HomeMy WebLinkAbout920853.tiffRESOLUTION
RE: APPROVE CHANGE OF CORPORATE STRUCTURE FOR METRO OIL COMPANY, DBA VICKERS
#2748
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, Metro Oil Company, dba Vickers #2748, the holder of a 3.2% Beer
License in Weld County, Colorado, has presented the Board with a Change of
Corporate Structure, and
WHEREAS, Metro Oil Company has indicated said Change of Corporate Structure
is as follows: David M. Bocks replaces Gerald DeHague as President and Director,
and
WHEREAS, after review, the Board deems it advisable to approve said Change
of Corporate Structure.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Change of Corporate Structure submitted by Metro Oil
Company, dba Vickers #2748, be, and hereby is, approved.
The above and foregoing Resolution was, on motion duly made and seconded,
adopted by the following vote on the 9th day of September, A.D., 1992.
ATTEST:
Weld County Clerk to the Board
BY:
Deputy Clef& to the Board
APPROVED AS 0 FORM:
County Attorney
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
EXCUSED DATE OF SIGNING
George Kennedy, Chairman
Constance L. Harbert,"Pro-Tem
(AYE)
C. W. KiDby
oc
Gor . Lacy
W. H. Webster
c
ThD , 50
920853
DR.9175 ( lap)
Colorado 'p:jrtment of Revenue
Liquor Enforcement Division
1375 Sherman Street
Denver, CO 80261
303-866-3741 t
DO NOT USE THIS FORM TO REFLECT A CHANGE IN PARTNERSHIP; IFT-HERE IS A CHANGE IN PARTNERSHIP, USE
THE DR 8404 OR DRL 403 AND FILE A CHANGE OF OWNERSHIP WITH YOUR LOCAL LICENSING AUTHORITY.
ALL LICENSEES FILL OUT THIS SECTION in dOnly or typo]
SALES TAX ACCOUNT NO.:
APPLICANT NAME:
METRO OIL CO., INC. 3 RECEIVED
LICENSE NUMBER:
7Yr e t y
;/- 7Y.7Y---"
TRADE NAME:
VICKERS, #2748 (� QQ
TELEPHONE NUMBER:
776-7101
ADDRESS OF LICENSED T(:xPREMISES: NOV 1 V 1992
Add W LONGMONT CO 8001
397 trees ress 119 City State tip
MAILING ADDRESS: LIQUOR ENF. DIV.
39-2005
55eeet5nedrH VANA ST. DENVER, State tyC802,ip
CHANGE OF CORPORATE STRUCTURE (ApPlieS to corporate licensees only) Attach a certificate of, Good Corporate standing;
and. for each new officer, director, and stockholder, attach a DRL 404-1 Individual History Record and Copy of Minutes.
NAME of new corporate officers & directors:
HOME ADDRESS
D.O.B.
REPLACES (Name):
President DAVID M BOCKS
11050 PYRAMID PEAK, LITTLETON,
CO
vice President VACANT
Secretary RONALD T. sRINKMAN
5504 S NEWCOMBE ST. LITTLFT0H.
CO
Treasurer RONALD L BRINKMAN
PLEASE SEE ABOVE
SAME
NEW STOCKHOLDERS/TRANSFERS OF CAPITOL STOCK
HOME ADDRESS
D.O.B.
V. OF STOCK NOW OWNED
TOTAL PETROLEUM, INC.
999 18th ST., #2201, DENVER,
CO N/A
100% SAME
DIRECTORS:
HOME ADDRESS
D.O.B.
REPLACES (Name):
DAVID M BOCKS
PLEASE SEE ABOVE
CFRJLD DeHAGTIF
RONALD L BRINKMAN
PLEASE SEE ABOVE
SAME
CHANGE OF MANAGER (For Beer & Wine, Tavern, Club, ` Arts, Racetrack and all 3 2 Beer -except -Off Premises")
Hotel/Restaurant Licensees must submit a DR 8367, Manager's Registration
FORMER MANAGER: Name 3 RECEIVED
Date of Birth
�^y
NEW MANAGER: Name ItnM 1 9 NS
NOV 2 7 1992
V
Date of Birth
OATH OF APPLICANT L)QUC,,
r F'F. 01V•
I declare under penalty of perjury in the second degree that I have read this report and all attachments thereto and mar I Know the contents hereo .
