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Home My WebLink About880801.tiffRESOLUTION RE: FINDINGS AND RESOLUTION CONCERNING APPLICATION OF ROBERTA AND C. RAY HINDERLITER, D/B/A I-76 MOTEL AND CAFE, UNIT B, FOR A TAVERN LIQUOR LICENSE The application of Roberta and C. Ray Hinderliter, d/b/a I-76 Motel and Cafe, Unit B, 35929 1-76 Access Road, Roggen, Colorado 80652, for a Tavern Liquor License, came on for hearing on the 18th day of July, 1988, at 9:30 A.M., and the Board of County Commissioners of Weld County, Colorado, having heard the testimony and evidence adduced upon said hearing, and having considered the testimony, evidence and remonstrances filed with said Board, and having carefully weighed the same now makes the following Findings: 1. The evidence discloses that the applicants have sustained the burden of proof as to the desires of the inhabitants of the neighborhood. 2. That the applicants are of good character and reputation. 3. The applicants have proven the reasonable requirements of the neighborhood. RESOLUTION WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to Colorado statute and the Weld County Home Rule Charter, is vested with the authority of administering the affairs of Weld County, Colorado, and WHEREAS, the Board of County Commissioners has considered the application of Roberta and C. Ray Hinderliter, d/b/a I-76 Motel and Cafe, Unit B, 35929 I-76 Access Road, Roggen, Colorado 80652, for a Tavern Liquor License for the sale of malt, vinous and spirituous liquors by the drink for consumption on the premises only, and WHEREAS, the applicants have paid to the County of Weld, the sum of $450.00 for the hearing fee, in addition to the other required fees, and WHEREAS, due to the Findings of the Board of County Commissioners in this matter, as stated herein, the Board deems it advisable to grant Tavern Liquor License No. 88-12 to Roberta and C. Ray Hinderliter, d/b/a I-76 Motel and Cafe, Unit B. 880801 Page 2 RE: FINDINGS - HINDERLITER NOW, THEREFORE, BE IT RESOLVED that the Board of County Commissioners of Weld County, Colorado, having examined said application, the qualifications of the applicants, and the testimony of those present at the hearing, does hereby approve the application of Roberta and C. Ray Hinderliter, d/b/a I-76 Motel and Cafe, Unit B, for a Tavern Liquor License for the sale of malt, vinous and spirituous liquors by the drink for consumption on the premises only, for the reasons stated herein. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 18th day of July, A.D., 1988. ATTEST: Weld County Clerk and Recorder and Clerk to the Board APPROVED AS TO FORM: eputy Count Jerk ounty Attorney BOARD OF COUNTY COMMISSIONERS WELD,C9UNTY, COLORADO ene R. Brantner, Chairman C.W. i- , Pr em EXCUSED DATE OF SIGNING EXCUSED DATr;►OF SIGNING Frank Yamaguchi (AYE) 880801 HEARING CERTIFICATION DOCKET NO. 88-32L RE: TAVERN LIQUOR LICENSE APPLICATION - ROBERTA AND RAY HINDERLITER, D/B/A I-76 MOTEL & CAFE, UNIT B A public hearing was conducted on July 18, 1988, at 9:30 A.M., with the following present: Commissioner Gene Brantner, Chairman Commissioner C.W. Kirby, Pro—Tem Commissioner Jacqueline Johnson Commissioner Gordon E. Lacy Commissioner Frank Yamaguchi Also present: Acting Clerk to the Board, Debbie Campbell Weld County Attorney, Thomas 0. David Certified Shorthand Reporter, Carol Rowen The following business was transacted: I hereby certify that pursuant to a notice dated June 6, 1988, and duly published June 15, 1988, in the Platteville Herald, a public hearing was conducted to consider the application of Roberta and Ray Hinderliter, dba I-76 Motel & Cafe, Unit B, for a Tavern Liquor License. Tom David, County Attorney, made this matter of record. He said an on -site inspection had been made on June 13, and the property had been properly posted. Mr. David said this application had been reviewed by his office and found to be in order. Roberta and Ray Hinderliter were present to answer questions of the Board. They said they are familiar with regulations pertaining to a Tavern License. Commissioner Kirby moved to approve the Tavern Liquor License application of Roberta and Ray Hinderliter. The motion was seconded by Commissioner Johnson and carried unanimously. This Certification was approved on the 20th day of July, 1988. APPROVED: ATTEST: Weld County perk and Recorder and Clerk to the Board By: ba Joffe BOARD OF COUNTY COMMISSIONERS WELD 54(Jj1TY, COLORADO ene R. Brantner, Chairman Deputy County Cldrk C.W. Kirby, Pro-Tem TAPE #88-33 DOCKET #88-32L LC0015 Frank Yamaguchi NOTICE DOCKET NO. 88-32L PURSUANT TO THE LIQUOR LAWS OF THE STATE OF COLORADO, ROBERTA AND RAY HINDERLITER, D/B/A I-76 MOTEL AND CAFE, UNIT B, 35929 I-76 ACCESS ROAD, ROGGEN, COLORADO 80652, HAS REQUESTED THE LICENSING OFFICIALS OF WELD COUNTY, COLORADO, TO GRANT A RETAIL TAVERN LICENSE FOR CONSUMPTION ON THE PREMISES ONLY, WITH A LOCATION MORE PARTICULARLY DESCRIBED AS FOLLOWS: NE} of Section 1, Township 2 North, Range 63 West of the 6th P.M., Weld County, Colorado. DATE OF APPLICATION: MAY 18, 1988 THE BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY, COLORADO, HAS DECLARED THAT THE NEIGHBORHOOD TO BE SERVED WILL BE AS FOLLOWS: Section 36, Township 3 North, Range 63 West; Sections 31 and 32, Township 3 North, Range 62 West; Sections 1 and 12, Township 2 North, Range 63 West; and Sections 5, 6, 7 and 8, Township 2 North, Range 62 West of the 6th P.M., Weld County, Colorado, which comprises a nine square mile area. THE HEARING ON SAID LICENSE WILL BE HELD IN THE FIRST FLOOR ASSEMBLY ROOM, WELD COUNTY CENTENNIAL CENTER, 915 10TH STREET, GREELEY, COLORADO, ON MONDAY, JULY 18, AT OR ABOUT 9:30 A.M. PETITIONS AND REMONSTRANCES MAY BE FILED AT THE CLERK TO THE BOARD OF COUNTY COMMISSIONERS OFFICE, WELD COUNTY CENTENNIAL CENTER, 915 10TH STREET, GREELEY, COLORADO. DATED AT GREELEY, COLORADO, THIS 6TH DAY OF JUNE, 1988. THE BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO BY: MARY ANN FEUERSTEIN WELD COUNTY CLERK AND RECORDER AND CLERK TO THE BOARD BY: Debbie Campbell, Deputy PUBLISHED: June 15, 1988, in the Platteville Herald 8808^'1 NOTICE a,f1idau;i (I Publication ET ATE OF ('OLOi Ct:: A. Winkler Riesel Platteville Herald u__ (:- , ut,i.::r: it, tit- Platteville „L - , h.:: tr. tNt C a, C e e n Lila. t. -rr ^rus;.av C oan; tte ..-o'. Lr,d time H pur:us,- , aatHo.: s. ^ < rn,'� ee it Lh c`sa.1 ^<vs,'crm rr hr -aunt tar d:ru. tNt 15 da,e nt June ; r i 88 ...,• tNt ias'. auL::<a:,r.t "hart a' in Itciss.ie of s.:,.a. r.:-.sspap-•. b.ar::.a ca. c. t!+,da' of June 8Q, ,, Platteville Herald MST S[CURITy BMX-- ado tin Street Fort Lupton, Colorado 8062: • DOCKETNO.8832L PURSUANT TO THE LIQUOR LAWS OF THE STATE OF COLORADO, RO- BERTA AND RAY HINDERLITER, D/B/A 1-76 MOTEL AND CAFE, UNIT B, 35929 1-76 ACCESS ROAD, ROGGEN, COLO- RADO 80652, HAS REQUESTED THE LICENSING OFFI- CIALS OF WELD COUNTY, COLO- RADO, TO GRANT A RETAIL TAVERN LICENSE FOR CONSUMPTION ON THE PREMISES ONLY, WITH A LOCATION MORE PARTICULARLY DESCRIBED AS FOLLOWS: NE1/4 of Section 1, Township 2 North, Range 63 West of the 6th P.M., Weld County, Colorado. DATE OF AP- PLICATION: MAY 18, 1988 THE BOARD OF COUNTY COM- MISSIONERS OF WELD COUNTY, COLORADO, HAS DECLARED THAT THE NEIGHBOR- HOOD TO BE SERVED WILL BE AS FOLLOWS: Section 36, Township 3 North, Range 63 West; Sections 31 and 32, Township 3 North, Range 62 West; Sections 1 and 12, Township 2 North, Range 63 West; and Sections 5, 6, 7 and 8, Township 2 North, Range 62 West of the 6th P.M., Weld County, Colorado, which comprises a nine square mile area. THE HEARING ON SAID LICENSE WILL BE HELD IN THE FIRST FLOOR ASSEMBLY ROOM, WELD COUNTY CENTENNIAL CEN- TER, 915 10TH STREET, GREE- LEY, COLORADO, ON MONDAY, JULY 18, AT OR ABOUT 9:30 A.M. PETITIONS AND REMON- STRANCES MAY BE FILED AT THE CLERK TO THE BOARD OF COUNTY COM- MISSIONERS OF- FICE, WELD COUNTY CEN- TENNIAL CENTER, 915 10TH STREET, GREELEY, COLORADO. DATED AT GREELEY, COLO- RADO, THIS 6TH DAY OF JUNE, 1988. THE BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO BY: MARY ANN FEUERSTEIN, WELD COUNTY CLERK AND RECORDER AND CLERK TO THE BOARD BY: Debbie Campbell, Deputy Published in the Platteville Herald, June 15, 1988. 