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Home My WebLink About890222.tiff RESOLUTION RE: APPROVAL OF CHANGE OF OWNERSHIP REQUEST FOR TAVERN LIQUOR LICENSE, WITH EXTENDED HOURS , FOR ZANE RICHARD PAVLICA, D/B/A HOMESTEAD SALOON - EXPIRES FEBRUARY 26 , 1990 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 , Zane Richard Pavlica, d/b/a Homestead Saloon, has presented to the Board of County Commissioners of Weld County, Colorado, an application for a Change of Ownership of a Tavern Liquor License, with extended hours, for the sale of malt, vinous and spirituous liquors for consumption by the drink on the premises only, said license previously held by Charles E . Nussbaum, d/b/a Homestead Saloon, and WHEREAS , pursuant to Weld County Ordinance No. 6 , Section II . , C. , said applicant has paid the required fees to the County of Weld for a Change of Ownership of the existing license , and WHEREAS, said applicant has exhibited a State License for the sale of malt, vinous and spirituous liquors for consumption by the drink on the premises only, outside the corporate limits of any town or city in the County of Weld at the location described as follows : 39520 Weld County Road 136 , Hereford, Colorado 80732 NOW, THEREFORE, BE IT RESOLVED that the Board of County Commissioners of Weld County, Colorado, having examined said application and the other qualifications of the applicant, does hereby grant License Number 89-4 to said applicant to sell malt, vinous and spirituous liquors for consumption by the drink on the premises only, only at retail at said location and does hereby authorize and direct the issuance of said license by the 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 26 , 1990 , providing that said place where the licensee is authorized to sell malt, vinous and spirituous liquors shall be conducted in strict conformity to all the laws of the State of Colorado and the rules and regulations relating thereto, heretofore passed by the Board of County Commissioners of Weld County, Colorado, and any violations thereof shall be cause for revocation of the license. Le t t SIB : te✓ 890222 Page 2 RE: CHANGE OF OWNERSHIP - HOMESTEAD SALOON The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 25th day of January, A.D. , 1989 . BOARD OF COUNTY COMMISSIONERS ATTEST: �Q tlu WELD COUNTY, COLORADO Weld County erk and Recorder 117/1 and Clerk to the Board C.W. Kir y, Ch irman C Pro-Tem Bl,� r�ll�vu,c.a 1 Ja 'ne J on, eputy County erk APPROVED AS TO FORM: ene R. Brantner George -n dy ounty Attorney /1 890222 22206& he $.. � ; SI N1 .L7 .. Z ii O td, o 1 z "O ,. O, rarn .cic�f' ii 7 O 0 01 'V� N c"' cc F o M o U cc ..C) z m .K V w a Z iO 37 F, '~p y r.A1 OS .tUJ UI .. y N 'I .. b O +o o ' w a O O N t Al rn O O1 7 z3 i,, O w ^ O ` O C z . 3 O �' CD p J IN 7 O W O ..G U O4 cd a7 N Z v a .. Ltiig W a'en O W X EH U W CID ro C O M g W 'O 01'17 a) ca I-P .C a4 z � W >71 n ° " •A x �v° o a v , Mona F LI a o .L m a3 v VD c+SA gel p m ofQ 'CS COP i a a b > w a) c F ^' ° ca001Po 1 w IF�ir.� ° a o U H o ..o p 5 aO1i'*' m 2 N r---.,� rrM ,I3 0 0 x o Le) a z > r-• p G O - O y y, a 1r�¢h`L ft +� v aflfl Cr it • a c) aJ O. W ,C O o a) cd •cn 14 I- IT-1 Cla CI a 44 O O`O �r H o o d 1+ N O O rn , 'b a) b Ha a a3 a) W w ' o � � � °a H G x � ° H ^ HO CA H O ti a) H �.' 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County City Indust. Type Lability Date , ��..±: .'^ 1 '�' `�r 14-29235 C3 2,76. 5813 1 022789 FEES 26• 199G ; r' Type Name and Description of License Fee !!{II!,I'''.., !T I TAVERN LIQUOR LICENSE - MALT• I ••-•"\-_) I1 ih., , ,, C - , VINOUS, AND SPIRITUOUS 25.00 � COUNTY 95 PERCENT OAP FEE S 276. 25 I r E 341.2 5 ,( f' 4 EXTENDED HOURS TOTAL FEE(S) l �``� This license is issued subject to the laws of the State of Colorado and especially under the i;� , �44' ` ;; 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 -r only valid through the expiration date shown above. Questions concerning this license it` ' should be addressed to the Department of Revenue, Liquor Enforcement Divison, 1375 '; ff�;. Sherman Street,Denver,CO 80261. ,J.-'55) ii . i In testimony whereof,I have hereunto set my hand. //"..---) 7-V ' --4, Division Director Executive Director DR �.roz is-saDB !r ) +J fr{' I "fiti) ..,-.,vp./,,,: -.:-Y/Am ...w.1).,./)-.7) I y,., -\\v.,_kfr----z)) i ,-,-,- .L.N,„i,..-g j! L z_._.,-\,.-- t.\, 1.1-.` II .,,.•-_,,, _,._,•-,?,-._-,/-1-1--,a,.,_ 890222 DRL 1555 (Rev. 10/33) _ ..2;, BEER AND LIQUOR LICENSE APPL._SATION .' 