HomeMy WebLinkAbout901234.tiffRESOLUTION
RE: APPROVE REQUEST FROM WINNY ENTERPRISES, INC., DBA PIZZA HUT
RESTAURANT, TO CHANGE MANAGER - 3.2% BEER LICENSE
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, Winny Enterprises, Inc., dba Pizza Hut Restaurant,
has submitted a request for a change of manager, said request
being attached hereto and incorporated herein by reference, and
WHEREAS, the local licensing authority, the Weld County Board
of Commissioners approved same, and said documents were submitted
to the Colorado Department of Revenue, Liquor Enforcement
Division.
NOW, THEREFORE, BE IT RESOLVED by the
Commissioners of Weld County, Colorado, that the
Enterprises, Inc., dba Pizza Hut Restaurant,
manager, be, and hereby is, approved.
The above and foregoing Resolution was,
and seconded, adopted by the following vote
November, A.D., 1990.
Weld County_Clerk to the Board
BY:
APPROVED AS TO FORM:
ounty
Attorney
Board of County
request of Winny
for a change of
on motion duly made
on the 19th day of
BOARD OF COUNTY COMMISSIONERS
WELD% 9[TNTY, COLOOtADO
Constance L. Harbert
41'
C.W. Kirby
EXCUSED
Gordon E. Lacy
Jet oire°
e C , t''if,3iv
901234
DR 8176 • (07/89)
Colorado Department of Revenue
Liquor Enforcement Division
1375 Sherman Street
Denver, CO 80261
303-866-3741
[FICPORT 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)
DO NOT USE THIS FORM TO REFLECT A CHANGE IN PARTNERSHIP. IF THERE 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
APPLICANT NAME:
rnris cS, a17c.
ss Ormfy or type).
SALES TAX ACCOUNT NO.:
4 :3411.
LICENSE NUMBER:
14-234n.
TELEPHONE NUMBER:
e7,,
J
TRADE NAME:
;_.. +..=.t t%ataurz':dL.
ADDRESS OF LICENSED PREMISES:
_ nVC
Street Address
MAILIN,Q ADDRESS
Street Address
CHANGE OF CORPORATE•SUCTURE (Applies to corporate licensees Only} Attacofh•ccertificate Good Corporate standing;
and, for each new officer, directorTR and stockholder attach a ORL 404-f, Individual History Record and Copy cal Minuses.
GreC Le'J
City
'.ai chi to
City
CO 30631
State Zip
KS 371_14)
s ate Zip
NAME of new corporate officers 8 directors:
President
HOME ADDRESS
D.O.B.
REPLACES (Name):
Vice President
Secretary
Treasurer
NEW STOCKHOLDERS/TRANSFERS OF CAPITOL STOCK
HOME ADDRESS
D.O.B.
OF STOCK NOW OWNED
DIRECTORS:
HOME ADDRESS
D.O.B.
REPLACES (Name):
...........................................
CHANGE OF MANAGER (For Beer & Wine, Tavern, Club, Arts, Racetrack and all 3.2 Beer -except 'Off Premises")
Hotel/Restaturant Licensees must submit a DR 8367, <Managers Registration
FORMER MANAGER: Name I
OF APPLICANT
I declare under penalty of perjury in the second degree that I have read this report and all attachments thereto and that I know the contents hereof,
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.
AUTHO IZED SIGNATURE: /
4
..&'c- £,., I ui*/
REPORT OF LOCAL LICEN AUTHORITY
TITLE OF SIGNER (if corporation)
DATE:
11/1` /r'=t
The foregoing changes have been received and examined by the Local Licensing Authority.
LOCAL LICENSING AUTHORITY I.D. NUMBER:
SIGNATURE:
r4TTES9T: A A
b(ie: Local authority, for Corpa'rate 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.
LOCAL LICENSING AUTHORITY FOR:
G uf..i , 0:..,Or:Ai i)
COUNTY
TOWN/CITY
TITLE:
C4,t'r.t y
DATE:
1 ,
Oi
DATE:
For change of managers, submit one copy to the Liquor Enforcement Division, retain one copy for local licensing authority
files, and give one copy to the applicant.