880501 The New N, ws Page 12 S'I'A'1'1' OP COLORADO COOS" 01. WELD }} J 1 . el,OLI° IJ // �cif-/ii- , being dully sworn, sates that he/she is publisher of the New News, a weekly newspaper published in Reenesburg in said County and State; that said newspaper has a genera] circulation in said County and has been contin- ously and uninterruptedly published t'1''' dur iuy a petiud of least, fifty-two consecutive weeks prior to the first publication of the annexed notice; that said newspaper is a newspaper within the meaning of the act of the General Assembly of the State of Colorado, entitled "An Act to regulate the printing of legal notices and advertisements," and amendments thereto that the notice of which the annexed is a printed copy taken from said news- paper, was published in said news- paper, and in the regular and entire issue of every number thereof, once a week for (92L -Z successive week(s); that said notice was so published is said newspaper proper and not in any supplement thereof, and that the first publication of said notice as aforsaid, was on the 7 day of 19a- , and the da last of the 19 Subscribed and sworn to before me this 19 eri . day of 7 „mmis;• o::... Boa 17, :crr_�•r, Notice DOCKET NO. 88-32L PURSUANT TO THE LIQUOR LAWS OF THE STATE OF COLORADO, ROBERTA AND RAY HINDERLIGTER, D/B/A I-76 MOTEL AND CAFE, UNIT B, 35929 I-76 ACCESS ROAD, ROGGEN, COLORADO 80652,HAS REQUESTED THE LICENSING OFFICIALS OF WELD COUNTY, COLORADO, TO GRANT A RETAIL 1'AVEttN LICENSE FOR CONSUMPTION ON THE PREMISES ONLY, WITH A LOCATION MORE PARTICULARLY DESCRIBED AS FOLLOWS: NE'/n of Section 1, Township 2 North, Range 63 West of the 6th P.M., Weld County, Colorado. DATE OF APPLICATION: May 18, 1988 THE BOARD OF COUNTY COMMISSIONERS OF WELD COUNTY, COLORADO, HAS DECLARED THAT THE NEIGHBORDHOOD TO BE SERVED WILL BE AS FOLLOWS: Section 36, Township, 3 North, Range 63 West; Sections 31 and 32, Township 3 North, Range 62 West; Sections 1 and 12, Township 2 North, Range 63 West; and Sections 5, 6, 7, and 8, Township 2 North, Range 62 West of the 6th P.M., Weld County, Colorado, which comprises a nine square mile area. THE HEARING ON SAID LICENSE WILL BE HELD IN THE FIRST FLOOR ASSEMBLY ROOM, WELD COUNTY CENTENNIAL CENTER, 915 10th STREET, GREELEY, COLORADO, ON MONDAY, JULY 18, AT OR ABOUT 9:30 A.M. PETITIONS AND REMONSTRANCES MAY BY FILED AT THE CLERK TO THE BOARD OF COUNTY COMMISSIONERS OFFICE, WELD COUNTY CENTENNIAL CENTER, 915 10TH STREET, GREELEY, COLORADO. DATED AT GREELEY, COLORADO, THIS 6TH DAY OF JUNE, 1988. THE BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO BY: MARY ANN FEUTERSTEIN WELD COUNTY CLERK AND RECORDER AND CLERK TO THE BOARD BY: DEBBIE CAMPBELL, DEPUTY PUBLISHED in The New News June 30, 1988. rise ;1 4 ,.,... off C d l©r . Flo att off Liquor Enforcement Division 1375 Sherman Street Denver, Colorado 80261 HINOERLITER ROBERTA HINDERLITER C RAY I SEVENTY SIX MOTELS CAFE 35929 I 76 ACCESS RD ROGGEN CO 80652 Alcoholic Beverage License Account Nut Inwow dust. snow Cpunh C8y Indus Type Li,biBv Date UCENSE EXPIRES AT WDNIGHT 14-27452-002 03 206 7011 5 080188 JUL 31. 1989 Type Name and Owaptbn of Livens, Fee T TAVERN LIQUOR LICENSE - MALT, VINOUS,. AND SPIRITUOUS E 25.00 COUNTY 85 PERCENT OAP FEE S 276.25 TOTAL FEES) $ 301.25 This license is issued subject to the laws of the State of Colorado and especially under the provisions of Title 12, Articles 46 or 47, CRS 1973, as amended. This license is non- transferable 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 Divison, 1375 Sherman Street, Denver, CO 80261. In testimony whereof, I have hereunto set my hand. Division Director DR 8402 (348) AUG 0 2 1988 Executive Director 880801 TO9O99 CO nat rn ti THIS LICENSE EXPIRES a Bs E 1 as a C C-> , s, 1 .7)' . - LL a C 1 qtr L c q T n 4= I' c ` d v C S861 aunt boBE WJo3 Sd i ► C m .c N N ^m 9 C 4 O C .C N •0 C 4- 3. Article Addressed to: o c o Do w W C!7 N CO IP g U 0 0 C7 O W O O La F I H Z s w Gs]vcN V' pa n Cr c O I L O 5. Signature — Addressee X 1n� ro X DOMESTIC RETURN RECEIPT .P.O. 1987-178-288 `4EASURER'S OFFICE, WELD COUNT - Greeley, Colorado. RECEIVED OF..." ✓(L! /... �! 1.�; • ('� eyittettbL,s cc N2 2137 i9.4 g "5 $ 19g, FOR U CREDIT County General Fund 101 0000 CuiUig2 „/,Cp�pti ,/ yJC) 00 U i 411 `J. Human Resources 121 0000 Social Services 112 0000 Housing Authority Road & Bridge Fund 111 0000 Airport 177 0000 County Clerk Cash Escrow 810 0803 Fee Fund 9000912 School District Gen Fund School District C R F School District Bond Fun �p `� p 8808(21 FRANCIS M. LOUSTALET I TOTAL AMOUNT ,/�, /' 7 -25 County Treasurer Clerk WIDc. COLORADO July 13, 1988 OFFICE OF BOARD OF COUNTY COMMISSIONERS PHONE (303) 356-4000. EXT. 4200 P.O. BOX 758 GREELEY, COLORADO 80632 Ray and Roberta Hinderliter P. 0, Box 28 Roggen, CO 80652 RE: Findings of Investigation Concerning Your Application for a Tavern License for I-76 Cafe Dear Mr. and Mrs. Hinderliter: Pursuant to Section 12-47-137(1), C.R.S., please be advised that the Board of County Commissioners of Weld County, Colorado, has made favorable findings in its investigation concerning your application for the proposed Tavern License to be known as I-76 Cafe located at 35929 I-76 Access Road, Roggen, Colorado 80652. The on -site visit which took place on July 12, 1988, revealed the following: a. The proposed licensed premises is not connected to a different licensed premises. b. The applicants' diagram of the proposed licensed premises is correct. c. There are no public or parochial schools or principal campus of any college, university, or seminary within 500 feet of the proposed licensed premises. d. The Notice of Hearing was properly posted. e. The investigation of your character has shown that it is good and comports with Section 12-46-108(1)(b), C.R.S. Very truly yours, BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO J Frank 4amaguchi Weld County Commissioner 880801 DEPUTY DATE: June 3, 1988 TO: Weld County Planning Department We have received an application for a Tavern Liquor License at the following described property: NE} of Section 1, Township 2 North, Range 63 West of the 6th P.M., Weld County, Colorado A Hotel/Restaurant Liquor License, which expired April 9, 1987, was previously held on this property. Please indicate the necessary information at the bottom of this memo and return to us. CLERK TO THE BOARD WHAT IS THE CURRENT ZONING AT THE ABOVE SITE? l -Let IS THIS TYPE OF REQUEST PERMITTED IN THE ABOVE ZONING? yes WELD COUNTY PLANNING DEPARTMENT DATED: Wen - 880801 1 I LTI DRL 1555 (Rev. 10/33) .