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) : T �i Individual Partnership 1=1 Corporation NAME OF APPLICANT: Z - c ehPc-`(C ` ) L'10(t. TRADE NAME: *I0\mQ S P 0-6 )Don) PLEASE CHECK ALL APPROPRIATE BOXES Applicant Local State Documents I. APPLICATION OR ADDENDUM / 1 Ii = - A. Original (green or yellow), not a copy I I I1 I1* B. Complete all appropriate sections • MI II I_i* C. Sign application I_I 1=1 II* _ D. Attach appropriate fee II. PROOF OF PROPERTY POSSESSION 17'1 A.I=1* A. Deed (or) II II I1* B. Lease (or) I—I I1 1I 1. Lease must cover entire license period (minimum one year) -_' II 1=1* C. Lease Assignment 1=I i—i I-1 1 . Acceptance of applicant 1 I1 I-1 • 2. Consent by landlord I1 I ' 11 D. All possession documents must be signed in I—I I_f* E. Floor diagram of premises to be licensed (maximum size 8 1/2" x 14") III. FINANCIAL DOCUMENTS I I II A.A. Purchase agreement or stock transfer agreement IT' I 11 8. Affidavit on source of all funds invested (Continued on Reverse Side) 890222 Applicant Local State Documents17‘ 1_' 1 C. Notes or loans (i .e. , assumed, banks, previous owner, etc. ) -a= I 1 . Applicant may not have any unlawful �T, I I_1 l—i financial interest in any other licensed establishment IV. BACKGROUND INFORMATION • -� 1-11,21 I-i I-1* A. Individual History Record(s) (fore DRL 404-1) I1 I1 1_1 B. Fingerprints taken and submitted V. MANAGEMENT (if other than applicant) I_1 II II* A. Manager Registration Form (form DRL 367) —. 7 . ,_E.22 c,e u red rii" if Hotel ana 1 — — Restaurant . sense I_I II I_i B. Written management agreement (or) I I 1 I C. Affidavit describing duties, limitations and compensation VI. CORPORATE DOCUMENTS (if applicable) I_I II I_i* A. Certificate of Incorporation (or) I 1-1 1-1* B. Certificate of Good Standing if corporation is more than two years old (or) 1-1 1-1 1-1* C. Certificate of Authorization if foreign corporation 1_1 I_1 I_1 D. Articles of Incorporation I_I I_I E.E. Minutes of meeting electing current officers 1_1 1_1 I_I F. .Stock certificates (100% of issued stock) 1-1 I—I 1-1 G. List of officers, stockholders and directors of parent corporation (if applicable) VII. PARTNERSHIP DOCUMENTS (if applicable) I_1 I_1 I1* A. Partnership agreement (general or limited) I1 I1 II 1 . Hot needed if husband and wife —_I 1_1 I_1 B. Dissolutionment of partnership (if applicable) VIII. ADDITIONAL LOCAL REQUIREMENTS I_TI 11 A. 3 letters of reference _ I I I=1 B. . 890222 CLERK TO THE BOARD P.O. BOX 758 1 GREELEY,COLORADO 80032 }� (303)3584000 EXT.4225 V • COLORADO STATE OF COLORADO ) ss COUNTY OF WELD I, Donald D. Warden, Clerk to the Board of County Commissioners, in and for the County of Weld, State of Colorado, do hereby certify that the attached Change of Ownership Application, containing five (5) pages, on Zane Richard Pavlica is a duplicate of the Application recorded with the Weld County Clerk to the Board's Office. IN WITNESS WHEREOF, I have hereunto set my hand and affixed the seal of said County at Greeley, Colorado, this 26th day of February, 1992.AA CLERK TO THE BOARD BY: CJ,y. t Deputy Clerk(Jo the Board 890222 DRL 404(Rev.5/ea) NOT WRITE IN THIS BLOCK 5 ` `°9 , STATE OF COLORADO us •]61 DEPARTMENT OF REVENUE " ,,, 'IMF OF LIQUOR ENFORCEMENT 1375 SHERMAN STREET DENVER,COLORADO 80261 USE LICENSE ACCOUNT NO. LICENSE ISSUED THROUGH FOR ALL REFERENCE (EXPIRATION DATE) COLORADO LIQUOR LICENSE APPLICATION LIABILITY INFORMATION COUNTY CITY INDUSTRY TYPE LIABILITY DATE ` 5\N17\; �� \�' KEY CODE STATE FEE CITY COUNTY PAID (� \\::, I/ \ \iv�' 'J 41-9 37-1 49-1 , �) %- TOTAL FEE Instructions on Page 4 of Application. _ ALL ANSWERS MUST BE PRINTED IN BLACK INK OR TYPEWRITTEN 1. Name of Applicant(s): If partnership,lis-pjartners names(at least two);if corporation,name of corporation: Date filed with Local Authority: A./AL— ll1PNrrIZQ 7Av�LicA 3--► AL lgC31 State Sales Tax No.: Semis friPPLiet io,- 2.Trade Name of Establishment; (DBA) Business Telephone: Horn&cTtr4Ll SACOC,v -99i.- 0298 CI 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 l it is impossible to give street and number,the lot and block number or part of section where located must be given.) VIII nit! "Re.Ate fat , ;„lt1NA 9912- ii-h-A=& 6/o Gino . 8073.& City: County: State: Zip Code: 2ef 113 W Gl-D L`e•lclRAbo 8073L. 4. ailing Address: (Number and Street) City or Town: State: Zip Code: Pi • Re X O HlpE 9,t), ��DPPDD 00732- 5. If these premises are now licensed,answer the following: Trade Name of Establishment(DBA): State License No.: Type of License:ft 4LT- Expiratior Date: j4'e. e6Tel?v 6.440o'/ 1`1-077‘., 7a ,nlos--4- -. A44;�I+4i,s,C gyp.; 1 7-Z,z-/9e9r KEY STATE LOCAL KEY STATE CODE COLUMN A FEES FEES CODE COLUMN B FEES 20 ❑RETAIL LIQUOR STORE LICENSE-City $177.50 $22.50 31 ❑WHOLESALE LIQUOR LICENSE 1,000.00 20 ❑RETAIL LIQUOR STORE LICENSE-County 262.50 37.50 32 0 WHOLESALE BEER LICENSE 500.00 21 ❑LIQUOR LICENSED DRUGSTORE-City 177.50 22.50 38 ❑IMPORTER'S LICENSE(Vinous&Spirituous Liquor)250.00 21 ❑LIQUOR LICENSED DRUGSTORE-County 262.50 37.50 44 ❑NONRESIDENT MANUFACTURER or 250.00 22 0 BEER&WINE LICENSE-City 152.50 22.50 IMPORTER (Malt Liquor) 22 ❑BEER&WINE LICENSE-County 237.50 37.50 27 0 BREWERY LICENSE 250.00 25 ❑CLUB LICENSE ❑City ❑County 110.00 15.00 28 ❑WINERY LICENSE 250.00 23 ❑HOTEL&RESTAURANT LICENr�S�ElQCity❑County 301.25 48.75 43 ❑LIMITED WINERY LICENSE 25.00 40 El TAVERN LICENSE ❑City 14 County 301.25 48.75 26 ❑PUBLIC TRANSPORTATION LICENSE_each 25.00 42 ❑RACE TRACK LICENSE ❑City ❑County 301.25 4835 41 O ARTS LICENSE OCity ❑County 110.00 15.00 ❑-OTHER(Specify) (Change of corporate structure,location,trade name,renewal,etc.) oQ0Ae>/� Page 1 of 4 II[�� conI (continued) YES NO 8. 