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Home My WebLink About880144.tiffRESOLUTION RE: APPROVE CHANGE OF OWNERSHIP REQUEST FOR 3.2% BEER LICENSE FOR RONALD L. AND NORITA J. HIATT, D/B/A ROAD RUNNER #283 - EXPIRES FEBRUARY 18, 1989 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, Ronald L. and Norita J. Hiatt, d/b/a Road Runner #283, have presented to the Board of County Commissioners of Weld County, Colorado, an application for a Change of Ownership for the sale of fermented malt beverages, containing not more than 3.2% of alcohol by weight, for consumption off the premises only, said license previously held by Roger Ward, d/b/a Road Runner Franchise #283, and WHEREAS, pursuant to Weld County Ordinance No. 6, Section II., C., said applicants have paid the required fees to the County of Weld for a Change of Ownership of the existing license, and WHEREAS, said applicants have exhibited a State License for the sale of 3.2% fermented malt beverages for consumption off the premises only, outside the corporate limits of any town or city in the County of Weld at the location described as follows: 3979 State Highway 119, Longmont, Colorado 80501 NOW, THEREFORE, BE IT RESOLVED that the Board of County Commissioners of Weld County, Colorado, having examined said application and the qualifications of the applicants, does hereby approve the Change of Ownership and grants License Number 88-3 to said applicants to sell 3.2% fermented malt beverages for consumption off the premises only, only at retail at said location and does hereby authorize and direct the issuance of said license by the Chairman of the Board of County Commissioners, attested to by the County Clerk and Recorder, of Weld County, Colorado, which license shall be in effect until February 18, 1989, providing that said place where the licensees are authorized to sell 3.2% fermented malt beverages shall be conducted in strict conformity to all of the laws of the State of Colorado and the rules and regulations relating thereto, heretofore passed by the Board of County Commissioners of Weld County, Colorado, and any violations thereof shall be cause for revocation or suspension of the license. ( 880144 Page 2 RE: CHANGE OF OWNERSHIP - ROAD RUNNER The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 10th day of February, A.D., 1988. C ATTEST: Weld County Clerk and Recorder and Clerk to the Board eputy County'Clerk APPROVED AS TO FORM: ounty Attorney Frank amaguchi BOARD OF COUNTY COMMISSIONERS WEOUNTY, COLORADO cC ene R. BranEner, Chairman EXCUSED DATE OF SIGNING (AYE) C.W. Kirby, Pro-Tem 880144 ,A-rr tell 0t e .1® of C o llor ®h off tiro Liquor Enforcement Division 1375 Sherman Street Denver, Colorado 80261 HIATT RONALD L HIATT NORITA J ROAD RUNNER NO 283 3979 HWY 119 LONGMONT CO 80501-9543 Alcoholic Beverage License Amount Nurt6r l..nnr County Ch Indust Troe WMCaih Dw LICENSE EXPIRES ATMDNGM 14-27928 03 206 5411 5 021988 FEF 189 1989 Type Nerve and D..aplcn d Lkenw Fee J 3.2 PERCENT BEER RETAIL LICENSE S 25.00 COUNTY 85 PERCENT OAP FEE E 42.50 TOTAL FEES) $ 67 • 50 This license is issued subject to the laws of the State of Colorado and especially under the provisions of Tide 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 (11/87) FEB 221988 Executive Director 580143 t"+ 0 co co O 0 N MW Kl, N (Y) >- J z 0 trr • -) a a o O. —i a) a) w yC p k c. o • ^C • aao 0 • to o D, a a) c 0 WCo • o ti W v O. m a a) w C9 b 2 es IV b to O roC A a) O cd O F .8 O O ail .w • o m cd c co -O O CO 4d3 O o o m al 'C B a' ad O I-4 'd a,xm. a) 7. A O H O Qg yU a• H H 6 J H d Q x Ln ._ so • cm ry oo_, -' H H1 tags 6 0 Y.a._. i H u1 w¢ l H M a%O o x W of 1 goo� co R � 0 C'l ri Z Cr U o w O gcua .4 a4 'D O yoi ra Z(I H. • b s a qa a x o - C) q a to Z 6N. Z 2 O O rn 0 zrxM a S86L aunt, `008E wiod Sd 880144 i DRL 403 (Rev. 9/83) NOT WRITE IN THIS BLOCK (DBA) c&0 -3 9 f c( \-4 A City: -- _4. Mailing Address: (Number and Street) v wr-Y.Y 2-_.8 3 c -Q —district where it is impossible to give street and number, the lot and block number or part of section whe 1V'et sec4;Qv' 3 -1v,.�, �e County: °t Elw•1 \\C,. 5. If these premises are now licensed, answer the following: Trade Name of ishment (DBA): DAa (A-vcfltY 1 LW3 City or Town: LarstyYvN STATE OF COLORADO DEPARTMENT OF REVENUE DIVISION OF LIQUOR ENFORCEMENT 1375 SHERMAN STREET DENVER, COLORADO 80261 COLORADO FERMENTED MALT BEVERAGE (3.2% BEER) LICENSE APPLICATION Instructions on Page 3 of Application. 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) 45-9 37-1 49-1 TOTAL FEE ALL ANSWERS MUST BE PRINTED IN BLACK INK OR TYPEWRITTEN 1. Ne e-ef * )licant(sl: If ertnenhip, list pa era names (at least two); if corporation, name of corporation: Date filed with Local Authority: f o�t� �ff / t� �z✓ /:,.', t �' /-�'1/ TTk,.•t9 (9 State Sales Tax No.: /41— .2 292f 2. Trade Name o Establishment n/13�A 3. Address of remises: (Exact location of premises must be given. Give street and number, when possible. If {(face to be licensed is located in a town or rural ed must be given 1 TS: ct el l -e<7 State: L State: CO (OYcd() •(0rkdo Business Telephone: r1 rl rl t O l 3/ w :US ."Z -ecJi - Zip Code: e0S0 Zip Code: �GSGj State License No.: Type of License: Expiration Date: KEY CODE COLUMN A STATE -LOCAL FEES FEES KEY COLUMN B CODE STATE FEES 11 ❑ Retail 3.2% Beer: Fermented Malt Beverage License - City 11 }❑( Retail 3.2% Beer: Fermented Malt Beverage License - County $ 46.25 $ 3.75 $ 67.50 7.50 ❑ Other (Specify) (Change of Corporate structure, location, trade name, renewal, etc.) 12 ❑ Wholesale 3.2% Beer License 13 ❑ Manufacturer's 3.2% Beer Llcnese 16 ❑ Nonresident Manufacturer or Importer License (Fermented Malt Beverage) $100.00 100.00 100.00 Page 1 of 4 88©144 (continued) YES NO 6. Is the applicant; or any of the partners; or officers, stockholders or directors of said applicant (if a corpl....cion); or manager; under the age of eighteen years? 7. la) 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. ❑ t7 (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: (e) been denied an alcoholic beverage license? (b) had an alcoholic beverage license suspended or revoked? (C) had Interest in an entity that had an alcoholic beverage Ilcanes suspended or revoked? If answer Is"yes." explain in detail (Attach separate sheet if necessary.) 9. Has a fermented malt beverage license for the premises to be licensed been refused within the preceding one year? L1, LE. - 10. 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 or Fermented Malt Beverage license (include loans to or from any licensee, or Interest In a loan to any licensee)? If answer is "yes," explain in detail. 11. State whether the applicant has legal possession of the premises by virtue of ownership or under a lease. If leased, list name and address of landlord and term of lease: / rciM?ar✓ toe gag 7 z. o /d ( o.•r'rl stun / "13 ��-y/east&, /-4)(as /JTr0 / ni 31, /5 `i 12. 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 dollars or other items of value • such as inventory, furniture or equipment; (i.e., bank, relatives, friends, previous owners, etc.). Use separate sheet if necessary. NAME � .n on. , C (, to „LK /H T,siljY/A ADDRESS /� `j • �e7 /-. / crKocINTEREST / 1 1 t ).cS 13/S.i. 0O Ea u. fen -ft-ft fl4 F✓AN<yr1C, \ I-4 �r+�' A 4\RY'CA .1"Scty i'b1s fPT / v,t.' 97nc .4u I4 ,-.1-0'+t'vMei4.