901274
DR8401- 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 constftutes evidence regarding the character and reputation of the
applicant : . ;
1. Name of Business:
PtzZa fickt-
Date:
//-/.5-9U
Social Security Number.
2. Your Full Name: (Iastfirsumiddle) ff 1
tJ0f-t e S Cyr egois/ f1 fl Gt
3. Also Known As: (maiden name/nickname, etc.)
4. )Mailing Address: (d different from residence)
2- 3z 8t1,- Ave; Grce/e co. 8063/
Home Telephone:
667- Z?//
s.Address: r, city, �re , zip
6 C Peach TreePI. L�ve.(avtni en, R -S-3?
8. Is your residence:
•
OWNED � RENTED .. ..
I Si MIf rented, ax from whom?
�
7. Date of Birth: -. p
/`
of Birth: J� n
1/ e i v e r 1, G,
6. U.S. Citizen?
YES
ENO
8 naturalized, Mete where:
When:
Name of U.S. District Court
Naturalization Certificate No.:
Date of Certificate: ;.
...
If an Merl, give Men's Registration Card No.:
Permanent Residence Card No.:
9. Height
Si ////
Weight
A9 -O
Hak Color:
8r"owp1
Eye Color:
Hate/
Sex:
M -
Race:
Wk;+c
10. Do you have a Colorado Diva's License? ryes; give number:
' IYEs ONO /4 -
What Is your relationship to the applicant? (sole owner, pan, corporate officer, director, stockholder or manager):
,Mavta.,e —
12. If Stockholder, Number of Sham Owned Beneficially or of Record:..
Percent of atatandng Stock Owned:
13. If Partner, star whether: . .-. . ,; p� .
❑ GENERAL LIMITED -... .. -
Percent of Parolaship Benefdally Owned:
14. Name of Present Emplcia:
LJt nhy twterpQri≤es =N c,
16. Type of Business of Employment
Resto. LArctrtli-
te. Address of Buiiness Where Emplot6d: (street and nuf Wr, city. sLq . zip)
k Ave,
2-325
Business Telephone:
ir?tTh
Gree(ey/e,,, 80631
3SZ-5)9(P/
17. Present Position: -
Maha9 el^
18. Marital Status: //
Marrt eat
19. Name of Spouse: (• ude maiden name if socksable)
Me in of ye
20. Spouse's Date of Birth:
s -/Z -
Place of Binh: - r .:'•...... . _..
Neb.
21. Spouse's residence address, If afferent than yours: (give street end number, city, state, zip)
22. Spouse's Present Employer: (t//
/1---
Occupation.
23, Address of Spouse's Present Employer:
24. List the name(s) of Si relatives working in the liquor industry, give then:
Name of Relative:
Relationship to You:
Position held:
Name of Employer:
Location of Employer.
NOio t____
CONTINUED ON REVERSE SIDE
25. Do you now, or have you ever held a direct or ir.
Li YES [NO
..ct Interest In a State of Colorado Liquor or Beer License. .. "yes; answer in detail.
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 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 M 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 ig NO .
29. Have you ever held a gambling or gaming license or owned a Federal Gambling Stamp? If yea; explain In detail below.
❑ YES gl NO
State/Federal:
Year:
City:
State:
State/Federal:
Year:
City:
State:
30. Military Service: (branch)
From:
To:
Serial No.:
Type of Discharge:
31, Ust as addresses where you have lived for the last five years. (Attach separate sheet if necessary)
Street and Number
City, State, Zip
From:
To:
?3? Slack MO- plt-
L
Love lar, Cfo. OS3SA
'o
539 V. 39 �-it S4:.
bass
32. List all former employers or businesses engaged in within the last live years. (Attach separate sheets If necessar.)
Name of employer:.
L o v Fo o ats
Address: (street, number, city, state, zip)
/boo s, L:iic O1K/ ve lath
Position Held:
Dr ✓er
From:
P/
To:
89
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:
Gary 50,1 -t -Oki
Rf p WQS Gtr Il4lUYi
�( ar PP/ 1
o f kt ,
Love la(n
Love 1 av104
OATH OF APPLICANT
V
I declare under penalty of perjury in the second degree that l have read the foregoing application and all attachments
thereto, and that all informatioi therein is true, correct, and complete to the best of my knowledge.
Singature:
Title:
Date:
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