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.
AUTHORIZED SIGNATURE:
l// `c /- .47"--4/H-77-------
��
TITLE OF SIGNER Of corporation)
PRESIDENT
DATE
7/15/92
REPORT OF LOCAL LICENSING AUTHORITY
The foregoing changes have been received and examined by the Local Licensing Authority.
LOCAL LICENSING AUTHORITY I.D. NUMBER:
84-6000813
LOCAL LICENSING AUTHORITY FOR: idd COUNTY
WELD COUNTY, COLORADO ❑ Townrcfry
SIGNAT
'-/--_ 7� _ ____ 1
TITLE: CHAIRMAN, WELD COUNTY
BOARD OF COMMISSIONERS
/
DATE:
09/09/92
A rbs-r
A J
/t r� ii /
/ / ��
/
/2, ( L�, 2„1,/,,,.. 9
BY: DEPUTY CLERK TO BOARD -
DATE.
09/09/92
REPORT OF CHANGES
Liquor and 3.2 Beer License
• Use to report change of corporate
structure or change of manager only.
• Submit to Local Authority
(Local Authority will submit to State)
Note: Local authority, for corporate structure changes, please submit all copies to the Liquor Enforcement Division. One
copy will be returned to the applicant and one to the local authority upon acknowledgement.
For change of managers, submit one copy to the Liquor Enforcement Division, retain one copy for local Hnrifv
files, and give one copy to the applicant. 92O85 s
LIQUOR ENFORCEMENT DIVISION
Department of Revenue
7375 Sherman Street, Room 600
Denver, Colorado 80267
Phone (303) 866-3741
FAX (303) 866-4547
STATE OF COLD
RADO
August 14, 1992 RECEIVE
Metro Oil AUG20 0 1992
d/b/a VickermsanY
PO Box 500
Denver, CO 80201
Re: Chain Store Application for Metro
Dear Sir or Madam: Oil Company,
This is to adviseheivision
Your that the State LiquorEnforcement
f of above -listed applreicant.A
created a"master
the date file"
the following this letter our masterfile includes
items which you have submit e
1. Individual submitted:
the History Records
following Persons; (Form DR -8404
for
David Michael Docks
Ronald L. Brinkman DOB
birthdatesAll the persons listed a names and
1, above. by the fingerprint a pare
Sub us toe cards paraColorado Bureau graph
een
I the and any prints history gation. The
and FBI no checve ked
reportedly found no
tort for Ronald L. record of
THIS DIVISION HAS Brinkman,
FOR DAVID MICHAEL THE FINGERPRINT
RESULTS
ESUL 5RECEIVED
BOCKS DOB
3' Certificate of
Good
Corporate of State
Authority standing or a fro Certificate
Secretary
m of
Oil Company is tate which the Colorado
Pan
ro
business in Coloradoa .
authorized,.toes that tdo
WHERE EXCELLENCE ADDS UP
DEPARTMENT OF REVENUE
Roy
Governor
lobo J. Tipion
Executive Direcor
David C. Reitz
Division Direcm-
920853
Metro Oil Co.
d/b/a Vicker's
August 17, 1992
Page 2
You must check with the local licensing authority to
determine what documents they may require of you to
process your application. Please feel free to provide
them with this letter as many local authorities will not
require you again to submit fingerprint cards to them if
you have already submitted such documents to the State
Liquor Enforcement Division. This letter will serve to
inform the local authorities exactly which documents you
have already submitted to the State Enforcement Division.
Finally, once the local authority has approved your
application, it must be sent to the Liquor Enforcement
Division. The only documents which are needed by the
Division are:
1. The approved application signed by the local
authority;
2. The appropriate fees;
3. A copy of this letter;
4. Proof of possession of the premises;
5. A diagram of the licensed premises;
6. Completed form DR 8367,if manager'
registration is required.
Sincerely,
Matt D. Cook
Licensing Administrator
mas-div-1
vickers3.mas
920853
7403 (5/89)
Dept. of Revenue
Enforcement Division
Sherman St.