(M 7 �. q a",X'N V TN 4ot'/ List the names and addresses of all liquor businesses In which any of the persons in the previous question are materially Interested. (Use separate sheet if necessary.) TNAME /�// / �7 it Q,t/ r A41.7c ipce �9d o>`�.er Erase e4,;, -e BUSINESS -s dove fq r ADDRESS if" I"2 my ^en r-« tee?' 744 Attach copies of WI note 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, end any agreement relating to the business which is contingent or con- ditional in any way by volume, profit, sales, giving of advice or consultation, 14. Colorado Manufacturer or Wholesaler applicants. answer the following: (e) 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. YES NO Li ❑ (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. — L✓ (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 fermented malt beverages, or malt, vinous or spirituous liquor? If answer Is "yes," attach ex?lanation 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. Page 2 of 4 88014' (continued) �'. No strident Manufacturer (fermented malt bey. vs) or Importer (fermented malt beverages) applicant %saver the following: (a) To what Colorado licensed wholesaler do you intend to ship your merchandise? YES NO (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 fermented melt beverage. or malt, vinous or spirituous liquor? If answer Is "yes," attach explanation in detail. lc) 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 US.? If "no," explain in detail. ❑ 16. If the applicant is an individual or partnership, answer the following: (Attach separate sheet if necessary.) (a) Name of individual or name and class Home Address, City and State: oftg h partner:, / /,� a v .• t l c . /4l a t -t r j'Z 'y r! w f /f q Z. e'+-. c rs, c -• t, .4eL14/7.9 ,4. r Sp .cG Date of Birth: - (b) Name of Operating Manager: Home Address. City and State: Date of Birth: (V When did said partnership commence doing business? (Attach a copy of the partnership agreement, except as between husband and wife, and trade name affidavit.) 17. 1 f the applicant is a corporation, answer the following: ` (al Corporation Is organized under the laws of the State of: (b) Principal business is conducted at: (cl Date of filing last annual corporate report to the secretary of state: County of: Date: State of: )J Name of each officer listed below: Home Address, City and State: Date of Birth: President: Vice -President: Treasurer: Secretary: Operating Manager: (a) Nisrtt all s o khold rs; include actual owner or pledge. (Use separate sheet if necessary) Home Address, City and State: % of stock: Date of Srth: (fl Name of all Directors or Trustees — of Corporation: Home Addres, City and State: Data of Birth: 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 typewritten or legibly printed in BLACK ink. 3) IMPORTANT: For those retail licenses described in Column A on page 1, this application and all supporting documents must FIRST BE FILED IN DUPLICATE WITH AND APPROVED BY THE LOCAL AUTHORITY. Application will not be accepted unless all appli- cable questions are fully answered, all supporting documents correspond exactly with the name of the applicant(s) and proper fees are attached. 4) Form DR L 404.1, " 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. Page 3 of 4 e80144 OATH OF APPLICANT This application 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. INDIVIDUS SAND ALL GENERAL PARTNERS OF CORPORATIONS SIGN HERE: PA ER PS MUST IGN HERE: DATE: 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 satisfactory. 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 ❑ (I I) Sales for consumption "on" the premises of the licensee; or E (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. DATED AT Greeley 10th this AT W (Name of Town/ ity and • nty) BY: r, Chaan o rd of co ntnt ,wmmisnsionenl or other title of the lice rig authority) ATTEST: P.(,/e/(, J c t�.�K71tc A' o. l / " ". e• (Clerk, retary of other officer having the off ial seal f the licensing auth ity) County, Colorado day of February ,AD 19 88 (lf 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 Ifp No ❑ Yes ❑ No ❑ - Pogo • of • 880144 , DRL.1555 (Rev. 10/S3) ,.24 BEER AND LIQUOR LICENSE APPLi,.ATIO1l STATE OF COLORADO DOCUMENTS CHECKLIST AND WORKSHEET DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION 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. Copies (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 x i Individual II Partnership I1 Corporation NAME OF APPLICANT: Ronald L. Hiatt & Norita.J. Hiatt TRADE NAME: Road Runner #283 PLEASE CHECK ALL APPROPRIATE BOXES Applicant Local State Documents I. APPLICATION OR ADDENDUM II I_i Ii* A. Original (green or yellow), not a copy 1f 1-.K1 I_I* B. Complete all appropriate sections -Iz1 ISI 1=I* C. Sign application II I)L1 1=1* D. Attach appropriate fee II. PROOF OF PROPERTY POSSESSION 11 I=1 I=1* A. Deed (or) '171 ICI 1=I* B. Lease (or) 1=1 I-1 I1 I —I I—i 1. Lease must cover entire license period (minimum one year) C. Lease Assignment 1. Acceptance of applicant 2. Consent by landlord D. All possession documents must be signed E. Floor diagram of premises to be licensed (maximum size 8 1/2" x 14") III. FINANCIAL DOCUMENTS 11* A. Purchase agreement or stock transfer agreement I_I B. Affidavit on source of all funds invested (Continued on Reverse Side) ,� €801 4�4. Applicant Local State Documents I1 ICI II C. Notes or loans (i.e., assumed, banks, previous owner, etc.) I I I_1 I_1 1. Applicant may not have any unlawful financial interest in any other licensed establishment IV. BACKGROUND INFORMATION IZGI I-1* A. Individual History Record(s) (form DRL 404-I) }":I IMI 1_I B. Fingerprints taken and submitted V. MANAGEMENT (if other than applicant) I_I I_1 1_I* A. Manager Registration Form (form DRL 367) t73.20 eee .,cui red only if Hotel ana — — Restaurant .icer.se 1 1 1_1 1_i B. Written management agreement (or) 1 1 1 1 1-1 C. Affidavit describing duties, limitations and compensation VI. CORPORATE DOCUMENTS (if applicable) I1 I1 Ii* A. Certificate of Incorporation (or) 1 I I I I_I* B. Certificate of Good Standing if corporation is more than two years old (or) 11 1 1 1_1* C. Certificate of Authorization if foreign corporation i_1 1_1 1_1 D. Articles of Incorporation 1_1 I_1 1 I E. Minutes of meeting electing current officers 11 11 11 F. _ Stock certificates (100% of issued stock) 1 1 11 11 G. List of officers, stockholders and directors of parent corporation (if applicable) VII. PARTNERSHIP DOCUMENTS (if applicable) I II II* A. Partnership agreement (general or limited) II I II 1. Not needed if husband and wife 1-1 11 1_1 B. Dissolutionment of partnership (if applicable) VIII. ADDITIONAL LOCAL REQUIREMENTS A. 1 1 B. esOi4) ;04112,0B) TE OF COLORADO ARTMENT OF REVENUE/LIQUOR ENFORCEMENT i Sherman Street le completed by each individual applicant, each general and over 5% limited partner of a partnership, each officer, director, and over 5% :kholder of a public corporation, and the manager of the applicant. TICE individual History Record provides basic information which is necessary for the licensing authorities' investigation. vered in their entirety. EVERY answer you give will be checked for its truthfulness. A deliberate falsehood will jeopardize tch falsehood within itself constitutes evidence regarding the character and reputation of the applicant. ALL questions must be the application Jame of Business Ko HyP F' d 2e3 Date: / n �_ (l fi ..Oo Social Security Number: ! � de a /Out Full Name: (last/first/middle) // A7 t 14 A"/ A -..44/Y 3. Also Known As: (maiden name/nickname/etc.) (97.(0 die 7/YJAi n/e0 il/ /iO/t9e) /"T/ / Jate of Birth: state where: When: Name of 11 S. District Court: OYES ENO ).laturalization Ce tificate No.: Date of Certificate: It an alien, give Alien's Registration Card No.: Permanent Residence Card No.'