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? ❑. (b) 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.) ❑ 9. Has a liquor license for the premises to be licensed been refused within the preceding two years? ❑ 0 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. ❑ r\ 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. 12. 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: &.oc.) -TOE trrt -s 4- CL t o C l+tL 'nuw,6yb o M5Es r 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 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 ADDRESS INTEREST WO 47C 14. 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.) NAME BUSINESS ADDRESS Attach copies of all notes and security instruments, and any written agreement or details of any oral agreement,by which any parson(including a corporation) will share in the profit or gross proceeds of this establishment,and any agreement relating to the business which is contingent or con- ditional in any way by volume,profit,sales,giving of advice or consultation. 890222 Page 2 of 4 (continued) • 15. Liquor Licensed Drug Store applicants,ansv^the following: - YES NO (a) Does the applicant for a Liquor Licenser ig Store have a Drug Store License issued by the Co o Board of Pharmacy? A, If answer is"no,"explain in detail. , (b)Is the applicant,or does the applicant for a Liquor Licensed Drug Store employ a Pharmacist registered In. the State of Colorado? n•( If"yes,"give License Number: 16. Club Liquor License applicants,answer the following: (a) Complete items 20(a) through (d) and (f). �+av (b) Is the applicant organization operated solely for a national,social,fraternal,patriotic,political or athletic purpose and not for CI O pecuniary gain? (c) How long has the club been incorporated? (d) How long has applicant occupied the premises to be licensed as a club? (Three years required.) 17. Colorado Manufacturer or Wholesaler applicants,answer the following: ctbb Q' (a) Does the applicant own,lease or operate any Colorado warehouse or storage plant in connection with this business? El If answer is"yes,"give full address:if"no,"explain in detail. (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 ❑ CI 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. [j ❑ 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? VV'' (b) If the applicant is an importer or manufacturer,does or did any owner,pan owner,shareholder,director or officer have E7 ❑ 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? It"yes,"attach a copy of the permit;if"no,"explain in detail. ❑ (di 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.) — la) Name of individual or name and class Home Address,City d State: Date of Birth: — of each partner: p p p a.Ian)11�17(aL. I/7ct o,z. 1� . �"'�' ''` `'" ; 7 d. )Jcry ,//acid, 91/yEte Jsd 735 /o- L 9-5 O .4 C?-i-rry+a— G.4 �aZor{— (bl Name of Operating Manager: Home Address,City and State: Date of Birth: (c) When did said partnership commence doing business? (Attach a copy of the partnership agreement,except as between husband and wife, and trade name affidavit.) 20.If the applicant is a corporation,answer the following: AA( ,(� Date: -(a) Corporation is organized under the laws of the State of: ULv f` (b) Principal business is conducted at: County of: State of: (c) Date of filing last annual corporate report to the secretary of state: 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 pledgee. (Use separate sheet if necessary) — Name of stockholder: Home Address,City and State: %of stock: Date of Birth: (f) Name of all Directors or Trustees Date of Birth: - of Corporation: Home Address,City and State: Page 3 of 4 890222 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 appllication 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 PAT RS OF CORPORATIONS SIGN HERE: PART ERSHIPS M, .SIGN HE: � ti-rte. -egt " Jaye, C , By //��GG (President,Vice President,or Secre_tary) DATE:t .1-,,,GZGU� /71T/ • 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. CH90222 Yes ❑ No ❑ Yes O No O Page 4 of 4 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 PA T} t ERS OF CORPORATIONS SIGN HERE: PARR ERSHIPS MUST-SIGN HE: //I �1 / �il �//4424_,-// / 7/L�L- 1 ✓ .._. By G (President,Vice President,or Secretary) DATE: i'C/C✓1/'✓�1 /YtT/ DATE: �� J 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. r. DATED AT Greeley this 25thjay of January ,A.D. 19 89 �, ,1' 11r,1� @fv, AT Weld County F (Name of Ton,City and County) BY: . 