HomeMy WebLinkAbout972461.tiffRESOLUTION
RE: APPROVE CORPORATE REPORT OF CHANGES FOR METRO OIL COMPANY/
TOTAL PETROLEUM, INC., DBA TOTAL #2748, AND AUTHORIZE CHAIR TO SIGN
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/Total Petroleum, Inc., dba Total #2748, holder of a
Liquor and 3.2 Beer License in Weld County, Colorado, has presented the Board with a
Corporate Report of Changes, and
WHEREAS, said corporate change is as follows: Kenneth K. Eaton replaces David
Bocks as President, Michael D. Russell is named as Vice President, and Harold D. Mallory
replaces David Hackett as Secretary, and
WHEREAS, after study and review, the Board deems it advisable to approve said
corporate report of changes.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of
Weld County, Colorado, that the Corporate Report of Changes submitted by Metro Oil
Company/Total Petroleum, Inc., dba Total #2748, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized
to sign said report.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 26th day of November, A.D., 1997.
ATTEST:
Weld County' tet )t(a)t
i, .
BY-
eputy CI
APPRO
ounty Attorne
Dale K. Hall
BOARD OF COUNTY COMMISSIONERS
WELD c,OUNTY, COLORADO
George'. Baxter, Chair
stance L. Harbert, Pro-Tem
Barbara J. Kirkmeyef O
W. H. Webster
Wtefutc
972461
LC0006
i 8177 (05/97) PAGE 1 •21 i
)LORADO DEPARTMENT OF REVENUE
UOR ENFORCEMENT DIVISION
75 SHERMAN STREET LIMITED LIABILITY COMPANYAND
_NVER CO 80251
D3) 2O5-2100 CORPORATE REPORT OF CHANGES
• _ -- — _-y - Liquor -.and 3.2 Beer Licenses
_ _ ; -�- .. - • Submit to Local Authority (Local Authority -will submit to State)
2355)0.LLC $100 PER MEMBER FOR BACKGROUND INV.
2350)0 CORPORATION .$100 PER 'PRINCIPLE FOR BACKGROUND INV.
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. Corporale/L.L.C. Name 12. State Tax Account Number 13. State Liquor License Number
Metro Oil Co 121-79919 I 21-79919-0047
I. Trade Name
Total #2748-
5. Telephone Number
303/776-7101
>. Address of Licensed Premises I City
3979 Hwy 119 i Longmont
State I ZIP Cooe
CO 1 80501
Mailinc Address it different than atiove City StatI
5590 Havana St. Denver !CO.
ZIP Code
I 80239
>. L1ST.ALL officers. directors (corporation) or Managing Members (L.L.C.). Attach a certificate of designation
(good standing) and each officer, director or manager MUST FILL OUT a DR 8404-I (Individual History Record).
Position Names of ALL Officers,
Held Directors or Managing Members Home" Address I DOE Replaces
Pres. ! Kenneth K. Eaton ' 19206 Birdsong West 112-
Hackett
': San Antonio, TX. 78230
L LIST ALL 10% (or more) Stockholders or 10% (or more) Members. All 10% (or more) stockholders and members
.MUST also fill out DR 8404-1 (individual History Record).
Stockholders/Members % I
-ownina 10% (or more) of business i Owned i Home Address I DOB Replaces _
Total Petroleum, Inc. , 100% 6000 N. Logo 1604 W.
San Antonio. TX. 78249-1112
0. Registered Agent !Address For Service
_
,._.... ..... ,_. _. -. OATH AF APPLIGANT�, '. .._.: ,;,-� .:�,.�..
,_-" I.declare rnder. penalty of penury. in the second..dearee that this.. application.andall attachments
s .:are true, correct, and Complete :f he?bet'of my knawledge —` ` ` ` `'`1'
.....:
, •�
'
"
. h ed Signature rtie �i
'Yl�fj. :i••( ti k .c.a. r � .-C.g,3,-/ (L O C C / / .17 ( e .r' ,-(
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.. REPORT OF LOCAL_ LICENSING AUTHORITY, �.
.--n,' - -- -• The .foregoing changes havetibeen received and examined by the Local Licensing Authority..
12. Local Licensing Autnonty For
,ugnature
utest
Weld Gotknt}i./
(I'
E County fl 7owrtvCity
Chair, Weld County Board
of Commissioners
I Date
Date
11/26/97
r - -,de.ut I 11 26 97
DO NOT WR�j.-f�''T.�' FOR DEPARTMENTOFREVENUE USE ONLY
ILITY'1NFORMATION. .