. Reight: --./,,,.? It Weight: --Lt. Hair Color: Eye Color: PNl. cQeccfr Sex: iG Race: I.Rk P. License? If ' YES', give number: 7. Do you have a Colorado Drivers 4,70 rO ._ _..._"........ ....nvhnlder nr man aoerl INDIVIDUAL HISTORY RECORD (our Relationship to Applicant: (sole owner/pa nwne", (cpnu rc) Stockholder, Number of $t,area Own d Beneficially or of Record Percent of Outstanding Stock Owned: '.t Partner State Whether: Percent of Partnership Beneficially Owned (GENERAL ['LIMITED Residence Address: (street and number/city/state/zip) -FV 4/ Akr y g C, /4 % / / n /17 /�-, n At ea a /tetra /nS s your residence: If rented, fro wham? ]OWNED RENTED .14/n e• Mailing Address, If Different From Residence: Ste,' fr /, ,61 Nam�ee Present Empl er: 15o.ro/ lSuhnee ,e? 93 Address of Business Where Employed: (street and number/city/state/zip) 3929 ,l/wy /I9 -2447AV Present Position: icon Pt/yeP.o fit Marital Status: /i%f �eey'ed 20. Name e. r,, /✓ L, ,4' ' t 15. Type of Business of Employment: t1 ,/ Sc:/c See. 9AC' S//J. /!'a /j U,/s.e de Sloe, (11,. e49 .6-6f 1B'Home Telephone: Business Telephone: . a3 10 57/-/1-6-.2 pouse (include maiden name If applicable): Spouse's Date of Birth: Place of Birth:// oZ� 510 & ./1 leen.S'/� /} If spouse's residence address is different than yours, list here.: (street and number/city/state/zip) 176-7/a / spouse work state state,nnaaa e of present employer: p tY /) N n r1 e e # c,20 .'3 Address Of present e/yII yer: 47 / 2L (/ p9, 02 O4-9 /77 e,✓ fi k'in the liquor n ustry giving their: List the names) of all televises Wor n e Name of Relative: Relationship to you: Position held: Name of employer: Location of employer: y/ Name of Relative: Relationship to you: Position held: Name of employer: i if " vcc^ s.s.uer Location of employer in detail. Occupation: el Guile'? o/e ,?A 7`a de o you now, or have you ever held a direct or indirect interest in a Sta ❑YES ONO i^s01 Fy' . e26. 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 bear related business outside ofthe State of Colorado? If "YES", describe in detail. OYES NO Y'J 27. Have you ever been convicted of a crime, fined, imprisoned, placed on probation, received a suspended sentence or forfeited bail for any offense in criminal 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. DYES ONO 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. •YES 2NO 29. Have you ever held a gambling or gaming license or owned a Federal Gambling Stamp? If "YES", exp ain in detail. syl DYES 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.(Attach separate sheet if necessary) Street and Number: 41'/,& Aw6e,e° City/State/Zip: J//A.rnf° A z 9So1 From: 5-tS To: 5-.74? 7 Street end Number: Y Z24 41,,Afs..✓ city/stn./zip:- gill/urea S %/Se/ From: F-'/ To: 5f PPS 32. List all former employert or businesses engaged in within the lest five years: (Attach additional sheets if necessary) /y Name of Employer: agr'cl.tet, ? Z70 Address: (street and number) ///e Id. S O/ (city/state/zip) �� !1/Z,re,.+ 4 /93c/ Position Held: ld S^,r etc/Nab/ From: 6 //—O/ To: ,1-431 Norge of plo er: Address: (street and number) (city/state/zip) / Position Held: I From: To: 33. List the names and attach letters of recommendation from three persons who can vouch for your good character end fitness in connection with this application. Name of eferen V# sreYe �i/beet I et Address: s e mil n er) . 7rJ� ) a � ell/ i (city/state/zip) ,0 �jei / 6,05a No.Vears Known: ma, emeiafref Reference: ' Log II/9- :Ate .S.d fe.� Address: (street and number) 7SVV lo C ie .74/ (city/state/hip) / O LA. /), n.v / a of No. Years Known: ; Ina. Name of Reference: ,A l a Address: (street and number) �/. (cityy//statte/ ip) �� /J ,I Ja% / E [vN d 7J7 No. Years Known: 11 >na. 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 d complete to the best of my knowledge. m ormanon is true, cor t, an comp e e SIGNATURE: //as, J5 / , TITLE: // DATE: 8801 r15, DR 84041 (2/85) STATE OF COLORADO DEPARTMENT OF REVENUE/LIQUOR ENFORCEMENT 1375 Sherman Street Denver, Colorado 80261 To be completed by each individual applicant, each general and over 5% limited partner of a partnership, each officer, director, and over 5% 1 stockholder of a public corporation, and the manager of the applicant. NOTICE I ( This Individual History Record provides basic information which is necessary for the licensing authorities' investigation. ALL questions must bey answered in their entirety. EVERY answer you give will be checked for its truthfulness, A deliberate falsehood will jeopardize the application E as such falsehood within itself constitutes evidence regarding the character and reputation of the applicant. I 1. Nam f Business: pp _i £ ne,r # e223 Date: • /-.29-Ie Social Security Number'. 2. Your F II Name: }(last/f irst/midg/�p) / .4 ft /1 L�.41 lc/ L. e eve // 3. Also Known As: (maiden name/nickname/etc.) 4. Date of Birth: : RYES ONO 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.: 6. Height: S19"I Weight: PDYES /1S Hair Color: 1odwni Eye Color: BRcwN Sex: /19.e% Race: sour give number. 7, Do you have a Colorado Drivers License? If'' YES", give B. Your Relationship to Applicant: (sole owner/partner/corporate officer/director/stockholder or manager) t2f,oail eet 9, If Stockholder, Number of Shares Owned Beneficially or of Record: Percent of Outstanding Stock Owned: 1oJf Partner State Whether: ❑GENERAL ❑LIMITED Percent of Partnership Beneficially Owned: 11, Residence Address: (street and number/city/state/zip) 9921 247 // 9 ..c / G G/ ,Lo 49 .>, 0,111, Clo. 12.Is your residence: DOWNED RENTED If rented, from Whom? (` J fAh e. S 1e,' �C A go 13 -Mailing Address, If Different From Residence: 14. Namur ,,9f Present Employer: /,,Se /)• — d M P. e,oe,4 nr,e2. aa1a (ow/lee) le 15. Type of Business of Employment: 1 Se /P .See qac shi (Yoh Veh I9nde JI6'ee 16. Address of Business Where Employed: (street and number/city/state/zio) / Sf7, iiwy /1% %6N9 m e.s'7L, c0. 4:71°Ca/ 17. Present Position: piv.vc� /otezn7L-0 - 18.Home Telephone: fe '/ e5- /d9.5 —"S3 Business Telephone: 3a-7-7 - 7/a/ 19,Marital Status: ll 41Atele,/ 20. Name of �Spouse (include maiden d/name If applicable): A /[tag/" /'ft JP n.v a/S oN H/'7"/ �t sr 21,Spouse's Date of Birth: ef"- of Birth: -4ye2 rS1 AcgrM 22. If spouse's residence address is different than your! list here.: (street and number/city/state/zip) 23. If spouse works, state name of present employer: a9ti U i'1 leCare #o?c9._3 Occupation: eito he/e/OPe_A to /2 ((( Address of present em I yer: 4929 /VWy 1/9. tie A"9a a.ff, /7. ,po5'oy 24. List the name(s) of all relatives working in the liquor indus rry, giving their: Name off' Relative: O/✓e Relationship to you: Position held: Name of employer: Location of employer: .4 Name of Relative: Relationship to you: Position held: Name of employer: Location of employer: 25.Do you now, sor have you ever held a direct or indirect interest in a State of Colorado Liquor or Beer License? If "YES", answer in detail. ONO NO INDIVIDUAL HISTORY RECORD ?f Ot44 126. 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. YES O 27. Have you ever been convicted of a crime, fined, imprisoned, placed on probation, received a suspended sentence or forfeited bail for any offense in criminal 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. YES WINO 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 US.? If "YES", explain in detail. OYES ONO 29. Have you ever held a gambling or gaming license or owned a Federal Gambling Stamp? If "YES", exp ain in detail. YES O State/Fe I: Year: City: State: State/Federal: Year: City: State: 30. Military Service: branch: it tS /Defy From: V -t 2 To: 4/-G5' Serial No.: Type of Discharge: /?1dfro.c,Pd/e 31. List all address where you have lived for the last five years.