7/7/4-1,1. Chair an rdrd ocommissio ers or other title of the license authority) ATTEST: l • 1C71c-tp.. ., � uii a) (Cie k,s� retary of other officer having'the offici it seal o e licensing authority If the premises ar 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. CHECKtkrynnn� Yes �Y No ❑ Yes E No (3 ifir r- i'.'4.4-kit e'r v. A' �r AR216545d 1219 A 02165453 12/19/88 16:18 $9.f 1/003 ` r` - 0596 NA..1 ANN FEUERSTEIN CLERK S RECORDER it- ..O CO, CO , • 'rt-: T,....„ betweenDEED, Made--CHARL Ss E. NUSSBAUM of andecember,39 88, r� -%F{,f"'y ft ,.i DOROTHY L0LA NUSSBAUM al..a DOROTHY L. NUSSBAUM :; t1"vial.44fari k"r • s rly: State Documentary Fee x V„,. Dote.1'2-- q—n �` "• r�r, Y �� r ,, of the County of Weld and State of Colorado, CC. . :hot' of the first part,and —_ZANE PAVLICA-- $ Q.-----� �eKt �P 4.7 ,,, !1. S..}`E ryv k r�.lrN F § 5i +*k 'f. y14 4 tA_^*}Ktj '' �i' of the County of Weld and State of Colorado,of the second1. .t WITNESSETN,That the said parties of the first part,for and in consideration of the sum of good A,+,.. . Irtr ' .a -�°-;; and valuable consideration and Ten and no/300ths DOLLARS, - I ' Mrk ' �, , to the saidpart 'k 4v.rr. -.... *,t.. 'G ley of the first part in band paid by the said party of the second part,the receipt whereof L � -. 4 F_ hereby confessed and acknowledged,ha ye granted,bargained,sold and conveyed,and by these presents do T' i.ItCy y. grant,bargain,sell,convey and confirm,unto the said party of the second part, his . I +..i +�' ' heirs and assigns forever,all the following described lot or parcel of land,situate,lying and being in the =``'"- S a t;. County of Weld and State of Colorado, to-wit: .., f v'+tJ'l rr 1 `"i y` a 1 y a. .?.t : ", See Exhibit A attached hereto and a, a &4 .; ; incorporated herein by reference ik3x h ' 1' vt. i '��rrt 'Sec*. k' �, • 0 .. also known as R.E.C. Lanes, Hereford, Colorado , 80732 I. / t 4. `- - y Y A ..:.. ... I r I t ;t i P, so � , # Scf u „ � w3 I '42,7 tf _ r.c it *tome: m l. C- :',.1.1.1,,,,,„.74,1/4:.,}3 -d 71 ii di f r ,iii: , la /lt .'r fib fl"Y stl^�"b""s r t e--,i4- x ° is - mi I .4 r . s �i ✓ �' i t'.'41.'1,' T is a �5 . �4 ; X .t.ii . . . - ,. i S f.VC' TOGETHER with appurtenancesaud alaniar the beredltamenta and appurtenances thereto belonging, or in,anywise 'kg , !g appertaining,and the»sualoa and revnalone,remainder and remaiadere,.ratk lemon sad profit lhmeofi and all 4l 'w � 44,444v4:44.4-� , the estate,right,trite;lntatn4 shim and demand whatmmr of the mid pert lea otthe flat part,tither in law t, r ,+ 4; s'or equity,of,in and to the telton.bargaleed premises.with the hereditament@ aid►pperta imeea' t+e s . yx EYix '; 11 fie, '3t g-.-- a c,-vao 1-"'-`;,3,,•�`r 4R ", ' � r• 4 D No.46.1. w DaUYM theasarnelie aanaL—enYM MYYly 00.111444 aMe Howl,Dow,Wombs—tl-re **t rte 890222 !x° tot a: G S ,H^:; - ki' ' r: A 1219 REC 02165453 12/19/88 16:18 $9.00 2/003 R F 0597 MARY ANN FEUERSTEIN CLERK & RECORDER WELD CO, CO ) . a s < �" 1 M1 �: TO HAVE AND TO HOLD the said premises above bargained and described,with the appurtenances, unto the el'S x $114:01}).11 {.,� )0i said party of the second part, heirs end assigns forever. And the said parties of the first part, . . `t �. ° for drama /heirs,executors,and administrators,do covenant, grant, bargain and agree to and with sy 'r�1> , 'y _-': �; the said part of the second part, his heirs and assigns, that at the time of the ensesi ag and delivery of w- r'6i 1. .,, < a these presents y are well seized of the premises above conveyed, as of good, sure, perfect, absolute and a' . -�^-I y.F „ rt., indefeasible estate of inheritance,In law,in fee simple,and have good right,full power and lawful authority to S ' 1 itttra '. 14, grant, bargain, sell and convey the same in manner and form as aforesaid, and that the came am free and -ice ,.. ratclear from all former and other grants,bargains, sales, lions, taxes, assessments and encumbrances of whatever A' Nn• - s-5 +'. kind ornaturesoever., except those easements and rights of way of record or ' '1..--,..-f+r,,, yy,- -t which may be determined by inspection. 1, �s . t. 3 . St �,. 4T 2s.. ):4. v �4fd vA k"Y 5 n . / T�5 1 'h .1:-" i ,, •y %� y W I •; Y 1'e 142.1r-;, ��v# >rt and the above bargained premises in the quiet and peaceable possession of the said party of the second pert. `` .,elkf S his heirs and assigns against all end every person or persons lawfully claiming or to claim the whole or any Y ,t,t ZZ , v 4y 3 part thereof,the said part y of the first part shall and will WARRANT AND FOREVER DEFEND. ;:-<E ` ,,• v $ ' .'.`.. g * IN WITNESS WHEREOF,the said part ies of the Tint part have hereunto set irhand s i Y ��} x and Beals the day and year first above written. t. We y Y 1 . ,-- -.47,4 Sar, lJ` Signed, sealed and Delivered in the Presence of ..Z 46.frec.....{.:-6J2 ssbrae....