License Account Number
Period
Cash Fund
-100 (999)
TOTAL
Z4b1
DR 8177 PROTO (95197) Paoe 2
INSTRUCTIONS
LIMITED LIABILITY .COMPANY AND -CORPORATE REPORT OF CHANGES
Do not use this form to reflect.a change in partnership. If there is a change in partnership, you must file a transfer
of ownership with your local licensing authority.
NOTE: If you are a Limited Liability Company (LLC) check box number 2355. Enclose a check payable to the
authority where -this information will be filed, for 5100.00 (for every person listed in the box numbered 2350 and
enclose a check payable to the authority where this information will be filed, for 5100.00 (for every person listed
in sections 6 & 9 on the application).
Attach the following documents to the Report of Cnanges Application:
Li Certificate of Incorporation (or) Date stamped Articles or, if the corporation has been in existence for at
least 2 years, a
Certificate of Good Standing dated within the last two years
E Certificate of Authority (only if a foreign corporation)
NOTE: If the Applicant's sole stockholder is .a corporation or LLC, attach a letter designating one .officer or
member to be the "principal.person"_for-the stockholder. This person MUST ALSO fill out DR 8404-i (Individual
History Record).
This application and all supporting documents must FIRST BE FILED WITH. AND APPROVED BY, THE LOCAL
LICENSING AUTHORITY (CITY, TOWN, COUNTY). Applications will not be accepted unless all applicable
questions are fully answered, all supporting documents correspond exactly with the name of the applicant.
. List the name of the Corporation or Limited Liability Company.
2. List the State Sales Tax Number.
3. List the Applicant's State Liquor License Number.
-4. List the Trade name of the business.
5. List the area code and telephone number of the business.
6. List the complete address, City, State and Zip Code, 'of -the licensed premises.
7. List your mailing address if different than number 6 above.
8. List all officers, directors of a corporation, or all managing members of the LLC, and that persons position,
home address. gate of birth, and the name of the person being replaced (if applicable).
9. List all 10% (or more) stockholders or members and indicate their names, % owned, home address, date
of birth, and the -name of the person they purchased their stock from (if applicable).
10. List the name and address for service of the Registered Aoent.
11. A. person authorized to sign on behalf of the Applicant must sign the application. list their title, and the date
the application was signed.
12. To be filled out by the -local licensing authority only. List the name of the authority and indicate if
the authority is a county, town/city. Then sign the application, list your title.and attest the city/
county officials signature and date the application.
9724€1
DR 8404-1 (02/94)
CCLORADO DEPARTMENT OF REVENUE
LICUOR ENFORCEMENT DIVISION
1375 SHERMAN STREET
DENVER CO 80261
INDIVIDUAL HISTORY RECORD
To be completed by each Individual applicant, all general partners of a partnership, all limited partners owning 10% (or more) of a
partnership; all officers and directors of a corporation, all stockholders of a corporation owning 10% (or more) of the stock of such
corporation; all limited liability company MANAGING members, or other limited liability company members with a 10% (or more)
ownership interest In such company and all managers of a Hotel and Restaurant license.
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 of the applicant.
1. Name of Business
Mptrn Oil Co
2. Your Full Name (last. first, middle)
_Mallory. Harold Darlington
4. Mailing Address (if different from residence)
5590 Havana St. Denver, CO. 80239
5. Residence Address (street and number, city, state, ZIP)
11020 Huebner Oaks #1812 San Antonio, TX. 78230
6. Date of Birth
II Naturalized, state where
N/A
Naturalization Certificate Number
Place of Birth
Tampa Florida
Dale of Certificate
Date
11/4/97
When
Social Security Number(s)
3. Also Known As (maiden name/nickname, etc.)
N/A
Home Telephone
210/558-5747
7. U.S. Citizen?
El Yes ❑ No
Name of U.S. District Court
II an Alien, Give Alien's Registration Card Number
8. Height
5, 8,,
10. Name of Present Employer
Diamond Shamrock Refining & Marketing
12. Address of Business Where Employed (street number, city, state, ZIP)
:+000 N. Loop 1604 W. San Antonio, TX. 78242
•'3, Present Position
Weight
160
Hair Color
Grey
Eye Color
Green
Sex
Male
Race
Caucasian
Permanent Residence Card Number
9. Do You Have a current Driver's License? II yes, give number, 8 state
aX Yes ❑ No
11. Type of Business or Employment
Refining/Marketing
assistant Gpmaral Coun`cel Corp.