(Attach separate sheet if necessary) Street rr,�andNumber: /ofl A /ke_av 6 e ce1c v City/State/Zip: /1 ///'A .4// P .Pe G 9•?n / From: 's'h'S From: 9 // To: S-:7 To: -r MS Street and Number: /' 4247 /�,9.r?dv 1o.t/ City/State/ZIP: /State/ZI ' Y P: ,1 //i, A/a to.,M/ / 9SeI/ 32. List all former employers r businesses engaged in within the last five years: (Attach additional sheets if necessary) �/�,Name of Employer: �o%Address: ACCVA (street and number) /adO IV, 3 t I ft (city//state/zip) y it4- P Z%3e/ Position Held: 1 /Rar;ae.ti/ From: o 7'1/ To: .se7 To: /r ctcty Name of Employer: Address: (street and number) (city/state/zip) Position Held: From: 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. Known: Name of Reference: %7r 2e// Address: (street and number) 0.%7 7�/wy //9 (city//state/zip n b 9r+,e..r 74 et. fo a/ Noyears /2 NQS. /}/�,ry wr Nam�j of Reference: LL /�// A4, / S7�L/144. Address: (street �yand number) /� nn /e7.Ft% Zu,N fi4/yr C"iR (city/state/zip) �r LO,Y4n, 4js'f ' ^. /55 J No. Years Known: Name of Reference: �% .C. A)11q g,q '/ Address: dr(street teand number) nu/`er 7.4505 /7a (citJy/state/zip) l n p ,ore O/li/ a. face/ No. Year�nown: 4 "90. OATH OF APPLICANT I declare under penalty of perjury in the second degree that l have read the foregoing application and all attachments thereto, and that all inform: '. i therein is tre, orrect and complete to the beef my knowledge. -�v TE: /7,- Z 9 /7v8' 880141 �^y f n" } • FA -, fo(R.4 t '1'4V d3ad i 1nnoQ 4 h3Q LC •I . r� .• 4 1---. I e-7,a7oo J `s,000r 779 �ooL • 1 STATE OF COLORADO COUNTY OF WELD X LEASE AGREEMENT THIS AGREEMENT OF LEASE, made and entered into by and between TRUMAN ARNOLD COMPANIES, a Texas corporation, having its principal office and place of business in the City of Texarkana, County of Bowie, State of Texas, hereinafter referred to as "LESSOR" and Ronald L. Hiatt. and Norita J. Hiatt, jointly and severally of 688 A Newberry Street, Aliance, Nebraska, hereinafter referred to as "LESSEE". WITNESSET H: That LESSOR hereby leases and lets unto LESSEE, and LESSEE takes, hires and rents from LESSOR, the land, building, and canopy located upon the following described property situated at 3979 Hwy. 119 in the City of Longmont, Weld County, Colorado, to wit: SEE ATTACHED EXHIBIT "A" TO HAVE AND TO HOLD said property hereby leased, subject to the following terms, covenants and conditions, to wit: 1. Term. The primary term of this lease shall commence on June 1, 1987, and terminate at midnight on August 31, 1996. -1- 880141 2. Rental. The LESSEE shall pay to the LESSOR as rental for the property hereby leased the sum of $2,800.00 per month between the commencement date hereof and August 31, 1996, such installments to be due and payable in advance on the first day of each month beginning July 1, 1987 through the thirty first day of August, 1996. All rentals shall be due and payable to LESSOR at LESSOR'S designated address. In connection with the rentals set forth during the primary term hereof, same shall be payable under the terms of this lease at its commencement as follows: TRUMAN ARNOLD COMPANIES P.O. BOX 973 TEXARKANA, TEXAS 75501 or at such other address furnished by LESSOR to LESSEE in writing. 3. Use of Premises. LESSEE shall have the right to use and occupy the premises herein leased for the purpose of operating a ROAD RUNNER Gasoline and Convenience Store. LESSEE shall not do or permit anything, or things, to be done on the leased premises which shall make uninsurable the leased premises or any part thereof, nor conduct any operations thereon in violation of any statute or ordinance. LESSEE shall at all times comply with all governmental laws, ordinances and regulations applicable to the use of the leased premises and shall comply in good faith and as promptly as possible with any and all governmental orders and directives of correction, preventative and abatement of nuisances, all of which such compliances herein being had at LESSEE'S sole expense. -2- 880"..s.41 4. Construction. LESSEE shall at its sole expense and liability have the right from time to time, with ROAD RUNNER PROPERTIES approval, to build or rebuild such buildings, structures, install equipment, and to make such other installations and constructions as it deems proper for the sale and distribution of products sold on these premises and/or as a convenience store for the sale of food stuff upon the premises. It is agreed that prior to the commencement of construction, or remodeling, alterations, or improvements or structural changes to the leased premises, LESSEE shall provide LESSOR with evidence of insurance showing that LESSOR is free from any liability or claims and LESSEE agrees to hold LESSOR harmless from any claims, suits, damages and settlements arising from such constructions, alterations, remodeling and improvements, etc. In addition thereto, LESSEE agrees that it will provide such bond as LESSOR may command to assure performance of any contract and to hold LESSOR free, clear and harmless from any contractors, subcontractors, laborers, materialmen's, or supplier's liens on said property resulting from work performed in connection with the making of such improvements, alterations or changes. 5. Maintenance. LESSEE shall, at its sole expense and risk maintain all parts of the building and other improvements on the leased premises in good repair and condition, including but not limited to repairs (including all necessary replacements) to the plumbing, window glass, plate glass, doors, heating system, air conditioning equipment, and the entire leased premises in general; and including the reasonable care of landscaping and the maintenance of the parking area of the leased premises and any parkways. 88014 -3- At the termination of this lease, LESSEE shall deliver the premises to the LESSOR in broom -clean condition in as good a repair and condition as that in which it was received, reasonable wear and tear and damage by fire, tornado or other casualty expected. Insurance provisions contained hereinafter shall control as to the provisions herein where damages accrue by virtue of insurable risk. It is agreed, however, that TRUMAN ARNOLD COMPANIES shall conduct maintenance and repair of the building and equipment as provided in Exhibit B, attached hereto and made a part hereof, prior to June 1, 1987 or within One hundred twenty (120) days after the inception of this lease whichever is later. At the time of completion of the repair and maintenance of the items listed on Exhibit B, Lessee shall indicate his acceptance and approval of the building and equipment in as is condition by affixing his signature to Exhibit B and thereafter Lessee shall thereafter be responsible for and have the duty to maintain at his sole expense and risk all parts of the building, equipment and other improvements on the leased premises as provided for in this section. 