— [SEAL] `E^- ,rr C arles El Nussbaum :n "V ". iri°`'ti., ft. _ Q4 'r,2 ..dneea,tesa✓___._._[SEAL] i r.grairpoDorot y Lola Nussbaum aka �n -. =x'p'- Dorothy^L. Nussbaum __ [SEAT,] 3a" I„ ,e d STATE OF COLORADO. ry< k-, Z t a ' St4 7 county of Weld �µ -11. * The f ing instrument was acknowledged before`me this 15-!\` tdal of 1 `{' i -zr J l M lA1V St7gyut� Dekcember rriU.' /- av i 1.941 19 88,by S 1... �IISS� llS a1C0. TI �+ a�ppa^e:�. �ore y ..s.n.. s� 1. i1.., ' ', P M7 eammWioa expires IAA/c2 19 ij.W' my hand ,Quidal.w. �,. '" 'n eOl , .." ri faA�.L firf t;�� r �t' Pr i pUp — _ >t.rrrwta "3r -s,- taut . . > i ( !t ! UW °� Vim. fit ' 144".:-°;' ,--",:,,n u :, •) 'a'1/4!' is S r j L4.' , r , i. "i i .1.i:, ,v• ,a:.t.yi ih*S t1 4.......a4 - ..i {. I` t{ 7 F 7.` f3Svi i v - ' r 1. p .. kk yu L4' 'r SzyxTr t i4j4 '.f '1 °*." w.t-lA7:q" z r 1 g r .. I . t 454ri' FP.rc f 1.I 'iii 3 /yam y _ ,`sn tr t• '{b ti '$ a s . 't ^v ' t 9 i, ! i 1 , -- -...e.)74..13' e II :� 0,Rhin .. Ili s ti e t ,if 11 99}0,( 1■ytple r n 't ".[r �. .+. n Ex.. N ._ Vw 4'.' * 5s:f AT si ,{' - _ -�+'`..d�,'C:ti'Ae.Krr ry • '" _ rr'g � B 1219 REC 02165453 12/19/88 16:18 $9.00 3/003 �"� � 7„' 4,-;,,....,-„, a ' F 0598 MARY ANN FEUERSTEIN CLERK & RECORDER WELD CO, CO tkikl(' f+ .� a �� "'"�' EXHIBIT "A" b„. ��t p'? , ',',-,,,,,v. ,,,•74A4,.. PARCEL #1 "'S4::! w t '.. . a xs z ',;--, '. A tract of land in the Northeast Quarter (NE1/4) of the � 3 *.rt NorthwestQuarter (NW1/4) of Section Thirty-four (34) , Township,...x Y- r' e :1;;,} -,; Twelve (12) North, Range Sixty-two (62) West of the 6th P.M. , rt -4 County of Weld, State of Colorado, described as follows: r:4. az -4`41,- -1:144,142 2 Commencing at the Northeast Corner (NE Cor) of said Section 34; ':-.61,, '.`. 4='y 414;54./,-;t: thence South 89 Degrees 53' West along the North line of said 7"04414,:.;1 '4+a Section 34, 2,741.40 feet; '1 *'� t ;mss '+g €g .., thence South 0 Degrees 07' East 30.00 feet to the True Point of - '-.� -*:07.i...-;;,....... Beginning; a ) ,,� . thence South 0 Degrees 07' East, 125.00 feet; +" " k-, rte' thence South 89 Degrees 53' West, 260.00 feet; �n"# ? { � ; thence North 0 Degrees 07' West, 125 feet; ' ,M ✓ thence North 89 Degrees 53' East, 260.00 feet to the True Point 'lt �lk *#$ of Beginning. CJ- h �f 't .!: PARCEL #2 %s 'A. k "",. All that portion of Section Thirty-four (34) , Township Twelve awl-v'(12) North, Range Sixty-two (62) West of the 6th P.M., County of ',Lt.. nE^4�.. �± Weld, State of Colorado, more particularly described as , I . . : follows: + ) E x A i av +;.k r Beginning at a point South 0 Degrees 07' East, 30 feet from the ', p,1+* ' i+ Section Line between Sections 27 and 34, Township 12 North, c , r# o� 71-S-44:-.. Range 62 West of the 6th P.M., and 2,691.4 feet West of the74"'`.:444,4 k �, ` �3+ t id Northeast Corner (NE Cor) of said Section 34, measured along the i cy# aP- z Section Line which Point of Beginning is on the South .4, right-of-way line of the County Road; S. r + �,y, I' thence South 0 Degrees 07' East, and at right angles to the ₹ s � , County Road, 125 feet; 2'�, -' 4. 5w,, thence South 89 Degrees 53' West and parallel to the County Road �zr� ' 50 feet to a point; -',1-02 '-"##. x. . k� thence North 0 Degrees 07' West, 125 feet to a point in the South s 3:,teaon '.: h,. right-of-way line of said County Road; . :-'.AQ:,nl ,L. '.'1 a line eoe NorthP89nDegrees esg53' East, 50 feet along said right-of-way .'r i s` �'," a4d i ,,,,„„..,s,,, ,,,::: >x . F, � , y i i e .: 1,1 .n NS i , k�>+q"a �°"v+4�4t 'ye': T,,,,,,,,Att.,,),.., o' SI'y M'0y0;p,,i ` " " '1dr 1 Y'b• •k '444f'.',.Y Y274 , 890222 W# . , 1 ill e i To Sheriff' s Office Date January 20 , 1989 COLORADO From Clerk to Board ' s Office subject: Nussbaum Liquor Licenses This is to advise you that Charles E. Nussbaum, dba Homestead Saloon, has sold his establishment in Hereford. He voluntarily returned his Tavern Liquor License to this office on January 19 , 1989 . Zane Pavlica, the purchaser, will be applying for a Change of Ownership at this establishment, located at Rd. 136 , Bldg. 39520; but until the Change of Ownership has been approved by the Board of County Commissioners and the State Department of Revenue the sale of liquor shall not be allowed at the Homestead Saloon. Be further advised that Paul Nussbaum, dba Hereford Liquor, also returned his Retail Ligor Store License, located at Rd. 136, Bldg. 39520 . Tami Lynne Van Pelt will be applying for a Change of Ownership, but this has not been approved by the Board of County Commissioners nor the State Department of Revenue, and until this is done, the sale of liquor shall not be allowed at Hereford Liquor. xc: County Attorney David Sauter, Liquor Enforcement Officer trThi 890222 � r • : / r 1 i`-! r t .. ei r T i .. ... /04 14' C i ,� -� I ,It, S O � 1 �A 7 /..