• STATE OF COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION .2% BEER AND LIQUOR LICENSE APPL_ ATION DOCUMENTS CHECKLIST AND WORKSHEET INSTRUCTIONS: This checklist MUST be completed by the applicant and the local licensing authority, and submitted with all necessary documents. ALL documents must be properly signed and correspond with the name of the applicant exactly. Conies (other than application) may be accepted if signatures are legible. ALL documents must be typed or legibly printed in BLACK INK. Upon final State approval, the license will be mailed to the local licensing authority. TYPE OF APPLICANT (check one): / I `�i Individual 0411: -Partnership I1 Corporation NAME OF APPLICANT: 1?08e2`l�k ///CR&/,kyl`/�/N-06W/'T3C4 TRADE NAME: T - 76 h0 i C t -%6 CA -FE) PLEASE CHECK ALL APPROPRIATE BOXES Applicant Local State Documents I. APPLICATION OR ADDENDUM I.Z..1 I_i A. A. Original (green or yellow), not a copy I71 I_1* B. Complete all appropriate sections 1=C C. C. Sign application 11 I I I I* D. Attach appropriate fee I-1 II. PROOF OF PROPERTY POSSESSION A. Deed (or) B. Lease (or) 1. Lease must cover entire license period (minimum one year) 1-1* C. Lease Assignment I-1 1. Acceptance of applicant J I 2. Consent by landlord Ii D. All possession documents must be signed I I E. Floor diagram of premises to be licensed (maximum size 8 1/2" x 14") I I I ICI 1=i 1=i III. FINANCIAL DOCUMENTS A. Purchase agreement or stock transfer agreement B. Affidavit on source of all funds invested 880801 (Continued on Reverse Side) Applicant Local State Documents I, C. Notes or loans (i.e., assumed, banks, previous 1.;>€,Il — owner, etc. ) iZI II I —I 1. Applicant may not have any unlawful financial interest in any other licensed estaolishment IV. BACKGROUND INFORMATION IXI ICI I-i* A. Individual History Record(s) (form DRL 404-I) I I I I_I B. Fingerprints taken and submitted V. MANAGEMENT (if other than applicant) gm I --I I_I* A. Manager Registration Form (form DRL 367) _ — _ CD cee , red only if Hotel ana 1 — — ",Restaurant icense I1 II Ii B. Written management agreement (or) I i I1 C. C. Affidavit describing duties, limitations and compensation VI. CORPORATE DOCUMENTS (if applicable) I1 I_i I_i* A. Certificate of Incorporation (or) 1I I I 1—I* B. Certificate of Good Standing if corporation is more than two years old (or) I Ii II* C. Certificate of Authorization if foreign corporation 1-1 1_I 1_1 D. Articles of Incorporation 11 II I1 E. Minutes of meeting electing current officers 1I II F. F. Stock certificates (100% of issued stock) 1 1 I1 II G. List of officers, stockholders and directors of parent corporation (if applicable) VII. PARTNERSHIP DOCUMENTS (if applicable) I -I I' A. A. Partnership agreement (general or limited) I-1 II II 1. Not needed if husband and wife I I_I I_1 B. Dissolutionment of partnership (if applicable) VIII. ADDITIONAL LOCAL REQUIREMENTS I 1=1 I 1 II A. B. 880801 DRL 404 (Rev. 5/83) STATE OF COLORADO DEPARTMENT OF REVENUE DIVISION OF LIQUOR ENFORCEMENT 1375 SHERMAN STREET DENVER, COLORADO 80261 COLORADO LIQUOR LICENSE APPLICATION Instructions on Page 4 of Application. NOT WRITE IN THIS BLOCK USE LICENSE ACCOUNT NO. FOR ALL REFERENCE LICENSE ISSUED THROUGH (EXPIRATION DATE) LIABILITY INFORMATION COUNTY CITY INDUSTRY TYPE LIABILITY DATE KEY CODE STATE FEE PAID CITY COUNTY (03) 41-9 37-1 49-1 TOTAL FEE ALL ANSWERS MUST BE PRINTED IN BLACK INK OR TYPEWRITTEN 1. Name of Applicant(s): If partnership, list partners names (at least two); if corporation, name of corporation: a k IN)€ L1r'Z Date filed with Local Authority: f24 I --I l N o E2 L, rep State Sales Tax No.: 1,1-a74/...CL" 2. Trade Name of Establishment: (DBA) — ei I C Lea -CA F J /7 Business Telephone: —1-76 C A Fs" i--7lo I'I�nt't--- tl l' S '19- 5367 J-3. Address of Premises: (Exact location of premises must be given. Give street and 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 be given 1 35a:2.9 L -m A-ccEss Rd City RoGG- GP County: Lje L-0 State: Co. Zip gD t0C z 4. Mailing Address: (Number and Street) Citygr �Town: IcDGG CV State: Ca Zip OV-co6sr Z 5. If these premises are now licensed, answer the following: Trade Name of Establishment (DBA): - _ •�f State License No.: Type of License: Expiration Date: KEY CODE COLUMN A STATE FEES LOCAL FEES KEY CODE COLUMN B STATE FEES 20 El RETAIL LIQUOR STORE LICENSE•City $177.50 $22.50 20 ❑ RETAIL LIQUOR STORE LICENSE -County 262.50 37.50 21 ❑ LIQUOR LICENSED DRUGSTORE- City 177.50 22.50 21 ❑ LIQUOR LICENSED DRUGSTORE -County 262.50 37.50 22 ❑ BEER & WINE LICENSE -City 152.50 22.50 22 ❑ BEER & WINE LICENSE -County 237.50 37.50 25 ❑ CLUB LICENSE ❑ City ❑ County 110.00 15.00 23 ❑ HOTEL&RESTAURANT LICENSEQCity❑County 301.25 48.75 40 E1TAVERN LICENSE ❑City County 301.25 48.75 42 ❑ RACE TRACK LICENSE ❑City ❑ County 301.25 48.75 41 El ARTS LICENSE ❑City ❑County 110.00 15.00 ❑ OTHER (Specify) (Change of corporate structure, location, trade name, renewal, etc.) 31 ❑ WHOLESALE LIQUOR LICENSE 1,000.00 32 ❑WHOLESALE BEER LICENSE 500.00 38 ❑ IMPORTER'S LICENSE(Vinous & Spirituous Liquor) 250.00 44 ❑ NONRESIDENT MANUFACTURER or 250.00 IMPORTER (Malt Liquor) 27 ❑ BREWERY LICENSE 250.00 28 0 WINERY LICENSE 250.00 43 0 LIMITED WINERY LICENSE 25.00 26 ❑ PUBLIC TRANSPORTATION LICENSE _each 25.00 880801 Page 1 of 4 (continued) YES NO 6. Is the applicant; or any of the partners; or officers, stockholders or directors of said applicant (if a corporation); or manager; under the age of twenty-one years? 7. (a) Has the applicant; or any of the partners; or officers, stockholders or directors of said applicant (if a corporation) ever been convicted of a crime? If answer is "yes," explain in detail. (b) Has persons lending assistance or financial support to the applicant; or the manager; or employees; ever been convicted of a crime? If answer is "yes," explain in detail. 8. Has the applicant; or any of the partners; or officers, directors or stockholders of said applicant (if a corporation): or manager; ever: (a) been denied an alcoholic beverage license? 1b) had an alcoholic beverage license suspended or revoked? (c) had Interest In an entity that had an alcoholic beverage license suspended or revoked? if answer is "yes." explain In detail (Attach separate sheet if necessary.) IM P1 9. Has a liquor license for the premises to be licensed been refused within the preceding two years? 10. Are the premises to be licensed within 500 feet of any public or parochial school, or the principal campus of any college, university or seminary? If answer is "yes," explain in detail. 11. 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 other Colorado Liquor license (include loans to or from any licensee, or interest in a loan to any licensee)? If answer is "yes," explain in detail. ag 12. State whether the applicant has legal possession of the premises by virtue p� Lof ownership or under a lease. If leased, list name and address of landlord and term of lease: ©w pe 2J.Ts iQ 13. 