6. Taxes and Assessments. LESSOR shall pay all taxes and assessments to become due against the demised premises before the same become delinquent. LESSEE agrees upon demand by LESSOR to reimburse LESSOR for such taxes and assessments within ten (10) days following receipt of such notice from LESSOR. In the event that there are any street improvements, or any improvements are constructed that result in a paving lien or special assessment being assessed against the property of the -4- )8C 41-1 LESSOR of which the leased premises are a part, LESSEE agrees to pay such paving lien and/or assessment as hereinabove provided. LESSOR shall pay any and all personal property taxes due and owing on his personal property before the same become delinquent and further agrees that it will not allow any tax liens to be surrendered on the property by virtue of its owning of personal property. 7. Insurance and Losses. LESSEE shall, during the term of this lease, keep in full force and effect, fire and extended coverage and other casualty insurance, as well as vandalism and malicious mischief insurance where same is available, against damage to or destruction of the property hereby leased in an amount equal to the full insurable value of such property hereby leased. LESSOR shall be named as an additionally insured party to this insurance policy. In the event of damage or destruction of the leased premises, LESSEE shall forthwith give notice to LESSOR of such fact. In the event the building on the leased premises is destroyed, in whole or in part,, by fire or other cause covered by LESSEE'S fire and extended coverage insurance within the primary term, LESSEE obligates himself to immediately commence rebuilding the building on the leased premises and to restore it to its former condition. During the time the LESSEE shall be unable to occupy any part or all of the building on the leased premises, there shall be a diminution or abatement of rent in proportion to the amount of the building which cannot be occupied or used for the purpose intended by this lease. It is expressly provided, however, that the LESSOR, in its sole e80144 -5- option, may waive the requirement of re -building the building, in which event the LESSOR retains the proceeds of the insurance and the lease shall terminate and become void. Any fire and extended coverage insurance carried upon the contents and fixtures placed in the leased premises by LESSEE shall be carried by LESSEE, and LESSOR shall have no responsibility therefor. 8. Utility Bills. LESSEE shall pay promptly all utility bills imposed on the premises hereby leased as the same shall become due during the term of this lease. 9. Assignment. LESSEE, provided LESSEE is not in default under the terms, covenants and conditions of this lease, shall have the right and privilege to assign this lease, or sublease the premises with the written consent of the LESSOR, provided that any such assigning by LESSEE in all respects shall be subject to and governed by all the terms and conditions of this lease and the franchise agreement, and provided further, that assignment of this lease or the sublease of the premises or any part thereof shall not relieve LESSEE from liability for the payment of rentals or for the full performance of each and every obligation of LESSEE as set forth in this lease. 10. Indemnity. It is agreed that LESSEE shall hold the LESSOR harmless against all claims, actions, damages, liabilities, judgments and demands of any person or persons whomsoever on account of any injuries (including injuries resulting in death) or accidents occurring on the leased premises. In this connection, LESSEE shall carry public liability insurance relating to the leased premises and -6- 8 stipulating minimum limits of One Hundred Thousand and No/100 ($100,000.00) Dollars per person per accident, and Three Hundred Thousand and No/100 ($300,000.00) Dollars per accident, and in which the property damage liability shall not be less than One Hundred Thousand and No/100 ($100,000.00), and which limit shall not be reduced without the prior written consent of LESSOR. LESSOR shall be named as insured and shall be furnished with the Certificate of Insurance evidencing the existence of such policy and evidence that the premium has been paid. 11. Signs. LESSOR hereby grants LESSEE the right to erect and maintain signs on the leased premises. 12. Access to Premises. LESSOR shall have the right to enter upon the leased premises at all reasonable hours of business purposes and for the purpose of inspecting such premises. 13. Possession. LESSOR covenants that during the term of this lease, the LESSEE, paying the rent aforesaid and performing the covenant set forth herein, shall peacefully hold and enjoy the herein leased premises without hindrance of interruption by the LESSOR and the LESSOR agrees to protect the LESSEE against the claims of any person, or persons claiming ownership of or the right to possession of the leased premises. 14. Right of Termination. If at any time during the continuance of said lease, LESSEE is prevented from establishing or continuing the business of distributing petroleum products on the whole or any part of said premises, or is prevented from building or rebuilding the buildings or structures, or making the installations to be provided in such lease, because of any 88014 -7- law, ordinance, or regulation by any federal, state, or local governmental authority, or order of any court prohibiting such business on such premises, or any restriction on the demised premises, and such prohibition or restriction is not removed within ninety (90) days, then LESSEE may terminate such lease upon giving thirty (30) days written notice, in which event the rental obligation shall be abated from the date that LESSEE is prevented in any manner from doing business on said premises. If during the continuance of such lease any part of said premises or any right appurtenant thereto, including but not limited to the right of convenient and direct access to the streets and highways adjacent thereto, shall be taken for public use under the right of eminent domain, or by any conveyance in lieu thereof, and if in the opinion of LESSOR the remainder is not suitable for its purpose, LESSEE at its option may cancel and terminate such lease upon giving thirty (30) days written notice to LESSOR, in which event the rental obligation shall be prorated to the date of such termination. The right of termination herein granted shall be in addition and cumulative to any right or remedy otherwise granted LESSEE under the lease or by applicable law. 15. Right to Remove Property. LESSOR shall have the right at any time during the continuance of said lease or within thirty (30) days after its termination, to sever and remove all pumps, machinery, compressors, and other equipment or any part of same. At the termination of this lease, for whatever cause, all such buildings, structures and improvements placed upon the leased premises by LESSEE during the continuance of said lease, Fis0 4;' . -8- shall be and remain the property of LESSOR without the payment of any compensation therefor. If, at any time during the continuance of said lease, any portion of leased premises or any right appurtenant thereto shall be taken for public use under the right of eminent domain or by conveyance in lieu thereof, LESSEE shall be paid its proportionate part of the total damages or consideration awarded or paid for such taking. 