ta. Marital Status 15. Name of Spouse (include maiden name it applicable)
Kathryn Elizabeth Mallory ( Campbell )
Married
16. Spouse's Date of Birth Spouse's Place of Birth
Bryan, Texas
17. Spouse's residence address, it different than yours (street and number, city, state, ZIP)
N/A
18. Spouse's Present Employer
Haynes & Boone, L.L.C. Attorneys
19. Address of Spouse's Present Employer
112 E. Pecan, Suite 1600 San Antonio, TX. 78205-1540
20. List the name(s) of all relatives working in or having a financial interest in the liquor industry.
NAME OF RELATIVE RELATIONSHIP TO YOU POSITION HELD NAME OF EMPLOYER LOCATION OF EMPLOYER
Occupation
Attorney
Business Telephone
210/592-2000
N/A
21. Do you now, or have you ever held a State of Colorado Liquor or Beer License, or loaned money, furniture, fixtures, equipment or inventory, to any Colorado Liquor or Beer
Licensee? If yes. answer in detail
O Yes [3 No
972461
- , -----• �........,,.,�._., v, a crlulu, Ur receives a suspended sentence, deferred sentence, or forfeited bail lot any offense in criminal or military court? (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 of drugs or alcoholic beverages.) II yes,
explain in detail.
❑ Yes ❑ No
?3. 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.? II yes, explain in detail.
❑ Yes ® No
?4.
Military Service (branch)
N/A
From
To
Serial Number
Type of Discharge
15.
List all addresses where you have lived for the past five years. (Attach separate sheet if necessary)
STREET AND NUMBER
CITY, STATE, ZIP
FROM
TO
11020 Huebner Oaks #1812
San Antonio, TX. 78230
dresen-
433 College Blvd.
San Antonio, TX. 78209
8/93
402 Encino Ave.
San Antonio, TX. 78209
7/89
8/93
z.
List all former employers or businesses engaged in within the last five years. (Attach separate sheet
if necessary.)
NAME OF EMPLOYER
ADDRESS (STREET, NUMBER, CITY, STATE, ZIP)
POSITION HELD
FROM
TO
Diamond Shamrock Refining & Mktg
6000 N. Loop 1604 W.
San Antonio, TX. 78242
Attorney
12/89
Presen
Norma A.Z.
5340 Alpha Rd. Dallas, TX.
Attorney
1982
7/89
'7. What is your relationship to the applicant? (sole owner, partner, corporate officer, director, stockholder, member or manager)
Corporate Officer
'8. It stockholder, number of shares owned beneficially or of record
N/A
Percent of outstanding stock owned
N/A
9. If partner, state whether 0 General ❑ Limited
N/A
Percent of Partnership Owned
N/A
If Limited Liability Company (percent owned)
N/A
0. Total amount you will invest in this business, including notes, loans, cash, services or equipment, and operating capital. (Reg. 46-106,1 and Peg. 47-107.1)
Amount S N/A
1.
Identify the sources of all funds you will invest in this business as listed in 30 above. List all bank names,
account numbers and the amount derived from such source. Also identify all persons authorized to sign on,
or who are part owners of said account. (Attach copies of all your notes or loans used in or for this business.)
Amounts
' Sources - Account Numbers
Names on accounts or person who can
sign on this account
$ N/A
a
5
S
Oath of Applicant
declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete to the best
li my knowledge.
ithonzed S�—:t%�J7-/444)''------
u'
Title
��� O
Date
///-7A-7_
9724€1
6. Date of Birth
II Naturalized, state where
3 B404-1 (02/94)
'LORADO DEPARTMENT OF REVENUE
)UOR ENFORCEMENT DIVISION
75 SHERMAN STREET
INVER CO 80261
INDIVIDUAL HISTORY RECORD
To be completed by each individual applicant, all general partners of a partnership, all limited partners owning 10% (or more) of a
partnership; all officers and directors of a corporation, all stockholders of a corporation owning 10% (or more) of the stock of such
corporation; all limited liability company MANAGING members, or other limited liability company members with a 10% (or more)
ownership interest In such company and ail managers of a Hotel and Restaurant license.
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 of the applicant.
1. Name of Business Date
Metro Oil Co. 11/4/97
2. Your Full Name (last, first, middle)
Russell, Michael 0.
4. Mailing Address (if different from residence)
5590 Havana St. Denver, CO. 80239
5. Residence Address (street and number, city, state, ZIP)
8526 Alydar Cr. Fair Oakes Ranch, TX. 78015
Place of Birth
Mechanicsburg, PA
N/A
Naturalization Certificate Number
Social Security Number(s)
3. Also Known As (maiden name/nickname, etc.)
N/A
Home Telephone
830/755-9030
When
Date of Certificate
7. U.S. Citizen?
Yes ❑No
Name of U.S. District Court
II an Alien, Give Alien's Registration Card Number Permanent Residence Card Number
8. Height Weight Hair Color
5'11 195 Blond
10. Name of Present Employer
Diamond Shamrock Refining & Marketing
12. Address of Business Where Employed (street number, city, state, ZIP)
6000 N. Loop 1604 W. San Antonio, TX. 78242
13. Present Position
V.P. Retail Operations
14. Marital Status
Eye Color 1 Sex L Race
Blue Male aucasian,
Married
16. Spouse's Date of Birth
9. Do You Have a current Driver's License? It yes, give number, & state
Yes ❑ No
b.&
11. Type of Business or Employment
Refining/Marketing
Business Telephone
210/592-4406
15. Name of Spouse (include maiden name if applicable)
Cherry B. Russell
Spouse's Place of Birth
Troy, N.Y.