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 financia interest expressed in dollars or other items to furniture or equipment• (i.e. bank, relatives, friends, previous owners, etc.). Use separate sheet if necessary. of value, such as raven ry, NAME A L- 9 -Don nil} ;l /IAkniur ADDRESS 3$v c. L)NccttVWAY 66-1,6,14,O4., INTEREST Lo* N 14. List the names and addresses of all liquor businesses In which any of the persons in the previous question are materially interested. if necessary.) NAME N0Ne KNn'wV BUSINESS ADDRESS Attach copies of all notes and security instruments, and any written agreement or details of any oral agreement, by which any person (ineluding a corporation) will share in the profit or gross proceeds of this establishment, and any agreement relating to the business which is contingent or con- ditional in any way by volume, profit, sales, giving of advice or consultation. Page 2 of 4 880801 (continued) 15. Liquor Licensed Drug Store applicants, answe --the following: (a) Does the applicant for a Liquor Licensed I Store have a Drug Store License issued by the Colo If answer is "no;" explain in detail. Board of Pharmacy? YES NO ❑ ❑ (b) Is the applicant, or does the applicant for a Liquor Licensed Drug Store employ a Pharmacist registered in the State of Colorado? If "yes," give License Number: ❑ ❑ 16. Club Liquor License applicants, answer the following: (a) Complete items 20(a) through (d) and (fl. (b) Is the applicant organization operated solely for a national, social, fraternal, patriotic, political or athletic purpose and not for pecuniary gain? (c) How tong has the club been incorporated? (Three years required.) (dl How long has applicant occupied the premises to be licensed as a club? FT ❑ 17. Colorado Manufacturer or Wholesaler applicants, answer the following: (a) Does the applicant own, lease or operate any Colorado warehouse or storage plant in connection with this business? If answer is "yes," give full address: if "no," explain in detail. El ❑ (b) Does the applicant have an active surety bond for the payment of liquor excise taxes? If answer is "yes," give amount and name and address of insuror; if "no," explain in detail. ❑ ❑ (c) If the applicant is a wholesaler, does or did 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 malt, vinous or spirituous liquor? If answer is "yes," attach explanation in detail. (d) Does the applicant have a valid Federal Basic Permit? If "yes," attach a copy of the permit; if "no," explain in detail. u n El ❑ 18. Nonresident Manufacturer (malt liquor) or Importer (malt, vinous or spirituous liquor) applicants, answer the following: (a) To what Colorado licensed wholesaler do you intend to ship your merchandise? (b) If the applicant is an importer or manufacturer, does or did 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 sell malt, vinous or spirituous liquor? If answer is "yes," attach explanation in detail. (c) Does the applicant have a valid Federal Basic Permit? If "yes," attach a copy of the permit; if "no," explain in detail. ❑ ❑ ❑ (d) If the applicant is an importer or manufacturer, are you the primary source of supply in the U.S.? If "no," explain in detail. ❑ ❑ 19. If the applicant is an individual or partnership, answer the following: (Attach separate sheet if necessary.) (a) Name of individual or name and d class clHome Address, City and State: — of each pann od E/Qr/1 /-4,diao--Tc/ta7L "cat 2K eF6,ivv fl6SZ Date of Birth: /D — N?m?pf Operating Manager: Home Address, City and State: Date of Birth: (ci When did said partnership commence doing business? (Attach a copy of the partnership agreement, except as between husband and wife, and trade name affidavit.) t 20. I f the applicant is a corporation, answer the following: (a) Corporation is organized under the laws of the State of: (b) Principal business is conducted at: (c) Date of filing last annual corporate report to the secretary of state: County of: State of: Date: till Name of each officer listed below: Home Address, City and State: Date of Birth: President: Vice'President: Treasurer: Secretary: Operating Manager: (e) List all stockholders; include actual owner or — Name of stockholder: pledgee. (Use separate sheet if necessary) Home Address, City and State: % of stock: Date of Birth: (f) Name of all Directors or Trustees — of Corporation: Home Address, City and State: Date of Birth: Page 3 of 4 380801 INSTRUCTIONS 1) Check the appropriate box for the type of license(s) being applied for on page 1. If you are applying for a retail license described in Column A, contact the Local Licensing Authority to obtain all local procedures and requirements. 2) You may attach separate sheets or additional documents if necessary to fully complete this application. Copies may be accepted (other than application) if signatures are evident. All documents must be type- written or legibly printed in BLACK ink. 3) IMPORTANT:. For those retail licenses described in Column A on page 1, this application and all support- ing documents must FIRST BE FILED IN DUPLICATE WITH AND APPROVED BY THE LOCAL AUTHORITY. Application will not be accepted unless all applicable questions are fully answered, all sup- porting documents correspond exactly with the name of the applicant(s) and proper tees are attached. 4) Form DRL 404-I, "Individual History Record" must be completed and filed in duplicate by the following: a. Each applicant b. All general partners c. Over 5% limited partners d. All officers and directors of a corporation e. All stockholders of a corporation not subject to the Securities and Exchange Act of 1934. f. Over 5% stockholders of a corporation subject to the Securities and Exchange Act of 1934. g. Operating managers h. Each person required to file form DRL 404-I must submit fingerprints to Local Licensing Authority. 5) NOTE: License status will not be given over the telephone. License will be mailed to the Local Licensing Authority upon issuance: OATH OF APPLICANT This appliication is to be signed by individual, each general partner of partnership and by corporate applicants. I declare under penalty of perjury in the second degree that I have read the foregoing application and all attachments thereto, and that I know the contents thereof, and that all matters and information set forth therein are true, correct and complete to the best of my knowledge and information; and I agree to conform to all applicable statutes and all rules and regulations promulgated by the Colorado Department of Revenue in connection therewith. INDIVIDUALS AND ALL GENERAL PARTNERS OF PART D>�R RSHI I➢S'M UST I G N, H ER E: Gvv�� E 1( DATE• /21 CORPORATIONS SIGN HERE: By (President, Vice President, or Secretary) DATE: REPORT AND APPROVAL OF LOCAL LICENSING AUTHORITY (MANUFACTURERS, IMPORTERS, WHOLESALERS DISREGARD THIS SECTION) The foregoing application has been examined and the premises, business conducted and character of the applicant is satis- factory. 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 47, CRS 1973 as amended. THEREFORE THIS APPLICATION IS HEREBY APPROVED. DATED AT this day of , A D 19 AT (Name of Town, City and County) BY: (Mayor, Chairman of Board of county commissioners or other title of the licensing authority) ATTEST: (Clerk, secretary of other officer having the official seal of 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.) Local Licensing Authority report the following pertaining to each person required to file form DRL 404-I: FINGERPRINTED & SUBMITTED BACKGROUND N.C.I.C. & C.C.I.C. CHECKS Yes ❑ No ❑ Yes ❑ No ❑ Pp. 4 of 4 StivotO INSTRUCTIONS 1) Check the appropriate box for the type of license(s) being applied for on page 1. If you are applying for a retail license described in Column A, contact the Local Licensing Authority to obtain all local procedures and requirements. 