16. pefault. That in the event that LESSEE should: (1) fail to pay any monthly rental within fifteen (15) days of the due date or (2) begin to' remove property or goods to the prejudice of the LESSORS lien, or (3) file a petition in bankruptcy, or (4) be adjudicated a bankrupt, or (5) make an assignment for the benefit of creditors, or (6) take advantage of any insolvency statute, or (7) fail to comply with any of the terms, conditions and covenants of this lease, LESSOR, their successors and assigns, shall have the option to pursue any of the following remedies: (1) To immediately terminate this lease and LESSEE shall agree, upon notice from LESSOR, to immediately surrender the leased premises to LESSOR and LESSOR is hereby granted, where LESSEE so refuses, without prejudice to any other remedy to enter upon and take possession of the leased premises, and expel and remove LESSEE and any other person who is occupying the premises or any part thereof without being liable for prosecution for any claim or damages therefore, and hold LESSEE for all past due rent and damages caused by LESSEE, or (2) Declare the entire amount of the unmatured monthly rentals to be immediately due and payable, together with all 8801_,.. -9- such damages, and re-enter the premises and let said premises for such price and on such terms and conditions as may be immediately obtainable and apply the net amount realized to the payment of the rental and damages. It is expressly understood that the above remedies are not exclusive, but LESSOR retains all other remedies provided by law and all conservatory writs. 17. Notices. All notices or notifications required or permitted under this lease shall be given or exercised in writing and shall be sent by certified mail, or registered mail, return receipt requested as follows: LESSOR: TRUMAN ARNOLD COMPANIES P.O. Box 973 Texarkana, Texas 75501 LESSEE: Ronald L. Hiatt and Norita J. Hiatt Road Runner #283 3979 Hwy. 119 Longmont, Colorado 80501 Either party may change the address or the name of the party to whom such notice shall be given in the same manner. 18. Miscellaneous Provisions. 1. No Waiver. No assent, express or implied, by the LESSOR to any breach of any of LESSEE'S covenants, agreements, conditions or terms hereof shall be deemed or taken to be a waiver of any succeeding breach of any covenants, agreements, conditions or terms hereof. -10- 2. Parties Bound. The agreement, conditions, covenants and terms herein contained, shall in every case apply to, be binding upon and inure to the benefit of the respective parties hereto, their heirs, successors and assigns, with the same force and effect as if specifically mentioned in such instance where a party hereto is named. 3. Applicable Law. This lease shall be governed by and construed under the laws of the State of Colorado and all obligations hereunder are performable in Longmont, Colorado. 4. Attorney's Fees. In the event either party hereto must employ an attorney to successfully enforce any of the terms and conditions herein, then upon such enforcement the other party shall be additionally obligated to pay the cost of reasonable attorney's fees for such action. 5. Additional Notices. LESSOR agrees that LESSEE may collaterally assign this lease to a third party at any time during the continuation of same, in order to obtain financing for the construction of improvements upon the herein leased premises. LESSOR further agrees that the notices called for by Paragraph 15 hereof shall additionally be made to such third party, provided LESSEE shall have first notified LESSOR, in writing, of the name and address of such third party. 6. Franchise Agreement. LESSOR and LESSEE agree and acknowledge the provisions set forth in LESSEE'S Road Runner Franchise Agreement that TRUMAN ARNOLD COMPANIES shall assume this Lease Agreement should LESSEE or LESSOR terminate said Franchise Agreement as provided therein. -11- 880141 THUS DONE AND SIGNED in the City of Longmont, Colorado, in the presence of competent undersigned witnesses and me, Notary, on this 1st day of June, 1987. LESSOR: TRUMAN ARNOLD COMPANIES BY: Larry Fincher, Vice President LESS 7Q z, CS01.44 -12- BEFORE ME, the undersigned Notary Public in, g fb he County ar�d/St4.t, aforesaid, personally appeared ,(� /.t�%(l� /r7O7, , to be well 'known as the person affixing his (her) signature to above and foregoing document, and acknowledged to me that he did sign the same for the purposes and consideration stated therein. WITNESS MY ND SEAL OF OFFICE, this �/ day of a.d. 19. 1 - to }y?��blic/ n an for the S of l -i'4 9 -o , Count��f My commission expires:! BEFORE ME, the undersigned Notary Public inid ,( the County and te oresaid, personally appeared , to be well r known as the person affixing his (her) signature to above and foregoing document, and acknowledged to me:that he did sign the same for the purposes and consideration stated therein. �1WITNESS MY HAND SEAL OF OFFICE, this �� day of �ot a.d. 19 i«, in an for the tte of :/ , Coun of My commission expires: 880141 EXHIBIT A A tract of land situated in the southeast one-fourth of Section 3 T. 2N. R. 68W of the 6th PM, county of Weld, State of Colorado, described as follows: Beginning at the southeast corner of said Section 3, thence S 89 degrees 31' W 109.2 feet along the south line of said Section 3; thence N 00 degrees 04' W 35 feet to a point on the north right of way line of Highway No. 119 the true point of beginning, thence S 89 degrees 31' W 225.0 feet along said north right of way line; thence north 148.77 feet to a point on the southeasterly bank of an irrigation ditch; thence N 41 degrees 48' E 310.35 feet along said southeasterly bank of said ditch; thence N 55 degrees 00' E 93.87 feet along said ditch bank to a point on the west right of way line of Highway No. 87; thence S thence 00 degrees 04' E. 257.11 feet along said west right of way line; thence S 89 degrees 31' W 33.9 feet; thence S 00 degrees 04' E 98.7 feet; thence S 18 degrees 40' W 79.1 feet more or less to the true point of beginning. ,801.41 EXHIBIT "B" TO LEASE ENTERED INTO BETWEEN TRUMAN ARNOLD COMPANIES AS LESSOR AND RONALD L. HIATT AND NORITA J. HIATT AS LESSEE LESSOR agrees to remove the existing water cooler, paint vestibule to restrooms, retile men's restroom where in the opinion of LESSOR it is needed, replace missing lightglobe in the men's restroom, replace ashtrays, repair the door in the men's restroom, repair the soap dispenser in the men's restroom, repair the hand dryer in the men's restroom, to cover the window in the men's restroom, retile where in the opinion of LESSOR it is needed in the women's restroom, to repair the hinge on the women's restroom door, to paint and clean the women's restroom, inspect for mechanical and electrical working condition of all equipment, including furnace and air conditioner, to replace the screen door on the back door of the building and repair the threshold, replace or repair the formica countertop by the sink in the kitchen, replace or repair the window in the office door, replace or repair the ceiling tile above grill, replace or repair the fluorescent lights, replace or repair the gutters and downspouts as needed, repair the steel post in front of store, repair soffits as needed, repaint roof as needed, and replace or repair the currently existing septic system. LESSORtwill rthe-abo `cespoasibi* f orveremovingr pumping. oc dischargingithesept+r .c ewe ralle system. mail -store ,- ix..aattarhad .rn the cit-ysaewer system, •apaint exterior of building as needed, wash and clean the canopy, install driveway lighting on the west entrance exit drive, if possible, replace the canopy support column on the southeast corner of the canopy, repair the Pepsi -Cola fountain vending machine, repair the door and ,fan of the Wyott Juice Cooler, repair parking lot lighting, provide LESSEE with two additional trash cans, repair exhaust fan in attic, and repair the faucets in the deep well sink. LESSEE agrees to remove trees and tree stumps on the property, to remove mobile home and chain link fence on the property, remove flower boxes on north and south end of the building, remove the white and barb wire fence on the property, to cut weeds and grass and clean area as needed, and to landscape area as needed. LESSEE agrees all of the above have been completed on day __ , 1987. ESSEE LESSEE 88014 ��. v - "may. �.