2r, CO 80261
Lolorado
Fermented Malt Beverage
(3.2% Beer) License Application
'ORTANT: For those retail licenses described in Column A below, this application and all
porting documents must FIRST BE FILED IN DUPLICATE WITH, AND APPROVED BY, THE
..:CAL LICENSING AUTHORITY (CITY, TOWN, COUNTY). Applications will not be accepted
-Jess all applicable questions are fully answered, all supporting documents correspond exactly
.rich the name of the applicant(s), and proper fees are attached.
You may attach separate sheets or additional documents if necessary to fully complete this
application. All documents must be typewritten or legibly printed in black ink.
Form DR 8404-I, -Individual History Record' must be completed and filed in duplicate by the
following:
- Each applicant
, - All officers/directors of a corporation
- All stockholders of a corporation not subject
to the Securities and Exchange Act of 1934
Over 5% stockholders of a corporation subject
to the Securities and Exchange Act of 1934
i
• All general partners
• Over 5% limited partners
• Managers
• Each person required to file form
DR 8404-I must submit fingerprints
to the Local Licensing Authority.
NOTE: License status will not be given over the telephone. License will be mailed by the Liquor Enforcement
Division to the Local Licensing Authority upon issuance.
ALL ANSWERS MUST BE PRINTED IN BLACK INK OR TYPEWRITTEN
License Issued Through
(Expiration Date)
Use License Account No.
for all reference
County
LIABILITY INFORMATION
City - Industry Type Liability Date
Cash Fund
66-1
FEE PAID
State,1 City
45-9 37-1
County
49-1
TOTAL
345-9(3)
APPLICANTS FOR BRAND NEW LICENSES, OR TRANSFERS OF OWNERSHIP
MUST CHECK THE APPROPRIATE BOXES BELOW IN EITHER COLUMN A OR COLUMN B
AND MUST ALSO CHECK EITHER BOX (18) OR (19).
COLUMN A
STATE FEES 45 - 9 (3)
COLUMN B STATE FEES
e 18 ❑ New License Application Fee
$250.00
19 ❑ Transfer of Ownership Application Fee $250.00
18 ❑ New License Application Fee
$250.00
19 ❑ Transfer of Ownership Application Fee $250.00
11 ❑ Retail 3.2% Beer (Fermented Malt $71.25
Beverage License) - City
1 ❑ Retail 3.2% Beer (Fermented Malt $92.50
Beverage License) - County
REQUEST FOR MASTER FILE
2. Name of Applicant(s): If partnership, list partners' names (at least two); if corporation, name of corporation:
METRO OIL CO., INC.
la. Applicant is a:
CE Corporation D Individual
_. Trade Name of Establishment: (DBA)
VICKERS
I. Address of Premises: (Specify exact location of premises.Diagram of premises must accompany this application.)
12 ❑ 3.2% Beer Wholesale License (Fermented Malt Bev,) $125.00
13 ❑ 3.2% Beer Manufacturers License (Fermented Malt Bev,) 125.00
14 ❑ 3.2% Beer Importer's License (Fermented Malt Bev,) 125.00
16 ❑ Nonresident Manufacturer License 125.00
(Fermented Malt Beverage)
Partnership ❑ Other (specify)
State Sales Tax No.:
City:
Date filed with Local Authority:
F.E.I.N.:
38-2114740
Social Security No.:
Business Telephone:
Nailing Address: (Number and Street)
5590 HAVANA ST., ATTN: LESLIE
County:
State:
Zip Code:
City or Town:
DENVER
State:
CO
Zip Code:
80239-2005
if this is a transfer of ownership application or renewal, you MUST answer the following questions about this business:
'resent Trade Name of That Establishment (DBA):
Present State License No.:
Present Type of License:
Present Expiration Date:
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 eighteen 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. Exclude minor traffic violations.
(b) Have 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. Exclude minor traffic violations.
YES NO
X
X
X
920853
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 'yes; explain in detail.
PLEASE SEE EXHIBIT ATTACHED
YES
X
X
X
NO
9. Has a fermented malt beverage license for the premises to be licensed been refused within the preceding year? If 'yes,'
explain in detail.N/A
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 'yes,' explain in detail.
PLEASE SEE EXHIBIT ATTACHED
X
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: N/A
i
12. Identify the persons, fim'c, 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 of any such persons, 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
TOTAL PETROLEUM, INC.
999 18th ST., DENVER, CO 802d2
100% STOCKHOLDER
13. 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
TOTAL PETROLEUM, INC.