-, 3. / r1 II i Z ; i t._i C7 .0 i i 1 r•. • • i 1, 890222 I I r DR 8401•I(1/88) COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION INDIVIDUAL HISTORY RECORD 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%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 be answered in their entirety. EVERY answer you give will be checked for its truthfulness. A deliberate falsehood will . Jeopardize the application as such falsehood within itself constitutes evidence regarding the character and reputation of the applicant 1. Name of Business: Date: Social Security Number. ,5 .Tam, /989 6;20 —6,2- col 2. Yo Full Name:(last/first/middle) 3. Also Known As: (maiden name/nickname,etc.) till/6j(.9 ZANc / ICMr}K'u 4.)Mailing Address:'(if different from residence) Home Telephone: 3c:3-x n A4 t 5.``Residence Address: (street and number,city,state,zip /'", &")/ g[% Netr,ccvv 6/OG./4'iuO, 00732 If rented,from whom? 6. Is your residence: If ❑ RENTED - 7. Date of Birth: Place of Birth: 8. U.S.Citizen? • YES ❑ 6--a-l- /75-0 �(?Vo. ,S s- (1c/to . NO If naturalized,state where: ,1 When: - Name of U.S.District Court L414 /1\ Naturalization Certificate No.: Date of Certificate: If an alien,give Men's Registration Card No.:Permanent Residence Card No.: 9. Height Weight Hair Color: Eye Color: Sex:�1 Race: 10.Do you have a Colorado Drivers License? If give number: .5" >/ if 0 MN 6,ex/ //(/Mu: //4L7 ❑YES 02410 11. What is your relationship to the applicant?(sole owner,partner,corporate officer,director,stockholder or manager): Sot% (2sa,vL20 12. If Stockholder,Number of Shares Owned Beneficially or of Record: Percent of Outstanding Stock Owned: 40/4'/9 L)IJQ 13.If Partner,state whether: Percent of Partnership Beneficially Owned: ❑ GENERAL ❑ LIMITED Z4,,/9 2M/A2 14.Name of Present Employer: 15.Type of Business of Employment Sete Empiut'e.l Svi✓1, ,(,sue 16.Address of Business Where Employed:(street and number,city,state,zip) Business Telephone: la.-21r Co- Pd. / 1',• £u,7n c' .395,2o4-I /'Cta (-//n &>7 3.7 503 - 4'9G --2-Lt 8 ? t 17.Present Position: CLUNcR- - fYiaAlA6Et 18.Marital Status: 19.Name of Spouse:(indude maiden name if applicable) 5/4./Cr!L DN A 20.Spouse's Date of Birth: Spouse's Place of Birth: DUA- b,UA 21.Spouse's residence address,if different than yours:(give street and number,city,state,zip) DNA 22.Spouse's Present Employer: Occupation: 23,Address of Spouse's Present Employer: DNA 24.List the names)of all relatives working in the liquor industry,give their: Name of Relative: Relationship to You: Position held: Name of Employer: Location of Employer: A2011L CONTINUED ON REVERSE SIDE 890222 -1 . 1 25.Do you now,or have you ever held a direct or Indirect interest in a State of Colorado Liquor or Beer License? If"yes,"answer in detail. ,❑ YES 1X/NO 26.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 of the State of Colorado? If"yes,'describe in detail. ❑ YES *NO 27.Have you ever been convicted of a crime,fined,Imprisoned,placed on probation,received a suspended sentence or forfeited ball for any offense in criminal or military court?(Do not indude 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. l❑ YES cZ(NO 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 c4NO 3 29.Have you ever d a gambling or gaming license or owned a Federal Gambling Stamp? If yes,'explain in detail below. ❑ YES NO State/Federal: TTTTTT Year: City: State: State/Federal: Year: City: State: 30.Military Service:(branch) From: To: Serial No.: Type of Discharge: ,t5iLiairet 13IP. Il,i- . 0-iii-42.6 / - 9 /9G9 ii-.1,2- 87- t .5'`' -e-,2-(2,07,2 Aleii ietit3cg- 31.List all addresses where you have lived for the last five years.(Attach separate sheet if necessary) Street and Number City,State,Zip From: To: e ore- *1/, tee x.Sz ( ',ecru , Gc22 0 , 6`2-05V /9,7.5 /989 32.List all former employers or businesses engaged in within the last five years.(Attach separate sheets if necessary.) Name of employer:- Address:(street,number,city,state,zip) Position Held: From: To: T wii.:,, 4/91az, Fiiew/76 .5 (AyeNtir. Brio Cray& alti"AQitee /92 y • I 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. Name of reference: Address:(street,number,city,state,zip) No.of Years Known: (LAlEdG � 24i1 fii&4 ,4 -6A/i) , 4/0,eA�o „2-&f y;es IC A/W L gry+e,'uc Ft Pc). 45, ,: 5,4 (1,4-ffc7l- � Lie/ci d �'Zd 5 9 /6 y r s An.16g L ZreK 4/,-•n; ir- Nesl',R0 ; (70 fog)4b 0 4'O732 .26 z2S 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 knowledge. Singature: Title: Date:O ..r-chek--,.� 7 -/�� 44i . /9?9 990222 // _ � r1 7 . ,P/ ,'�_[. C. �!--�^-`e J�IL,/c.T.o, (17-e, - _ S•d73 ,iv°.� h- �!l J / / (vu-Qa.,G'-a.,.v,-....- Cc..-C' ;/J 070-----O4-,i xi % 1�.c.— cau-4-..._ ,J DG."LC.- a te:-.,d 1;P-Al c:-- SUBSCRIBED AND SWORN TO BEFORE ME THIS 3RD DAY OF JANUARY, 1989, BY ZANE RICHARD PAVLICA. WITNESS MY HAND AND OFFICIAL SEAL. n NOTARY"PUBLIC MY COMMISSION EXPIRES: 8/7/89 915 TENTH STREET GREELEY, CO 80631 890222 iLJ 4Xc7 '7 . G2 r L7 coorL.thyt�i zicoa /)4-Z 4AI-cc-telt ... _- Ceette-: , Lam•/t��/J' '� Q,O, _ . • 890222 / ?Ysif L / a / / I 71 t Q --it, yeJl 74.