�.> . MAINTENANCE NEEDED Water cooler doesn't work — I�-VxoVC Vestibul to restrooms needs painting Men's rest room - retile - replace window light globe missing - ash tray needs replacing door off - won't close - hinges soap dispenser off wall hand dryer won't work Women's rest room - retile hinge off door (door closer) complete paint and clean up Mechnical and electrical inspection need on all equipment (including furnace and air conditioner) Back door threshold missing - needs new screen door Formica counter top by sink - loose need replaced No window in office door Ceiling tile above grill falling from ceiling Ceiling - light florecent - ballest? Repair and replace gutters and down spouts as needed Re -install steel post in front of store Repair sofets as needed Repaint roof — .rasa. .Lc.&5 asst Septic system - repair - replace as needed Repaint exterior of building as needed Canopy - remove bird nests - power wash exterior of canopy / Lighting - north east corner of parking lot non-functional rt.Val /G/ef Lighting - recommend removal of 3 present light heads and replace with hi -line fixtures. Install drive -way lighting on west entrance/exit drivec7 ' r Replace canopy support column on SE corner Pepsi fountain not working properly (0. erfrou—r- 88G14 MAINTENANCE NEEDED Page 2 Need 1 more trash cans - lids in back room, containers gone Faucets on deep well sink need new washers and need to reattached to wall 3 54 Exhaust fan in attic not working Leasee will: Remove trees and tree stump Remove mobile home and chain link fence Remove flower boxes on north and south ends of building j ,f Remove white fence and barb wire fence 'T e i .�6 ,1 Nt Cut weeds, and clean the area as needed Landscape area as needed - grass, trees, etc. h-44 880144 BILL OF SALE THE STATE OF COLORADO COUNTY OF WELD KNOW ALL MEN BY THESE PRESENTS: That TRUMAN ARNOLD COMPANIES, of Texarkana, Texas for and in consideration of the sum of $45,000.00 DOLLARS and other good and valuable consideration, to it in hand paid by Ronald L. Hiatt and Norita J. Hiatt, the receipt for which is hereby acknowledged, have BARGAINED, SOLD, and DELIVERED, and by these presents do BARGAIN, SELL, and DELIVER unto the said Ronald L. Hiatt and Norita J. Hiatt of the County of Weld and State of Colorado, the following described personal property in Weld County, Colorado, to -wit: SEE ATTACHED EXHIBIT "A" And it does hereby bind itself, its successors and assigns, to forever WARRANT and DEFEND the title to the said property unto the said Hiatts, their heirs, executors, administrators, and assigns, against every person whomsoever lawfully claiming, or to claim the same, or any part thereof. EXECUTED at Longmont, Colorado, this 1st day of June, 1987. BY: TRUMAN ARN! J COMPANIE BY: Larry iV nc er, Executive Vice President Buyer: THE STATE OF COLORADO COUNTY OF WELD is inst nt was Adknowldg A7fore me on this (-it day of .L[ , �� , by /7/ 7`--7-2 Notary Public, Weld County, Colorado My Commission Expires:• 5/7�`/ 880141 • Quantity 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 7 3 1 1 1 1 2 4 1 1 1 1 1 1 1 EXHIBIT "A" ROAD RUNNER #283 STORE EQUIPMENT Item 2 Drawer File Cabinet Blodgett Oven Broaster w/Breader Toaster Meat Slicer Berkel Scale Heat Wrapper 4 Ft. Deli Case Round -up Hot Dogger Star Nacho Display Wilder Donut Display Star Grill Vegetable Refrigerator Litton Microwave 3 Door Top Reach -in Refrigerator 2 Door Top Reach -in Freezer 3 Tray Food Warmer Milk Shake Blender Biscuit Program Equipment Remcor Ice Dispenser Pepsi Fountain Cup Dispenser Wyott Reach -in Cooler (Juice) 7 Ft. Ice Cream Freezer Booths Ceiling Fans "Coca-Cola" Iced Drink Box 32 Ft. Linear Gondola Shelving Novelty Display Table Star Ice Merchandiser Hand Dryers Single Pk. Cigarette Racks Scotsman Ice Maker 2 Door Upright Freezer Desk Top Chair Menu Board Calculator Walk-in Cooler (19 1/2 x 9) C80144 • ti - is .;Y'��Itrivag$ iii :979 I1IGHWAY 119 t ilidCGNOtiT, CO f;Q5U1 BORROWER'S NAME AND ADDRESS I" includes each borrower above, jointly and severally. FIRST AMERICA' SAYINGS Dr1A7(, F'. S.B. 400 LA:AILEY ;i1.DG 1 i6U1UITE 120 LONC;.ONT, CO bO501 LENDER'S NAME AND ADDRESS "You" means the lender, its successors end assigns promise to pay to you, or your order, at your address listed above the •RINCIPALsumofL.. LICIT i IVf; T iflt„iArii) Al() NO/1uO Loan Number 01= JUNE 1.2 • 1.:11)87 Maturity Date li1.Y 12 1 g Loan Amount $ 25,000.40 Renewal Of Dollars $ 25t006.06''' ❑ Single Advance: I have received all of this principal sum. No additional advances are contemplated under this note. i Multiple Advance: The principal sum shown above is the maximum amount of principal I can borrow under this note. As of today I have receive the amount of S —0_ and future principal advances are contemplated. Conditions: The conditions for future advances are ALL FITI.71rIE. ADVANCE REQUESTS MUST BE MALE IN PF.RSwN, IN' 'pRiiTjG (1R BY 1EL2PEONE ❑ Open End Credit: You and I agree that I may borrow up to the maximum amount of principal more than one time. This feature is subject to all otht conditions and expires no later than 19 Closed End Credit: You and I agree that I may borrow up to the maximum only one time (and subject to all other conditions). 'URPOSE: The purpose of this loan is : tr._NG CA? NTEREST: I agree to pay interest on the principal balance(s) owing from time to time as stated in this section. ❑ Fixed Rate: t agree to pay interest at the fixed, simple rate of ... % per year. O Variable Rate: I agree to pay interest at the initial simple rate of 1 1.11 % per year. This rate may change as stated below. • O Index Rate: The future rate will be 1 • (!-4-•• `• the following index rate: ❑ No Index: The future rate will not be subject to any internal or external index. It wilt be entirely in your control. :Q Frequency end Timing: The rate on this note may increase as often es NIL.: r•.Y An increase in the index will take effect N wf3E SP -1..J.: DAY ❑ Limitations: The rate on this note will not at any time (and no matter what happens to any index rate 0 Maximum Rate: The rate will not go above 0 Minimum Rate: The rate will not go below Post Maturity Rate: I agree to pay interest on the principal owing after maturity, and until paid in full, as stated below: 4J on the same fixed or variable rate basis in effect before maturity (as indicated above). ❑ at a rate equal to used) go above or below these Iimifs:'^ar .. -'rrw. • t ,(1+fa:, t.; ] ADDITIONAL CHARGES: In addition to interest, I 0 have paid ©Cagy a to pay the following additional charges '- 56 UCC FILING FEE AND $6 RE ,EASE I'EE • • .j iR AYMENTS: I agree to pay this note as follows: -❑ Interest: I agree to pay accrued interest PRINCIPAL: i 0 Principal: I agree to pay the principal ON i hi•_:LN i) BUT 1.1.: %0 1J * 1ND IS "'Air.: 0 Installments: I agree to pay this note in payments. The first payment will be in the amount of and will be due 2:4 -4 -;C:, -E l , 19 7 . A payment of S 552.13 will be due on the 12^'fi day i each principal and interest will be due •ULY 1 2 . , 19 0 Effect of Variable Rate: An increase in the interest rate will have the following effect on the payments: -0 The amount of each scheduled payment will be increased. ❑ The amount of the final payment will be increased. _ S 552.13 thereafter. The final payment of the entire unpaid balance t .DDITIONAL TERMS: :yC AGiC ,E: 70 '2AY .. LATE ii,RG,-2 ukr5g OF THE UNPAID A. OJNT 07' AN IVSTALLYE;A:T ThAT IS NOT PAID WI'f: IN TEN DAYS ArTPi IT IS DUE • SIGNATURES: I AGREE TO THE TERMS OF THIS NOTE (INCLUDIN• THOSE ON THE OTHER SIDE). I have received a copy-pn•todity' .;.1 ROAD UNNER.