VICKER'S
VARIOUS - PLEASE SEE
(100% STOCKHOLDER OF METRO
OIL CO., INC d/b/a VICKER'S)
ATTACHED
Attach copies of all notes and security instruments, and any written agreement or details of any oral agreement, by which any person (including a
corporation) will share in the profit or gross proceeds of this establishment, and any agreement relating to the business which is contingent or
conditional in any way by volume, profit, sales, giving of advice or consultation.
14. Colorado Manufacturer or Wholesaler applicants, answer the following: N/A
(a) Does the applicant own, lease or operate any Colorado warehouse or storage plant in connection with this business?
If 'yes,' give full address.
(b) 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 beverage, or malt, vinous or spirituous liquor? If 'yes,' attach explanation in detail.
(c) Does the applicant have a valid Federal Basic Permit? If 'yes; attach a copy of the permit; if 'no,' explain whether
one has been applied for.
f
L
Page 2 of 4
920853
,. Nonresident Manufacturer (fermented malt beverages) or Importer (fermented malt beverages) applicants, answer the
following: N/A
(a) To what Colorado licensed wholesaler do you intend to ship your merchandise?
(b) Does or did any owner, part owner, shareh.,ider, director or officer of the applicant have any direct or indirect financial
interest in an importer, manufacturer or retailer already licensed by the State of Colorado to sell fermented malt
beverages or malt, vinous or spirituous liquor? If 'yes,' attach explanation in detail.
(c) Does the applicant have a valid Federal Basic Permit? It 'yes,' attach a copy of the permit.
(d) Are you the primary source of supply in the U.S.? If 'no, explain in detail.
YES
NO
16. If the applicant is a partnership, answer the following: (Attach separate sheet if necessary.) N/A
(a) Name of each general partner and each limited partner
holding a greater than 5% interest
Home Address, City and State
Social Security #
Date of Birth
(h) On what date was the partnership formed? Attach a copy of the partnership agreement (except for
partnerships consisting only of a husband and wife).
Date:
17. If the applicant is a corporation, answer the following:
(a) Corporation is organized under the laws of the State of: MICHIGAN Date of Incorporation: 3/16/72
(b) Out-of-state corporations, give date authorized to do business in Colorado: (Attach Certificate of Authority
11/25/85 from Colo. Secretary of State)
(c) Date of filing last annual corporate report to the Secretary of State: 12/11/91
(d) Name of each officer listed below:
Home Address, City and State:
Social Security #
Date of Birth:
President: DAVID M. BOCKS
11050 PYRAMID PEAK, LITTLETON, CO
1/3/59
secretary:
RONALD L BRINKMAN
PLEASE SEE ABOVE
(e) Name all 5% or greater stockholders;
include actual owner or pledgee
Home Address, City and State
% of stock
Date of Birth:
TOTAL PETROLEUM, INC.
999 18th ST., #2201, DENVER, CO
100%
N/A
(t) Name of all Directors or Trustees of
Corporation:
Home Address, City and State
DAVID M BOCKS
PLEASE SEE ABOVE
RONALD L BRINKMAN
PLEASE SEE ABOVE
18- Manager:
N/A
Page 3 of 4
92095'
OATH OF APPLICANT
I declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and
complete to the best of my knowledge.
Authorized S' na/tJ�,re: //�;////
LCtCCC/�(e ��
T44
PRESIDENT
lute: 7/8/92
REPORT AND APPROVAL OF LOCAL LICENSING AUTHORITY
(Manufacturers, nonresident manufacturers, Importers, wholesalers, limited wineries, and public transportation licensees
disregard the section below.)
Is this application for a: New License
Change
Structure
in Corporate
YES NO
Transfer of Ownership X Other (specify):
Each person required to file DR 8404-I: Has
Background
The liquor licensed premises is ready for occupancy
If 'no,' the building will be completed and ready
been fingerprinted
NCIC and CCIC checked
and has been inspected by the Local Licensing Authority.
for inspection by (date)
C.R.S., as amended, 12-46-117
(1) (a) The local licensing authority shall restrict
(I) Sales for consumption 'OFF'
(II) Sales for consumption 'ON'
(III) Sales for consumption 'BOTH
(b) The provisions of paragraph (1)(a) shall
for under this article prior to July 1,
the use of said license to: CHECK ONE
the premises of the licensee; or X
the premises of the licensee; or
ON AND OFF' the premises of the licensee.
not apply to any license issued or applied
1967, nor to any renewal or reissuance thereof.