2) You may attach separate sheets or additional documents if necessary to fully complete this application. Copies may be accepted (other than application) if signatures are evident. All documents must be type- written or legibly printed in BLACK ink. 3) IMPORTANT:. For those retail licenses described in Column A on page 1, this application and all support- ing documents must FIRST BE FILED IN DUPLICATE WITH AND APPROVED BY THE LOCAL AUTHORITY. Application will not be accepted unless all applicable questions are fully answered, all sup- porting documents correspond exactly with the name of the applicant(s) and proper tees are attached. 4) Form DRL 404-I, "Individual History Record" must be completed and filed in duplicate by the following: a. Each applicant b. All general partners c. Over 5% limited partners d. All officers and directors of a corporation e. All stockholders of a corporation not subject to the Securities and Exchange Act of 1934. f. Over 5% stockholders of a corporation subject to the Securities and Exchange Act of 1934. g. Operating managers h. Each person required to file form DRL 404-I must submit fingerprints to Local Licensing Authority. 5) NOTE: License status will not be given over the telephone. License will be mailed to the Local Licensing Authority upon issuance. OATH OF APPLICANT This appliication is to be signed by individual, each general partner of partnership and by corporate applicants. I declare under penalty of perjury in the second degree that I have read the foregoing application and all attachments thereto, and that I know the contents thereof, and that all matters and information set forth therein are true, correct and complete to the best of my knowledge and information; and I agree to conform to all applicable statutes and all rules and regulations promulgated by the Colorado Department of Revenue in connection therewith. INDIVIDUALS AND ALL GENERAL PARTNERS OF PART RS4CUST,SIGN,H&(RE: CORPORATIONS SIGN HERE: By DATE: �✓ — DATE - (President, Vice President, or Secretary) "5-1-16 > REPORT AND APPROVAL OF LOCAL LICENSING AUTHORITY (MANUFACTURERS, IMPORTERS, WHOLESALERS DISREGARD THIS SECTION) The foregoing application has been examined and the premises, business conducted and character of the applicant is satis- factory. 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 47, CRS 1973 as amended. THEREFORE THIS APPLICATION IS HEREBY APPROVED. DATED AT Greeley, Colo • this AT BY: . f an o ands•nd of mmisrioners or r title the ensin t ority) ATTEST: .,�(/ (Clerk, retary of other officer having the al seal of the licensing author ) / ( If the premises are located within a town or city, the above approval should be signed by the mayor an 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.) Local Licensing Authority report the following pertaining to each person required to file form DRL 404-I: FINGERPRINTED & SUBMITTED BACKGROUND N.C.I.C. & C.C.I.C. CHECKS Yes ❑ No ❑ 18th day of Weld County, Colorado July AD 19 $$ me of Town, C. and Coun Cha Yes ❑ No ❑ 880 8( Page 4 of 4 TOSORS a)z O � H a) v] CG 0 H a) a) za a)r"f 4-1[4 0 -i o al W cJ) P4 0 O HO+, cti cb W' 00 A W OW O .C • O a) a) O RS off 4 M a) U r-7 CJ] O * U.S.G.P.O. 1967-178-268 Co 2 U. N I.. In Postmark o• Date rI r 1 a a) Spec al Delivery Fee Restricted Delivery Fee Return Receipt showing to whom and Dale Delivered Return Receipt showing to whom Date. ar.a Address of Delivery TOTAL Postage and Fees L. �ag c'''i i C 0 a) a U S8fit aunr '009E u+aod Sd NixfrJc-- ITc!-rcN i No rN C oouirK Go u- i<oop' MEN; 6100 ccis• EA) boat 3oo-rks Poo 'a9 p ei -7 op C * r RO c GEC Gp880801 op 84041.{2/85) STATE OF COLORADO DEPARTMENT OF REVENUE/LIQUOR ENFORCEMENT 1375 Sherman Street Denver, Colorado 80261 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 public 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 b. 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 -r-7 of Business: 6 Pr1 ©TeL C74 Fe Date: Mh--Y (l , i i1E7 Social Security Number 2. Yjostr frt Full Name: Ilast/first/middle) iuo�QLirE� , XD4 1zr Z -, 3. Alsoflown As: (maiden name/nickname/etc.) , ��n �A 4 4. Date of,B lrih: / Place of Birth: ,r-6uy2/ Pen 17 a 7 5. U.S. Citizen?: %YES ENO It naturalized, state where: �- When: Name oifS. District Court: Naturalization Certificate No.: Date of Certificate: If an alien, give Alien's Registration Card No.: Permanent Residence Card No.'. 5. Heygn r. Weight: X30 Hair Color: 64v.pC8 Eye Color: # Sex: F Race: 7, Do you have a Colorado Drivers License? If ' YES", give number: r:544, ES 0 N ,frrcif'/ 8. Your Relationship to APpl�c n�ls o ner/partneri corporate officer/director/stockholder or manager) � �res�s 9,1t Stockholder, Number at Owned Beneficially or of Record: Percent of Outstanding Stock Owned: 10.1t Partner State Whether: GENERAL ❑LIMITED Percent of Partnership Beneficially Ouute 11. Residence Address: (street and n mber/city/state/zipl /s �%l(Qy�S G 359,sa 2 76 ,Acc. ES.s GeokD let, cc� e /C 12.11,44 your residence: If rented, from whom? OWNED [RENTED 1 Mq© Address, If Diffy{ent Fr Residence: 14. Name of Present Employer: 15. Type of Business of Employment: 5 &-2-4:: r7 ©r—ez ©/6-0 ,a-7-0& 16. Address of Business Where Employed: (str et and number/cityy�tater zio) --/o Ice— ss number/city Sc'? 24 /ear's ,v Co g'o be2 .C on: 17. Present PoP#zmcrz 18.Home Telephone: 899 - L 367 L/a/pplicaJble): Business Telephone' 899—�? /7 -] tG' 19. Marital Status: 20. Name of Spouse (include m den name �1i /VIP 221 CO �' , tttcc y H,,,v,0 WL/rcA0 21, Spouse' s Date of Birth: 7—/ — of B ten: "4-- �� kwT1v5 ' 22. if spouse's residence address is different tnan yours, list here.: (street and number/city/state/zip) u G— 1. , cb 8t /zs 720e S,S/-1-ev 1t�77Z 23, it spouse worst state name 01 present employer: TEx c C Occupation:��/� � �� `////�ICC��// i /Ad�djres//]s or3,6, A -loo tI-o Q��,ii/ CO may/ � � V / L/�/"rJ"�/1� l.. !JY V 24. _:st the name's) or all relatives working in the liquor industry, giving tne'r. Name of Reiauve: /VS Relationsnip to you: Position held: Name of employer. Location of employer'. .ame of Relative: Relatlonsnip to you: Position held: Name or employer Location or employer; 25,.JJ you now/ or nave you ever nerd a direct or indirect interest in a State of Colorado Liquor or Beer License/ If "YES", answer in detail. VES NO pn s o801 DR 34041 (2/85) STATE OF COLORADO DEPARTMENT OF REVENUE/LIQUOR ENFORCEMENT 1375 Sherman Street Denver, Colorado 80261 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 public 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 b, 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. Nam of mess' .--�0 M 0 El_ C14c' � Date: M Pr; I l, 15 g7 Social Security Numner 2. r Full Name' [last/first/middle) NVoi�vvcR�i�, c�� ¢; Known As: maiden /nickname/etc..) 3. Also am C, ,�,�-r,�-or,�z../ — 4. Date at Bird,: /` —3zJVJ Place d B�rtn: 1 I# 02iv PA- tL5 ,s 5. U.5. Citizen?: EVES ENO If naturalized, state where: When: Name of U.S. District Court: Naturalization Certificate No.: Date of Certificate: If an alien, give Alien's Registration Card No.. Permanent Residence Card No.. Heq t 6./4" Wj/eii f.nr V'1 —TS Hair Color: 6g0 Eye Color: 8W5 Sex::�j /1 Race. L 7. Do you have a Colorado Drivers License?(I /ff ' YES", give ,/,(‘(,r Reia wnsnip to Applicant: (sole owner, partner, corporate off iceridirecto (stockholder or manager) A- 2 f ivE- g If Stocxhower, Number of Shares Owned Beneficially or of Record: Percent of Outstanding Stock Owned: 10.If Partner State Whether: GENERAL LIMITED Percent of Partnership Ben rigially Owned: ✓ /Q 11. Residence Adores stre andn mber/city• state/zip[ Co g© /mss. -S -7 ao( .