�t26a { rie:YiilRrt l,♦ 0 SECURITY: This note is secured by :.►L,?, "L'ENT0:cY Oi i7I•:•iOi( :•.•:•:. (;:?TED C.I. ::::i:i.AFTF;R ACQUIRED K1) .. ERV.NLR LOCATED ,] If checked, no agreement was signed today securing this note. {This section is for your internal use. It may not include every agree- ment or item of collateral securing this note. You will not lose any security by jmitting it from this section. ) • 1984 BANKERS SYSTEMS, INC. ST. CLOUD. MN FORM UN 2/17/84 GLOYO. „Kf r1f �YfTaos. es°.. 9Y. M.MN. �� ----,.ondcleexofellSeCunlytnlerests.1.ensandencvnOraneeteteoaveth•SeeurrtylntRe .4 MX.{, .. ._ .__..,••_u ......... .....a.e•.e.i,.roteA enAen..,am,nw inanectendcoovDebtor'sboekeend-, . PROMISSORY NOTE $45,000.00 Longmont, Colorado For value received, I, We, or either of us, as principals, promise to pay to the order of TRUMAN ARNOLD COMPANIES, 700 S. Robison Road, in the City of Texarkana, Bowie County, Texas, the sum of Forty-five thousand Dollars ($45,000.00), in legal and lawful money of the United States of America, with interest thereon from date hereof until maturity at the rate of nine per cent (9%) per annum; the interest payable monthly; matured unpaid principal and interest shall bear interest from date of maturity until paid at the rate above stated or ten per cent (10%) per annum on the maximum allowable by law whichever is greater. This note is due and payable as follows, to —wit: Sixty (60) equal monthly installments of, $934.13 each beginning July 1, 1987 or upon demand of holder. It is expressly provided that upon default in the punctual payment of this note or any part thereof, principal or interest, as the same shall become due and payable, the entire indebtedness evidenced hereby shall be matured, at the option of the holder. In the event this Note, or any part hereof, is collected through Probate, Bankruptcy or other judicial proceedings by an attorney or is placed in the hands of an attorney for collection after maturity, then the undersigned agree and promise to pay a reasonable attorney's fee for collection, which in no event shall be less than ten per cent (10%) of the principal and interest then owing. Each maker, surety and endorser of this Note expressly waives all notices, demands for payment, presentations for payment, notices of intention to accelerate the maturity, protest and notice of protest, as to this note and as to each, every and all installments hereof, and each consents that the payee or other holder of this Note may at any time, and from time to time, upon request of or by agreement with any of us, extend the date of maturity hereof or change the time or method of payments without notice to any of the other 'makers,.sureties or endorsers, who shall remain bound for the payment hereof. Address 688 A NewberrY_Stxset Aliance. Nebraska Ronald L. Hiatt . Norita J.4iiatt rs // 722, 893141 /2'i STATE OF/ / f 'c ;/e%% BEFORE ME, the undersigned- Notary Public in and for/the County ayd Sta• aforesaid, `personally appeared �1��171G v �ltl�f! , to be well known as the person affixing his (her) signature to above and foregoing document, and acknowledged to me that he did sign the same for the purposes and consideration stated therein. ' WITNESS MY 1-IAND SEAL OF OFFICE, this -i/ r a.d. 19,,/. 2 day of ///. .Y%e/€ Vi/c;'c_ Notay ublic,in and for the State of / / 7i%%wit , County of,/,////&3/42-Lt My commission expires: '7';',/c/72.‘?' STA E .QT ' �r(re.,-,7(:- 1/1 76- ,7; 7 / OF g -W/7/74 BEFORE ME, the undersigned Notary Public in and for the County and Syat,e aforesaid, personally appeared /l/97'%/// ii w!f'ir , to be well known as the person affixing his (her) signature to above and foregoing document, and acknowledged to me that he did sign the same for the purposes and consideration stated therein. WITNESS MY .HAND SEAL OF OFFICE, this -7// day of fr 4/ a.d. 19 .v �// //// ,/' :jam Notay!,Public, in and for the Stiate of '.4C/, e4) , County /of /7/ „:,'_/iz4_, My commission expires: )'/-%fir i' 880144 TO WHOM IT MAY CONCERN I, Doug Grant, have known the applicant Ronald L. Hiatt for the past six months. I consider Mr. Hiatt of excellent moral character and impecible integrity. Ron is a good business man and dedicated to serving the public. Should you have further questions please feel free to contact me. Sincerely, sett Doug Giant P.O. Box 948 Longmont, CO 80501 Tele. - 776-9119 880144 TO WHOM IT MAY CONCERN I, Duane Dezell have known the applicant Ronald L. Hiatt for the past 11 years. I consider Mr. Hiatt of excellent moral character and impecible integrity. Ron is a good business man and dedicated to serving the public. Should you have further questions, please feel free to contact me. Sincerely, Duane Deze11�JG✓/ 0517 Hwy. 119 Longmont, CO 80501 Tele. - 772-0188 080141 TO WHOM IT MAY CONCERN I, Phil Stocker, have known the applicant Ronald L. Hiatt for the past five years. I consider Mr. Hiatt of excellent moral character and impecible integrity. Ron is a good business man and dedicated to serving the public. Should you have further questions please feel free to contact me. Si illip tocker 1234 Twin Peaks Circle Longmont, CO 80501 Tele. - 651-3972 880144 TO WHOM IT MAY CONCERN I, Vanette M. Gilbert, have known the applicant, Norita J. Hiatt, for the past six months. I consider Mrs.Hiatt of excellent moral character and impecible integrity. Norita is a good business woman and dedicated to serving the public. Should you have further questions, please feel free to contact me. Sincerely, Vanette M. Gilbert 7669 WCR 24 Longmont, CO 80501 0&14.1 TO WHOM IT MAY CONCERN I, Ramona Montano, have known the applicant, Norita J. Hiatt, for the past eight months. I consider Mrs. Hiatt of excellent moral character and impecible integrity. Norita is a good business woman and dedicated to serving the public. Should you have further questions, please feel free to contact me. Sincerely, Ramona Montano v� v Box 41 Johnsotown, C0 80534 Tele. 303-587-4417 '&30144 TO WHOM IT MAY CONCERN I, Lorraine Sater, have known the applicant, Norita J. Hiatt, for the past eight months. I consider Mrs. Hiatt of excellent moral character and impecible integrity. Norita is a good business woman and dedicated to serving the public. Should you have further questions, please feel free to contact me. Sincerely, seA Lorraine Sater 7544 W.C. Rd. 24 Longmont, CO 80501 Tele - 785-2490 38011 J_ ®a D W > a {L i i W a U f gm Er ru O N0. z w o_ W 0: o cn •1 • aa) Fa a u 4-I U) O w v - N O H •O CC) • CO O U 4J CO fai W (a 0 >J W 1.3 •. OO O p cc) CO o s+ O O u-) a� N. O M Denver, CO Postmark nnor Date m A in Certified Fee Special Delivery Fee Restricted Delivery Fee Return Receipt showing to whom and Date Delivered Return Receipt showing to whom. Date, and Address of Delivery TOTAL Postage and Fees CL S961 aunr •OOBE WIOJ Sd +• i O J 1 ii 1' I �1 1 1 "p o V 0 ort V13 k xv.. ILiquor Enforcement Diviso Colorado Dept. of Revenue 1375 Sherman Street I Denver, CO 80261 y u�Y 8 T4 P A 1 F: g 880144 Hello