The foregoing application has been examined; and the premises, business to be conducted, and character of the applicant are
satisfactory. We do report that such license, if granted, will meet the reasonable requirements of the neighborhood and the desires
of the inhabitants, and will comply with the provision of The 12, Article 46, C.R.S. THEREFORE, THIS APPLICATION IS APPROVED.
Local Licensing Authority lot:
❑ TOWN, CITY
❑ COUNTY
Signature:
TOE
Gals:
Sgnature (attest):
Title:
Date:
If premises are located within a town or city, the above approval should be signed by the mayor and cleric, 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.
Page 4 of 4
920833
ATTACHMENT FOR STATE APPLICATION
Question #8 (A) :
Denials to Total Petroleum, Inc. (Stockholder of Metro Oil Co.) :
March, 1983 - License denied to Durango due to failure to
establish needs and desires.
1984 - Two licenses denied in Denver because "Applicant did
not have right to possession of property for intended use."
Denials to Metro Oil Co. :
July 16. 1987 - License denied in Durango due to failure to
establish needs and desires.
February 9, 1989 - License denied in Lakewood due to local
ordinance concerning "500' Rule."
920853
EXHIBIT FOR STATE APPLICATION
METRO OIL - TOTAL PETROLEUM VIOLATIONS
On June 5, 1990, acknowledged one violation of sale to a
person not twenty-one (21) years of age, in connection with
a "sting" operation in the City of Federal Heights, and paid
a $250.00 fine in connection with the same.
On September 5, 1990, acknowledged one violation of failure to
post beer licenses at 7607 East Iliff, Arapahoe County, and
paid a $200.00 fine in connection with the same to the State
Department of Revenue -Liquor Enforcement Division.
Or October 3, 1990, acknowledged one violation of sale to a
person not twenty-one (21) years of age, in connection with
a "sting" operation in Adams County, and paid a $280.00 fine
in connection with the same.
September, 1991 - Metro Oil Co. stipulated to one violation of
the Colorado Beer Code (possession of three [3] bottles of
wine cooler not labeled as 3.2% alcohol by weight). License
suspension totally held in abeyance.
December, 1991 - Metro Oil Co. stipulated to one violation of
failure to post license at its store number 2485 - 1794 South
Academy Blvd., Colorado Springs, Colorado 80909. Licensee
paid a minimum fine of $200.00.
January, 1992 - Stipulated to two violations of sale to a
person not twenty one years of age, in connection with a
"sting operation in the City of Thornton, paid a $900.00 fine,
served two days in connection with each violation, all other
penalties held in abeyance.
May 1992 - Stipulation to one violation of sale to a person
not twenty one years of age, in connection with a "sting"
operation in the City of Greenwood Village, served three(3)
days of suspension four(4) days. held in abeyance.
920853
DR 8404 - 1(2/89)
----
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
jeopardjze,the application as such falsehood within Itself constitutes evidence regarding the character and reputation of the
applicant.:
1. Name
of Business:
METRO OIL CO., INC. d/b/a VICKERS
2. Your Full Name:
( Date:
7/8/92
Social Security Number:
(law/first/middle)
BOCKS, DAVID MICHAEL
4. Mailing
3. Also Known As: (maiden name/nickname, etc)
N/A
Address: (if different from residence)
SAME
S. Residence
Home Tele phone:
303/973-3236
Address: (street and number, cry, state, zip)
11050 PYRAMID PEAK, LITTLETON, CO 80127
6. Is your residence:
7. Date
lip
OWNED O RENTED
N�Ated, from whom?
of Birth:
Place of Birth:
DETROIT, MICHIGAN
8. U.S. Citizen?
TO YES ENo
If naturalized, state where:
N/A
Naturalization
When:
N/A
Name of U.S. District Court
N/A
• N/A
Cern iieste No.:
Date of Certificate:
N/A
If en alien, give Alien's Registration Card No.:
N/A
Permanent Residence Card No.:
N/A
9. Height.
5'6"
11.
Weight
155
Hair Color
BROWN
Eye Color.