- ? t DA-I-� CT %rz&,-aA/ (� f -3 12.Is your resioence: [XWNED 11RENTED If rented, from wnom? 13. Mai ing Aaorys if Difieren From Residence: 14. Name of Present Employer: %X 15. TYPe of Business of Employment AA_RGe F'NE2GyCDrjP.a,2y 16. Address of Business Where Employed: (street and number/city/state/zio) b7ON.$toA-D QkY� Delu VER. Co 8'`0? O2 17. Present Position: COOS/4v*-� 4 7294/1/9f� �- IB.Home Telephone: 973-3"iar e: Business Teleepnon5� � g'6 19. Marital Status ' /ilA-2 /L o 20. Name of Spouse (include maiden name if applicable): Coaepi3- rjG/1-1-6 eA-r#) 21.SPouse's Date of Birth: Ip- f Birth: 1 ^_ [ I Sg(-CR&(1 4 /1 /7 22. if ,,,spouse',.! t residence addres)s different than yours, list here.: (street and umber/city/state/zip) °°i6 `; --..t? - �,* Co 80 co. Z (A RS i -s s ) 23, it spouse .vctss, state name of present emo.oyer: Se 1.—C- en p� y OccuPatio Ore L PLQ��--,Q Address of present employer: 24. Lst the namelsi or all relatives wori.ing in ice liousr industry, giving tneir. Name or Rt iative: ` Relat,onsnip to you. Position held: Name OT employer: Location of employer: Name or Re.acne: Relationsnip to you: Position held: Name of employer: Location of employer. 25,D0 'raw now or nave you ever held a air •c, or inoirect interest in a State of Colorado Liquor or 'leer License? It -YES", answer in aetan. EYES NO N 880801 CrIlf.C19 lu. Do you now, or nave you ever nod a ovoct or i ct interest in a liquor or beer license, or been empl(in a liquor or beer related business outside or trio Stare of Colorado? If "YES", describe in detail. DYES NO 27, Have youeverPeen convicted of a crime. tinec, impruoneo. piaceo on probation, received nm a susoenoeo sentence or forfeited bail for any oense in cr,,na or military court? (Do not Include traffic violations, unless they resulted in suspension or revocation of your driver's license, Or you were convicted of driving under the influence of alcoholic beverages.) If "YES", explain in detail. AYES y0 28. Have you ever rece:ven a violation notice, suspension or revocation for a liquor law violation, or peen denied a liquor or beer license anywnere in the U.S.? If "YES". explain in oetail, DYES NO 29. Have you ever help a gambling or gaming license or owned a Federal Gambling Stamp? If "YES", exp ain in detail. YES 12(N0 State/Federal: Year: City: State: State/Federal: Year: City: State: 30. Military Service: branch: K n �G,/VAU From: To: Serial No.: Type of Discharge: 31. List all addresses where you have lived for the last five years.(Attach separate sheet it necessary) Street and Number: 3SR2 p L'2 , Less Eh/'EGG City/S eta/Zip: -cry Co o04�L From: :5 ll To: /•% Street and Number: 7,1-00 S 51171€12.16)“/ C7 Ci /State/Zip: From: Toy ?— 7C,5 ��j ,Li7TGE/DA) Co Y©/za 32. List all former employers or businesses engaged in within the last five years: (Attach additional sheets if necessary) Na�q of Employer: / / Uo%7resen7ae Address: (street and number) (city/state/zip) Position Held: From: /9u� 8� To: %`iw1.,,.� N}tye of E lover: -�/ v/1 cr qtl�drefs: (stree anq number) YO O L (city/state/zip) jQ/A'3 r%/ Pfry Cfo$ � Poi ion He ti.eiero•. .fitness From To: 83 uQy /r/rlra frmth 3 List the names a attach letters of recommendation from three persons who can vouch for your good character andin conndc ester this appllcavon. i7me of Referen 1/ t l I r�Gz Address: (stree nd number) loc's5` fin s, �i (city/state/zip L/ raze-nrdCO ?&/z.3 No.Years Known: 6 Name of Reference: pinr�0 /4 ��z 1&C Address: (street and number) & zt/48 (city/state/zip) L.47e6.4„002:7 l'o ?Ov�O No. Years Known: /O Name of Referents: Address: (street and number) /`CE-1'l✓L;Sin 65 64-R/Jitni�oZ9 ur s1 e-to,9' (city/state/zip) No. Years Known: /z LI-r'rct+aN 8'O/23 OATH OF APPLICANT I declare under penalty of perjury in the second degree that I have read the foregoing application and all attachments thereto, and that all information therein is true, correct, and complete to the best of my know/edge. SIGr •T RE: TITLE: pikavwc tz DAT //-62 /- / a 880801 870542 re<t riteres, aeon er Derr ? ss u. ccc" end ovie a i�aeo o.. n.0 d... ,. State of ZAbradOc if 'YE$ dBSOiba .c,�r EYES /o w 0i; f `ICLC Ac T) Gm / � 4 L CGC_ cC) 9 (AA S I D /A- `)) of PrrT/ D,u4 L D15 J /Li_e J2-5 / V'7�7 17. Have you ever been convicted 01 a crime, rived, imprisoned, placed on Probation, received a suspenaea sentence or forfeited bail for any ortense in crimina' o military court? (Do not Include traffic violations, unless tney resulted in suspension or revocation of your driver's license, or you were convicted of driving .nf _ /�� , under the influence of ` aloof' c ever/ages.( If "YES", explain inin detail. '/ �s �1 /) fig/ �IYES ENO 1 1J V S“s pe , mil' ai &,t L.3g E'i, J& /.t/ /T 74 Fog_ 5-pEeD,u& (c/Nc/NA/4D ©//fl 28. Have you ever rece:ven a violation notice, suspension or revocation for a liquor law violation, or been Denied a liquor or beer license anywnere in me U.S.? If "YES",,,, explain //,, in detail. Iyy YES NO 29. Have you��, ever nelo a gambling or gaming Iicense or owned a Federal Gambling Stamp? If "YES", explain in detail. DYES NO State/Fe era : Year: City: State: State/Federal: Year: City: State: 0. Military Service: branch: ,, /l � /w fitL From: To: Serial No.; Type of Discharge: 31. List all addresses where you have lived for the last five years.(Attach separate sheet if necessary) Street and Numb 72oo S,s-f4egit A Ai CT C ty/States p: ).-/7-E7z/✓,C6 go/2-3 From: fi7S To: To: Street and Number: City/State/Zip: From: To: 32. List all former employers or businesses engaged in within the las five years: (Attach additional sheets if necessary) Name of Employer: %'2X,4CD Address: (street and nu ber) /6?0 6720/rDS (cif stale/xip) �N� Ca � 2� ✓osl on Held: czlk& From: /5)/° To: giotd Name of Employer: Address: (street and number) (city/state/zip) Position Held: From: To: .33. List the names and attach letters of recommendation from three persons who can vouch for your good character and fitness in connection with this application. Varna of Re ante: OC/{I /OEz Address: (street and number) G,SiegeS.M.A€5tpML Sr (city/state/zip Lirnno/vCodV/2-3 No.Years Known: (p Name of Reference: Div -A41 M%+'i-6A Address: (street and number) fe 241 A8 (city/state/zip) La g4-.- Co Yaz14 No. Years Known: /0 Name of Reference: Address: (sire t and number) flR-'-H2S 2A-�c-s SQ,�H/ci_5oaRu�Fn-€$swir*V (city/state/zip) Litt( rog6gr°/73 No. Years Known: /"Z -- OATH OF APPLICANT I declare under penalty of perjuryyin the second degree that I have read the foregoing application and all attachments thereto, and that all inform ti n therein ' rue, co rect d Mete to the best f my knowledge. SI T,ORE' TITLE. 880801 870542 as S (1'c4rk 'd Fc.cnuun No Re order BILL OF SALE RECORDER'S S I %StP FNO\W ALL MEN BY THESE PRESENTS, 'hat ALEJANDRO C. MARTINEZ and DORTHY A. MARTINEZ of the Wyoming Count). of Laramie , inthe Suit olr�r-nc4r (Seller). or and in consideration of other valuable O:risjderatjni ox'd Ten and NO / 100 Dollars. to him in hand paid. at or before the ensealine or deliver)_ ofthesepresentshy C. RAY HINDERLITER and ROBERTA J. HINDERLITER, joint tenants of the County of Weld , in the State of Colorado. (Buyer)_ the receipt of which is hereby acknowledged. has bargained and sold. and by these presents does grant and convey unto the said Buyer. his personal representatives. successors and assigns. the follnsyinc prolxmy goods and errands. to wit: See Exhibit A consisting of Y pages attached hereto and incorporated herein by reference. Iocatedat I-76 Motel and Cafe, Rogcen Colorado TO HAVE AND TO HOLD the same unto the said Buve,-, nis personal rcnresentams. successors and assigns. tor;ver The said Seller covenants and agrees to and with me Buyer. nn personal rcnresentative>. successors and assign:. to \\ARRANT AND DEFEND the Sale of said nronem. glxvs and chanersagainst all and even per>on nu persons sv iurmcver. When used herein. the singular shall include the plural. the plural tor_ smgula:. and the use or any gender 'h:.Ii he applicable to alt genders. �-r7 IN WITNESS WHEREOF. the Seller has executed this Bill of Sale this I' 4"ft day of /11�ti ly -"`—/ STATE OF COLORADO. County d Weld ss The foregoing :r' -arm ent wen acknowledged help e pre this / My conninsidon \Witness my nano and Citic)ai ;cal. - 2 , Alejandro t. Martinez � � Dort ) A. brar 3nez1 dos of ✓ ALEJAI:D C . F 7, D.; t i.vR 111.C... STATE :0 Dr. prl / COUNTY OF _.AiL4MIE 's - The forecoinc tnctrument was acicnowledged before me this /.