�Y{/,$.��y/ N a/vi 4��^/'T t klb)1/44 rteta4t) /?o, , S'a / Gael J. gz0 Y 890222 V!J VC-41W( e121C24.4( , \C" ‘M-7-‘0")00( x.t_ 2,---- C c--) ..121-4? d/da • /9G .1. &� a-2,�O ee.u/ v e-2/ P Q/c,,-,77, ) -ii Qa -fa!! 21.4 2 t c2 e 2 « (pc, 890222 Ci Ot • i Off C 0116 e CJO E `1\._ :0® 0 a rte enf Off Mcawatolics _f 1 Liquor Enforcement Division 1375 Sherman Street Denver, Colorado 80261 '�J Nuss9AuM CHAKL S HQMt STr:AD SALO`sN i+ 7, 135 BLOC, 37521 HEREFORD CO P,073223.ii ,/ Alcoholic Beverage License ))) Amount Number County City Indust,dust""'°" UCENSE EXPIRES AT MIDNIGHT Type Liability Date 4 14-2767? 03 216 5s313 1 ^72397 JUL 22, 1 q9 Type �' Name and Description of License Fee € t JAVERN LIQUOR LICENSE - MALT. VENOUS. AN') SPIRITUOUS t 25.00 JD) COUNTY 35 PERCENT OAP FFF c 276.25 riEXTENDED TGTALPEE(S) x 3.i1 Fit:\ 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., i In testimony whereof,I have hereunto set my hand. / vim• ,..; rJ Division Director Executive Director DR 8402(11/87) D 890222 To whom it may concern : On February 5, 1989, a wall was built over the existing door between Hereford Liauors and Homestead Saloon storage . The door was locked and a wall of 1" x 6" wood slabs was fixed over the door. There is now no passage through the two businesses . / ._er 1L ban f_e' J / . 6A,Tif Nice 7-o _/ &}&FOP-b bc€„ cic; / hovy.6-S rc u i PKro I qlrt� ANC AloW Co✓e: GD W' iTH \\ i '5x12” 130CtiCled l,EMI-I- I > i ecczee Roo AA r (IA ea I I 3Tert'-ie. l fio K;lrhxy C,pr` I � Ii a / 1 U L.f✓:yv�G i /� yy�` y� q ( I.)_ 0( a ttita.20z,r_i _. yG � �. 890222 My Commission expires March 14, 1989 J J b yyqqO6S // ZZ \\ 0 O/ f ---> n\ J FIIEI H 6,1 Do I) V� -�\ --(p_ V G 1 C • .7-•ft, t„' • JIDi i . • Ifill:.. -:.3111,•, _ ' Li, if- • . • • k : Lit i , • i / ...!7-X, i 11: ' ' 3 f§ li To Herb Luoma Date February 22 , ].989 :.;:.5"_,'t3RADD From Weld County Clerk to the Board subject: ` OQa and Hereford Licuors Attached please find new diagrams of the licensed premises fcr inclusion in the Change of Ownership requests for illmestaloi.en and Hereford Liquors. Also enclosed are notarized statements paying that the door has been covered over; therefore, there is no longer an access between the two businesses. Thank you, t 6,7,c-n Lac_ T ramie Antuna Deputy County Clerk 890222 e is ea lx rt 4 l a WA 1 1 4i tin %, Z� { ' HOED 0d #z rtgt. SI c4 la4 awao uwcwo " 2i .1 o2wa i o H H O �l W ' Ate, .� i _ _•- ,,.d t fr, a 4.-n1 4 . . z O w _J VI .Z a H Z O 2I.4 > N a- al 8' Ayl F E IL d� '� HWw o ZWw - 3z m ¢sum woa � v ti W of N W P O o �≥ rnpd d U ,�w � 'a UH - Sw c_ V ¢�`=_ m a rw w m 3 o a o = LL Ow r sv N o d S ° P4 W Fa O d 52 m 8 A U o m Vj:':\ x En LL d a E= 4, "o r 11 to' W O V1 W D p Q E 2 LLI C Cr ti A U N ¢ ¢g ¢o a° S861 aunp `0090 w'od Sd 890222 \J f10 /Z9e;t5(-7-E/.6 S>q a/CC < �?9 � ar' 1 ea NI AcTh c /Jo w /. ,/9rLa , � ) 890222 7EASURER'S OFFICE,WELD COUNr r/ p�N2 33 6 0 8 Greeley .(14121444.. . .�1. . . 19. O.7• o / RECEIVED OF Cr/! ' �,�aU.n�n. $ ��A. r 57 l :(JYN FOR CREDIT , , c7.57;00 County General Fund 101 0000 �i M/,(fnp� ,FleeMrDepartment I IYUouu C/Ir'rHn (/ / ' /arfr Al(.GPil) 78. 75 Human Resources 121 0000 /VJ l Social Services 112 0000 Housing Authority Road & Bridge Fund 111 0000 Airport 177 0000 County Clerk Cash Escrow 810 0803 Fee Fund 900 0912 School District Gen Fund School District C R F p School District Bond Fund 830222 FRANCIS M. LOUSTALET CI /X O I 3 TOTAL AMOUNT ^ 6 75 County Treasurer I /1 tk-etac / `74(a e e � Si-xe 6, 4� -/r�k, CE' p�/��c 6 ��ff t-ed-t°-cow- ) 6<-;;ty 00Z a �cu�.[vrcAd6 �Ctede ;aSIS -2 y t yd 4t L.ft • eazDaite,x �� ut-it d, cojet aved_ivt , "ply. dal cycivunte. :DNcyozirkte___ 590222 J .kit,4 O.'"olorado • Oepartm:^nt of Revenue LIQUOR ENFORCEMENT DIVISION REQUEST TO CHANGE, ALTER OR MODIFY PREMISES NOTE: A retail or wholesale licensee may make no physical change,alteration or modification of the licensed premises which materially or substantially alter the licensed premises or its usage from the plans and specifications submitted at the time the original license was obtained unless prior request is made on this form and prior written consent obtained _ from the local and state licensing authorities.Consent of the licensing authorities is not necessary before a licensee paints or redecorates the licensed premises;installs or replaces electrical fixtures or equipment,plumbing, refrigerat- ion, air conditioning or heating fixtures and equipment; lowers ceilings,installs or replaces floor coverings;or replaces furniture and equipment. Questions concerning whether to obtain prior consent of the licensing authorities shall be addressed to the State and Local Licensing Authorities. . • The undersigned licensee hereby requests permission to change,alter or modify the licensed premises pursuant to Colorado Liquor Code Regulation 47-106.2 or Colorado Beer Code Regulation 46.106.3 All answers must be printed in ink or typewritten. If additional space is required to answer any question,a separate sheet may be attached. 