BROWN
Sex:
MALE
Race:
CAUC
10. Do you have
® YES
a
•
Colorado Drivers License? U 'yes,' give number:
NO
What is your relationship
CORPORATE OFFICER
to the applicant? (sole owner, partner, corporate officer, director, stockholder or manager):
12. If Stockholder, Number of
N/A
Shares Owned Beneficially or of Record:
Percent of Outstanding Stock Owned:
N/A
13. It Partner, stale whether.
N/A
•
GENERAL O LIMfTED
Percent of Partnership Beneficially Owned:
N/A
14. Name of Present Employer:
TOTAL PETROLEUM, INC.
15. Type of Business of Employment
GASOLINE/CONVENIENCE STORES
16. Address of Business Where Employed: (street and number, dry, state, zip)
999 18th STREET, DENVER, CO 80202
Business Telephone:
291-2000
17. Present Position:
GENERAL MANAGER — ADVERTISING AND SALES PROMOTION AND MERCHANDISE
',
3. Marital Status:
MARRIED
19. Name of 5 pouse: (include maiden name if applicable)
GAY CHRISTINE BOCKS (STOCKDAT,E)
20. Spouse's Date of Birth:
Spouse's Place of Birth:
DETROIT, MICHIGAN
21. Spouse's residence address, if different than yours: (give street and number, dry, state,
SAME
zip)
22. Spouse's Present Employer:
NONE
Occupation:
N/A
23. Address of Spouse's Present Em
Employer:
N/A
24. List the name(s) of all relatives working in the liquor industry, give their.
Name of Relative:
Relationship to You:
Position held:
Name of Employer:
Location of Employer:
NONE
CONTINUED ON RFVFRSF sine
920853
25.
Do
•
you now,
YES
or
P
have you ever held a direct or Indirect Interest In a State of Colorado Liquor or Beer License? If yes; answer In detail.
NO
26.
Do
Colorado?
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
If yes; describe in detail.
YES I; NO
27.
Have
court?
of alcoholic
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
(Do not Include traffic violations, unless they resulted in suspension or revocation of your drivers license, or you were convicted of driving under the influence
beverages.) If 'yes,' explain in detail.
YES ® NO
28.
If
Have
yes;
■
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
explain in detail.
YES El NO
29. Have you ever held a gambling or gaming license or owned a Federal Gambling Stamp? If yes; explain in detail below.
YES ® NO
State/Federal:
N/A
Year:
City:
State:
StaterFederal:
N/A
Year:
City:
State:
30. Military Service: (branch)
N/A
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
City, State, Li)
From:
To:
11050 PYRAMID PEAK
LITTLETON, CO 80127
2/85
PRESENT
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:
TOTAL PETROLEUM
999 18th ST., DENVER, CO 80202
ADVERTISING MGR
1977
PRESENT
MERCHANDISINC
33. List the names of 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:
ANNE WAGNER
42 SOUTH SHERWOOD GLEN, MONUMENT, CO 80132
1 YEAR
EDWARD W SCHWACKER
12175 E OHIO, AURORA, CO 80012
11 YEARS
WARREN A PETERSON
4798 W 68th AVE., WESTMINSTER, CO 80030
4 YEARS
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.
Signature:
<`(� /-
/{//.j//^,
Title:
PRESIDENT
Da
7/8/92
920853
STATE 42. RADO
DEPARTMENT OF
STATE
CERTIFICATE
I, NATALIE MEYER, Secretary of State of the State of
Colorado hereby certify that
According to the records of this office
METRO OIL CO., INC.
(MICHIGAN CORPORATION)
has complied with the applicable provisions of the laws of
the State of Colorado and on this date is in good standing
and authorized and competent to transact business or to
conduct its affairs within this state.
Dated: JULY 2, 1992
SECRETARY OF STA
920853
MINUTES OF CONSENT TO ACTION
BY SHAREHOLDER
OF
METRO OIL CO.: INC.
DATED! August 10, 1992
EFFECTIVE! Upon Approval By Local And
State Licensing Authorities
1. Pursuant to the terms of C.R.S., Section 7-4-122, the
undersigned, being the only Shareholder of Metro Oil Co., Inc.
(hereinafter the "Corporation"), does hereby consent to,
specifically authorize and confirm the following actions and
specifically instruct the officers and agents of the Corporation to
take any and all steps necessary or convenient in order to
effectively implement the actions and natters set forth-irr-these-
"Minutes of Consent To Action" hereby consented to. Ft=thetx, the
undersigned hereby waives any right to dissent from such actions.
