21 63
Greeley, Colorado p� 8
19 9 $.
RECEIVED OF2-Q m#.nl v"" }!)')„ , _ yyl t/ , So
CREDIT FOR
Count General Fund
Health Department
Human Resources
I. G. S.
Payroll
Road & Bridge Fund
Weld County General Hospital Fund
Count Clerk Cash Escrow
Fee Fund
School District Gen Fund
School District C R F
School District Bond Fund
FRANCIS M. LOUSTALET I ci I
County Treasurer TOTAL AMOUNT
87 Co
Hello