-r/day of Hay 1967, by DORTE7 A. NARTII3EZ. My coassieY.p±res : 4-' 'no Witness my hares and Official seal. y 880801 ot.ar,: ru(ic No. 35 \. I@'. 9'N. u ol.(0suJ .NVENIORy OF F URNITC,s0 AND FIXTURES, 1-76 MOTE CAFE Roggen, Colorado - 4/7/ 4 UNIT t 11: 3 Mattresses 3 Box Springs 3 Shower Kits 8 Cases Paint 2 Gallons Paint (open) 1 Harvard Frame 1 Headboard Frame 4 Dressers 3 Inserts 1 Lounae Chair 2 End Tables 2 Night Stands 2 Hanging Lamps 1 Mirror UNIT t 12 1 Mirror 1 Waste Basket UNIT t 14 1 Double Bed, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 1 Night Stand 2 Hanging Lamps 1 Mirror 1 Waste Basket 1 Air Conditioner 1 TV UNIT t 15 2 Double Beds, Complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 2 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner UNIT t 16 2 Double Beds, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 2 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner UNIT t 17 2 Double Beds, complete' 1 Straight Chair I Dresser Desk 1 End Table 2 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV A:_ C...._ __v:.e_ UNIT € 18 2 Double Beds, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 2 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner UNIT k 19 1 Double Bed, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 2 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner UNIT 20 on Page 4 UNIT t 21 2 Double Beds, complete* 4 Lounge Chairs 1 Straight Chair 1 Dresser Desk 2 Hanging Lamps 1 Mirror 2 waste Baskets 1 TV 1 Air Conditioner 1 Harvard Frame 1 Headboard UNIT W22 2 Double Beds, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 3 Hanging Lamps 1 Mirror Waste Baskets 1 TV 1 Air Conditioner UNIT t 23 1 1 1 1 1 Double Beds, complete* Lounge Chairs Straight Chair Dresser Desk End Table Handing Lamps Mirror Waste Easet TV Air Conditioner C larin 880801 V. G'ivili ::i1'C: ----FIXTURES, I-76 MOTEL & -'E �_ an, Colorado 4/7 . UNIT r 24 1 Double Bed, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 3 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner UNIT r 25 2 Double Beds, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 3 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner UNIT 4 26 2 Double Beds, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 3 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner UNIT t 27 2 Double Beds, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 2 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner UNIT 4 26 2 Double Beds, Complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 3 Hanging Lamps 1 Mirror Waste Basket TV 1 Air Conditioner UNIT V 29 L,A1llUli .� -- Page 2 1 Double Bed, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 3 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner UNIT 4 30 2 Double Beds, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 3 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner UNIT r 31 2 Double Beds, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 3 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner UNIT k 32 2 Double Beds, complete* 2 Lounge Chair 1 Straight Chair 1 Dresser Desk 1 End Table 3 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner UNIT ='33 441 (Units 33,34 on Page 3) 2 Double Beds, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 3 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner 870542 880801 INVENTORY OF FURN&,RE & FIXTURES, I-76 MOTI( ; CAFE Roggen, Colorado 4/7/84 Exhibit A Pace 3 UNIT # 33 2 Double Beds, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 3 Hanging Lamps 1 Mirror I Waste Basket 1 TV 1 Air Conditioner UNIT n 34 2 Double Beds, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 3 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner UNIT k 36 2 Double Beds, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 3 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner (Units 37 & 38 on Page 4) LIVING QUARTERS: 1 Vanity w/Mirror 1 Dresser 2 Hanging Lamps 1 Lounge Chair 1 Small Vanity 1 Table 1 Dishwasher 1 Range 1 Ice Box 1 Washer & Dryer 1 Flourescent Light LOBBY: 1 Couch 2 Lounge Chairs Coffee Table 1 End Table Hanging Lamps 2 Standard Chairs Hoover vacuum 2 Waste Baskets 1 High Chair 1 Hanging Mirror 1 Key Rack --Room recorder In -Out Basket 1 Pepsi Board 1 Fire Extinguisher *Double Bed complete includes: 1 Box spring 1 Mattress 2 Pillows 2 Sheets 2 Pillow Cases 1 Blanket 1 Bedspread WORKSHOP Miscellaneous Panelling Beer Sign Push Broom (2) Walk-in Cooler Misc. supplies 3 Bar Stools 1 Heater LAUNDRY ROOM 3 Cribs 1 Maids Cart (needs repair) 1 Maids Cart Mis. Chair Covers 1 Hand Truck 3 Bug Zappers 3 TVs(not working) 2 Mattresses for Cribs 4 Hanging Lights' Used Elec. Toaster Misc. Pans Misc. Drapes 1 Hoover Vacuum Misc. Cleaning Supplies 1 Roll -a -Way 12 Changes of linen per bed POOL HOUSE Supplies & Equipment 1 Coke Machine TRADING POST 1 Display cabinets 1 Metal Shelf 1 Mirror 1 Magazine Rack 4 Chairs 1 Air Conditioner RESTAURANT 12 Tables 5 28 Booths Cha c 2 is is ' Counters 1 CLar': Cash Register 1 Cr-_dit Card Validator 1 Fef. Display -Storage Cabinet 1 Iced Tea Dispenser 1 Cake Case 1 Pop Dispenser 1 Orange Juice Dispenser 1 Ref. Milk Dispenser Ice Cream Freezer 1 Malt Machine is Carts 2 High Chairs 880801 INVENTORS OF IUITURE & FIXTURES - I-76 JY'TEL & CAFE Roggen, Colorado 4/7/84 Exhibit A Page 4 UNIT r 37 2 Double Beds, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 3 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner UNIT # 38 1 Double Bed, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 2 Hanging Lamps 1 Mirror 1 Waste Basket 1 Air Conditioner RESTAURANT (Cont. from Page 3) 1 Micro Wave Oven 1 Work table Meat Slicer G. E. Refrigerator 1 Metal Storage Shelf 1 Scotsman Ice Machine 1 Vacuum 1 Steam Table 1 Toaster 1 Deep Fryer 1 Grill 1 Egg Grill - Speedfast 1 Delfield Refrigerated 1 Vulcan Oven -Range 2 Chest Freezers 1 Air Conditioner 1 Work Table 1 Metal Rack 1 Eag Cooker 1 Metal Stand UNIT #20 2 Double Beds, complete* 2 Lounge Chairs 1 Straight Chair 1 Dresser Desk 1 End Table 3 Hanging Lamps 1 Mirror 1 Waste Basket 1 TV 1 Air Conditioner make up counter 880801 F rrnS 2' Reception No Recorded at ...o'clock M - Recorder. RECORDER'S STAMP THIS DEED. Made this 11th day of May I 19 87. between ALEJANDRO C. MART:NE and DORTHY A. MARTINEZ 3800 East Lincoln>:ay at McCann Cheyenne, Wyoming 82001 !I i• I. of the County of Laramie and State of ram of the first part, and Wyoming C. RAY HINDERLITER and ROBERTA 1-76 Motel and Cafe. Rtsgen. Colorado of the County of Weld WITNESSETH. that the said parties of the valuable consideration