2. The undersigned hereby waives any and all notice that may
be required to be given with respect to a meeting of either the
Officers, directors, or shareholders of the Corporation, and hereby
takes, ratifies, confirms and approves each and every one of the
following items.
3. The Corporation hereby accepts the resignation of Mr.
Gerald DeHague as a corporate officer and director, effective only
upon the approval of all licensing authorities.
4. Mr. David M. Hocks is hereby elected as President and a
director of the Corporation, effective upon approval of all
licensing authorities.
920853
1cL N0:303-25_-2141
tt651 P03
5. The office of vice
remain vacant President of the Corporation shall
until further action of the Corporation.
6. This Consent shall be
Co delivered to the Secretary of the
delivered for inclusion and filing with the Corporate records,
These Minutes of Consent to Action ma
or more counterpartsy be executed in one
all of which taken together shall constitute
the same Minutes of Consent to
Action and when signed by all of the
persons set forth herein ma
the Co y be certified by any proper officer of
rporation as having been unan
bores inwusly adopted by a vote
qualified to addrooe the of all
8. Qua�p l.Zun.
The undersigned hereby approve
bonuses paid to officers and directors any and all salary and
9. to date.
There being no further business, the meeting was
adjourned.
SHAREHOLDER:
TOTAL PETROLEUM, LTD.
By:
}Wines David Hocks
Title: President
Date t 8 10 92
-2-
RESIGNATION
i, Gerald Dexague, hereby resign as President and Director of
Metro Oil Co., Inc., a Colorado corporation, effective upon the
approval of mt. David M. Hocks as my successor to these positions,
by all appropriate liquor licensing authorities.
92O%a
TO WHOM IT MAY CONCERN:
I have known ,AVi/j (?G�S for
//
years and find him/her to be a person of honest
and sound character and has the background to maintain a
professional approach to the liquor business.
It is my opinion that he is the type of person who has
the maturity and judgment to responsibly handle a liquor license.
Signed,
Signat
Print Name: gpcd GU gc-G cuff-cfr—_C_____
Address: /
/a/7S e• O1,:b
Au.rm,c,1, Ca /o gc4O
Phone Number: 303- 3Y-3 —7 8 /f
Date: /7 (, , Ig92-
92U853
TO WHOM IT MAY CONCERN:
I have known -7)M//L 2 ciCS
for
years and find him/her to be a person of honest
and sound character and has the background to maintain a
professional approach to the liquor business.
It is my opinion that he is the type of person who has
the maturity and judgment to responsibly handle a liquor license.
Signed,
LL'n tit_ �L
Signature
Print Name: Anne F. Wagner
Address : 42 South Sherwood Glen
Monument, CO 80132
Phone Number: (303) 291-2283 - Work
(719) 481-9549 - Home
Date: 7-6-92
920853
TO WHOM IT MAY CONCERN:
I have known DA/0 c-G,eSS for
years and find him/her to be a person of honest
and sound character and has the background to maintain a
professional approach to the liquor business.
It is my opinion that he is the type of person who has
the maturity and judgment to responsibly handle a liquor license.
Signed,
'signature
Print Name: „&? /7 /j4RS2rN
Address: y79Y-66! (277777/ta-
(,2,5fyJ,70(P) ); lC E-7?,G30
Phone Number: ( s) -J/29._52C1k
Date: Jttl,t d)/1l'�i
920853
DILL, DILL & CARR
WELD COUNTY
C0IF^^!.f. T0N,NERS
A PROFESSIONAL CORPORATION
ATTORNEYS AT LAW
August 28, 1992
1992 SEP -3 Pig 2: 45
CLERK
TO THE BOARD
Carol Harding
Weld County Commissioner's Office
P.O. Box 758
Greeley, CO 80632
H. Alan Dill
Robert A. Dill
Ion Stonbraker
Daniel W. Carr
John A. Hutchings
Lucien J. Dhooge
Thomas M. Dunn
Leslie Block Kaye
Daniel E. Bronstein
Re: Metro Oil Co. d/b/a Vicker's - Change in Corporate Structure
Dear Carol,
Metro Oil Co., Inc. d/b/a Vickers has undergone a change in their
corporate structure and we have filed for a new master File letter
with the State replacing Gerald DeHague as President and a Director
of this corporation with David M. Bocks.