1. NAME OF LICENSEE: 2. TRADE NAME OF ESTABLISHMENT: CN47L as Ali ss.ETA aM . IiiinenE.5"764.0 s4Lo 6A-/ 3.' LICENSE NUMBER: / �/�2tr')4. TYPE OF LICENSE: 5. CLASS OFLIQUOR LICENSE: p ✓I- — /) / a 76 3.2 ❑ Liquor /4A�T— it)dy1S SfiY,T(to Liz 6. AD RESS OF THE LICENSED PREMISES(state the address or legal description as it apprears on the latest prior license application): ..34 .ieR- .39 S CITY: COUNTY : ZIP: BUSINESS PHONE: R5re , UL,L , 767 9.,t_ . 19‘ --...ziL P? 7. MAILING ADDRESS(if Different): e�_• o X /3 CITY: STATE: ZIP: y.C , ''PrJ t 0060 g d 7_3 8. WILL THE PROPOSED CHANGE RESULT IN ANY INCREASE 0 DECR ASE IN^TF�E TOTAL SIZE OR CAPACITY OF THE LICENSED PREMISES? (If the answer is yes,explain In detail): r v ' CTin"/ YES NO El ' ci OJ'IIJC r . � 9. WILL THE PROPOSED CHANGE ALTER THE INGRESS OR EGRESS TO E LICENSED PREMISES? (If answer Is yes,expldn in detail): YES ❑ NO el' 10.WILL THE PROPOSED CHANGE ENLARG QR RELOCATE ANY EXISTING BAR,OR DADA SEPA jv�'TEE BEAR?(If answer is yes expaiin In YES II... NO El ._412z7 11.N�ILL PROPOSED CHANGE AFFECT THE BASIC CHAR T ,.ER THE PREMIS,OR THE PHYSICAL STRUCTURE THAT EXISTED IN THE PLAN ON FILE WITH THE LATEST PRIOR APPLICATION? (If answer is yes,expain in detail): YES ❑ NO �...--• tt 12.WILL.THE PROPOSED CHANGE LIKELY RESULT IN A CHANGE IN CONSUMPTION OF BEER OR ALCOHOLIC BEVERAGES ON OR FROM THE LICENSED PREMISES?(If answer is yes,state how large a change in consumption is anticipated): YES J NO i_.l:/.)ES THE LICENSEE HAVE LEGAL POSSESSION OF THE CHANGED PREMISES IF THE PROPOSED CHANGE IS APPROVED? (If answer is no, irate how legal possession is to be obtained): ralll possession is to be obtained): YES NO ❑ :4.ARE SUCH CHANGED PREMISES OWNED OR LEASED(Attach copy of deed,lease or contract): IF LEASED,FROM WHOM?: YES O E ou,. _FJ7 .'::ILL THE PROPOSED CHANGE RESULT IN THE LICENSED PREMISES BEING LOCATED WITHIN 500 FEET OF ANY PREMISES OCCUPIED BY A PUBLIC OR PAROCHIAL SCHOOL OR THE PRINCIPAL CAMPUS OF ANY COLLEGE,UNIVERSITY,or SEMINARY? (If answer is yes,explain in detail): YES q NO • :5.'Nl LL THE PROPOSED CHANGE BE IN COMPLIANCE WITH THE BUILDING AND ZOING LAWS OF THE APPLICABLE GOVERNMENTAL AUTHORITY? (If answer is no,explain in detail): YES ,� i NO L :'.WHENWILL THE PROPOSED CHANGE BE INITIATED? WHEN WILL THE PROPOSED BHANGE BE COMPLETED? Montt,`lu I i DayMonth JT I Year fq� J Day • ,,� I Year J j- LI i J ?.:F NO TI'.'E SCHEDULE HAS BEEN ADOPTED FOR THE PROPOSED CHANGE,APPROXIMATELY HOW LONG WILL BE REQUIRED TO ',AKE THE CHANGE ONCE APPROVED? Ae4 _,..2.,'„,../cle. &--- -4.! .'ESL RISE BELOW T!-.E PROPOSED CHANGE IN THE LICENSED PREMISES WITH ALL PERTINENT DETAILS NOT HERETOFORE G;_S, IBED.(Attacn ,i separate sheet if needed): i ..-- i .':C:i 10 THIS FORM COPIES CF THE INTERIOR PLANS AND SPECIFICATIONS CF THE LICENSED PREMISES WHICH SHOW THE EMISES AS PRESENTLY LICENSED,AND THE PREMISES AS PROPOSED AFTER THE CHANGE. • • AFFIDAVIT APPROVAL OF LOCAL LICENSING AUTHORITY This affidavit is to be signed and acknowledged by individual, each The foregoing request to change,alter or modify licensed premises general partner of partnership and by corporate applicants. has been examined and is hereby approved. STATE OF COLORADO: __ - - Dated at Greeley, Colorado this 22nd SS COUNTY OF day of June 19 88 ei 6 JJJ AND At: Weld County, Colorado Name of town,city and county) Cho rle s E . KxksshW.Wrn BY. -,14/i 6 being first duly sworn,deposes and says that he is the above named (ma3dOR Chairman of Board of County Commissioners licensee,or a general partner of the above named licensee,or that asx R(E ata BINX& ix ATTEST he is (title) : (C erk ecretary or other officer having the official of the above named corporate licensee; that he has read the fore- eai he Licensing A rity) going request to change,alter or modify premises and all attach- ments,that he knows the contents thereof,and that all matters, therein set forth are true of his own knowledge. A PROVAL OF STATE LICENSING AUTHORITY • SUBSCRIBED AND SWORN TO BEFORE ME The foregoing request to change alter or modify licensed premises has been examined and is hereby approved. THIste � ?se)of ass,e , 19 . Dated at this ' �`\ • day of , 19 ' Notary Public (affix seal) My commission expires: My Coflp11�Ofl Expires 3-2419 • STATE LICENSING AUTHORITY INDIVIDUAL AND ALL GENERAL PARTNERS OF PART- BY: NERSHIPS MUST SIGN HERE: AI Ems- /7z.4 09 • Corporation sign here: (Affix corporate seal) 6'1: President, Vice President,or Secretary L% II J Fl c9 ,, uJ Qc) Do 4 o ?0 it Os k �, , 9„ � Q, x -- 0`<r ran`' �� X v -01 dt ..1460 J N x A. w ��o A' t 1(k7? �v t J 0 0 Hello