and ten to the said part les of the first part in hand paid hereby confessed and acknowledged, have granted. grant, bargain, sell, convey and confirm unto the said in tenancy in ccmmon but in join: tenancy, all the folio being in the County of J. HINDERLITER 80652 and State of Colorado, of the second part: first part, for and in consideration of the sum of other and no/100 DOLLARS, by the said parties of the second part, the receipt whereof is I; bargained. sold and conveyed, and by these presents do parties of the second part, their heirs and assigns forever, not wing described lot or parcel of land, situate, lying and Weld and State of Colorado, to wit: See Exhibit A attached hereto and incorporated herein by reference. Colorado Doc. Fee $22.50 TOGETHER with all and singular the hereditaments and appurtenances thereunto belonging. or in anywise II t; reversions, sions remainder and remainders rents issues and profits thereof; and all the 11 i' i Il into.rC-ora°�" ._- _ reference. I� =-. li and the above Dargamec premises in the nowt and peaceable nussession of the said parties of the second par., their 'II, heirs and assigns. against all and ever: person or persons lawfully claiming or to claim the whoie or any part thereof, the said part ieC of the first part shall and will WARRANT AND FOREVER DEFEND. IN WITNESS WHEREOF the said par. I1 of the first part have hereunto set their hands and I e 5 � seal the cay and year firs: above written. appertaining, the reversion and , estate, right, title, interest, claim and demand whatsoever of the said parties of the first part. either in law or i equity, of. in and to the above bargained premises. with the hereditaments and appurtenances. , TO IHA\'E AND TO HOLD the said premises above bargained and described, with the appurtenances, unto the said parties of the second part, their heirs and assigns forever. And the said part ies of the first part. for their selves . their heirs. executors. and administrators do covenant, grant. bargain and agree to and with the said parties of the second part. their heirs and assigns, that at the time of the ensealing and delivery of these pres- ents they are well seized of the premises above conveyed. as of good, sure. perfect, absolute and indefeasible i estate of inheritance. in iaw. in fee simple. and ha ye good right, full power and lawful authority to grant, bar- j. gain. sell and convey the same :n manner and form aforesaid, and that the same are free and clear from all former and other grants. bargains. sales. liens, taxes, assessment and encumbrances of whatever kind or nature soever. subject to those items _istec on. Exhibit E. attached hereto and Signed. Sealed and Delivered in the Presence of Ale-jandro C. Martinez ( r rf,N. --nr\n fw+. Dortny1ti. Martinez STATE OF COLORADO County of...."-�` 1ss. The foregoing instrument was arknowiedged before me this 1E J^. by - RTI1IE7. 11e rommlaston expires c. .- , , . Witness my hand and official seal cay cif :jn V [SEAL] ,, [SEAL] ii is [SEAL] I, rl an',S The __n i.^.c_ instrur.ent was acknowledged before me this/Z711day ly�l C1 . J n. r..._:I,G.... p ..:-T_` c.., roc^ '/f. /9.5. // of May 1. No.9a. % A Kit e]11 DEED to Joan irn.nlr. 'brailurd 1'uLnJ,mu Cc.. Ihtt. r4 Stout Strtrt. bonier. Cu:ur.00 ,. L.•Sui IO8Op t 36'19" thence thence tnence tnence tnence_ tnence EXHIBIT A That certain interest granted in the deed from Harold L. Andrews, Sheriff of Weld County, to Alejandro C. Martinez and Dorthy A. Martinez, dated November 9, 1983 and recorded November 9, 1983 in Book 1012 as Reception No. 1946530, in and to all buildings, structures and improvements existing, situated, erected or constructed (as of the date of said deed and as described in said deed) upon the following property: That part of the NE 1/4 of Section 1, Township 2 North, Range 63 West of the 6th P.;:., Weld County, Colorado, described as follows: BEGINNING at the intersection East line bearing N 00°06'00" of Parcel No. 6 described in State of Colorado, recorded Weld County Records; thence N 67°44'00" W along said of 172.30 feet to the beginning radius of 250.00 feet, a central angle chord that bears N 85°50'30" W, 155.40 feet; thence along the arc of said curve a distance the end of said curve; thence S 76°03'00" W a OF BEGINNING; thence continuing along said Northerly R.O.W. line a distance of 156.60 feet to the beginning of a left, said curve having a radius of 250.00 feet; a central angle of 30°53'23" and a long chord which W a distance of 133_16 feet; along the arc of said curve a N 39°33'30" W a distance S 50°26'=0" W a distance N 01°9'2?" W a distance N 6°°P5'25" E a distance S 0 2° ?' 0'" W a distance OF BEGINNING. of cf of of c - distance 101.51 1':1.03 233.8C 431.00 '94.46 of the East line, said NE 1/4 (said W) with the Northerly R.O.W. line Deed to the Department of Highways, in Book 1523 at Pages 404 and 405, Northerly R.O. W. line a distance of a curve to the left, having_ a of 36°13'00" and a long of 158.00 feet to distance of 15.20 feet to the TRUE POINT s 76°03'00" W curve to the bears S 60° of 134.79 feet; feet; feet: feet; feet: feet to the TRU= POINT 3'2'0542 EXHIBIT B Subject to the following however they may affect the subject buildings, structures and improvements: The 1987 taxes payable in 1988; All building and zoning regulations; The right of the proprietor of a vein or lode to extract and remove his ore from the land as contained in the Patent to Patric}: H. Travers Pa1k6; t ,- recorded September 9, 1891, in Book 57 at The right of ingress and egress at all operating and developing saitimes for , purpose of minerals, as granted to ProspecctlRoyaltands o^ oil, November Royalty Company ��✓' and other 21, 1952 in Book 1344 at 5 by Deed recorded therein or rights thereunder; page 291 and any interests Lease dated September 1, 1967 between Frank C. Mann, Lessor, and StuekeV's, Inc Lessee ssee recorded October 31, 1967 Reception No. 1509491, and Assignment in Book 587 as Inc., assignor and Pecan p of R Lease , c., Stuckey's, recorded Shoppe of Roggen, Inc., assignee, July 12, 1968, in Book 597 as Reception 8 01; No. 1518601; Non -Exclusive Easement for right of way granted to Corporation by Deed recorded November Reception No.Premier 1558158; 30, 1970 in Book 636 as Covenants, Conditions and Restrictions contained in the Deed from Frank C. Mann, recorded November 30, 1970, in Book 636, as Reception No. 1558158; Easement over the Southerly 200 feet of the Easterly shown on the Survey prepared by Lind April 2, 1974• Engineering, , All esistinc [11 ^ \'C'_^- roa:ds. C__ways. ditche'y ' t' c r aL an d der n is „' the efor� ::"lOr._ C' a e1 rid `, a=1 C 1' A__ . ecor-'in c .are on the Co.^n_ f weld County, Colorado. O' the Clerk and Recoraer 100 feet, as Inc., dated Deed of Trust from Le Birkett L. Burke and Futile trusteeHarriet to s`i of the County of Weld for the of Franke to the 0,000.00ore d May 2 1975, 7 ir, Boo dated May ?9. 1975 recordedC. F: 7u . as Reception No. 2 , balance 169.065 with a remaining ;; of cD�.^C::iIDaLe1C wllCi.�69.0v. principal , SLCu- _ lny rest under to r. .f�. - _ 1 Jn_ �. Ol^� _ _ sue - . not_ce C= wbi3r. s r_`= _ -.._ae ibr eta _ tr't Mann, -_- gat" L. _urk e an: _ .c. r"se- ^b' , rs Statement secu-_ a. - f:le: e_ May - I C _ c .. __ t_. :. .. are.^ _. g I':C. c�I�I^i7. 870542 880811 Zen n CtJ', tO O'S 947) (98'1 C` ,0 - 71. ✓ ,ED. r, Co . Notary Public My Commission Expires: My Cammission Expires June 8, 1990 8942 Hello