Enclosed find a Report of Change as well as all other documentation
appropriate for filing such a change within your jurisdiction.
Should you have any questions please do not hesitate to call me.
54nserely,
Llora T. Singer
Paralegal
is
920853
dcc CHr2AAAKI CTPCCT CI me Inn i rICNIVCo rn, (loArlll onflno i r rim.
DILL, DILL & CARR WELD COUNTY
A PROFESSIONAL CORPORATION
ATTORNEYS AT LAW
October 20, 1992
Alan Dill Lucien I. Dhooge
Robert A. flf� l Thomas M. Dunn
^ii'� CCPo iei nb.y ekQ 23 Leslie Block Kaye
t/ l.• Darsiel W. Carr Daniel E. Bronstein
John A. Hutchings
CLERK
TO THE GOAFD
Carol Harding
Weld County Commissioner's Office
P.O. Box 758
Greeley, CO 80632
Re: Metro Oil Co. d/b/a Vicker's - Change in Corporate Structure
Dear Carol,
Enclosed find the Master File letter, from the Colorado Department
of Revenue, to be filed with the above referenced change.
Should you have any questions or need any additional information
please do not hesitate to call me.
Llora T. Singer
Paralegal
Is
920853
ACC cWcpk1AAl cToccT CI uTF 'en / nckwcL /'nl no nn Arlene / FAY nnT, 777_2R11 / /QM) 777ATl7
STATE OF COLORADO
LIQUOR ENFORCEMENT DIVISION
Department of Revenue
1375 Sherman Street, Room 600
Denver, Colorado 80261
Phone (303) 866-3741
FAX (303) 866-4541
October 9, 1992
Metro Oil Company
d/b/a Vicker's
PO Box 500
Denver, CO 80201
Re: Chain Store Application for Metro Oil Company.
Dear Sir or Madam:
This is to advise you that the State Liquor Enforcement
Division has, at your request, created a "master file"
for the above -listed applicant.
As of the date of this letter our master file includes
the following items which you have submitted:
1. Individual History Records (Form DR -8404) for
the following persons:
David Michael Bocks DOB
2. Fingerprint cards bearing the names and
birthdates of the persons listed in paragraph
1, above. All the fingerprint cards have been
submitted by us to the Colorado Bureau of
Investigation.
THE CBI AND FBI HAVE CHECKED THE PRINTS FOR
DAVID MICHAEL BOCKS AND RONALD L. BRINKMAN AND
REPORTEDLY FOUND NO RECORD OF ANY CRIMINAL
HISTORY.
3. Certificate of Authority or a Certificate of
Good Corporate standing from the Colorado
Secretary of State which indicates that Metro
Oil Company is a corporation authorized to do
business in Colorado.
}
Roy Romer
Governor
John J. Tipton
Executive Director
David C. Reitz
Division Diredor
COLORADO DEPARTMENT OF REVENUE
0
WHERE EXCELLENCE ADDS UP 4s3
Metro Oil Co.
d/b/a Vicker's
August 17, 1992
Page 2
You must check with the local licensing authority to
determine what documents they may require of you to
process your application. Please feel free to provide
them with this letter as many local authorities will not
require you again to submit fingerprint cards to them if
you have already submitted such documents to the State
Liquor Enforcement Division. This letter will serve to
inform the local authorities exactly which documents you
have already submitted to the State Enforcement Division.
Finally, once the local authority has approved your
application, it must be sent to the Liquor Enforcement
Division. The only documents which are needed by the
Division are:
1. The approved application signed by the local
authority;
2. The appropriate fees;
3. A copy of this letter;
4. Proof of possession of the premises;
5. A diagram of the licensed premises;
6. Completed form DR 8367,if manager'
registration is required.
Sincerely,
-1,17tirri; ere -14 -
Matt D. Cook
Licensing Administrator
mas-div-1
vickers4.mas
9710853
P 387 472 E4
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED
Not FOR INTERNATIONAL MAIL
(See Reverse)
COLORADO DEPT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
STATE CAPITOL ANNEX
1375 SHERMAN ST
DENVER CO 80203
PS Form 3800, June 1985
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
S
Postmark or Elate
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