17. Spouse's residence address, if different than yours (street and number, city, state, ZIP)
N/A
18. Spouse's Present Employer
N/A
19. Address of Spouse's Present Employer
-N/A
20.
N/A
Occupation
N/A
List the name(s) of all relatives working in or having a financial interest in the liquor industry.
LOCATION OF EMPLOYER
NAME OF RELATIVE
RELATIONSHIP TO YOU
POSITION HELD
NAME OF EMPLOYER
21. Do you now, or have you ever held a State of Colorado Liquor or Beer License. or loaned money, furniture. fixtures, equipment or inventory, to any Colorado Liquor or Beer
Licensee? If yes, answer in detail
Yes E2 No
3404-1 (2194) Page 2
L2.
Have
violations,
explain
■
you ever been convicted of a crime, or received a suspended sentence, deferred sentence, or forfeited bail for any oilense in criminal or military court? (0o not include traffic
unless they resulted in suspension or revocation of your dnvers license, or you were convicted of driving under the influence of drugs or alcoholic beverages.) If yes,
in detail.
Yes ® No
23. 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 ®No
24. Military Service (branch)
N/A
From
To
Serial Number
Type of Discharge
25.
List all addresses where you have lived for the past five years. (Attach separate sheet if necessary)
STREET AND NUMBER
CITY, STATE, ZIP
FROM
TO
8526 Alydar Cr.
Fair Oaks Ranch, TX. 78015
7/97
resen
6000 S. Jamaica Cr.
Englewood, CO. 80111
10/86
7/97
26,
List all former employers or businesses engaged in within the last five years. (Attach separate sheet if necessary.)
NAME OF EMPLOYER
ADDRESS (STREET, NUMBER, CITY, STATE, ZIP)
POSITION HELD
FROM
TO
Same as above
27. What is your relationship to the applicant? (sole owner, partner, corporate officer, director, stockholder, member or manager)
Corporate Officer
28. If stockholder, number of shares owned beneficially or of record
N/A
Percent of outstanding stock owned
N/A
29. if partner, state whether ❑ General ❑ Limited
N/A
Percent of Partnership Owned
N/A
If Limited Liability Company (percent owned)
N/A
30. Total amount you will Invest in this business, including notes, loans, cash, services or equipment, and operating capital. (Reg. 46-106.1 and Reg. 47-107.1)
Amounts N/A
31. Identify the sources of all funds you will invest in this business as listed in 30 above. List all bank names,
account numbers and the amount derived from such source. Also identify all persons authorized to sign on,
or who are part owners of said account. (Attach copies of all your notes or loans used in or for this business.)
Amounts
Sources - Account Numbers
Names on accounts or person who can
sign on this account
N/A
$
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 Signature
;� .�9.:�' -,
Title
V f r -P fyc i. i e*
Date
/// /�
9`44 0i
DR 8404-i (02/94)
:OLORADO DEPARTMENT OF REVENUE
.JCUOR ENFORCEMENT DIVISION
1375 SHERMAN STREET
:ENVER CO 80261
INDIVIDUAL HISTORY RECORD
To be completed by each individual applicant, ail general partners of a partnership, all limited partners owning 10% (or more) of a
partnership; all officers and directors of a corporation, all stockholders of a corporation owning 10% (or more) of the stock of such
corporation; all limited liability company MANAGING members, or other limited liability company members with a 10% (or more)
ownership interest in such company and all managers of a Hotel and Restaurant license.
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 of the applicant.
i. Name of Business
Metro Oil Co
Date
11/4/97
Social Security Number(s)
2. Your Full Name (last, first, middle)
Eaton, Kenneth Kyser
3. Also Known As (maiden name/nickname. etc.)
N/A
4. Mailing Address (it different from residence)
5590 Havana St. Denver, CO. 80239
Home Telephone
210/491-9811
5. Residence Address (street and number, city, state, ZIP)
19206 Birdsong West San Antonio, TX.. 78258
6. Date of Birth
Place of Birth
Orlando, Florida
7. U.S. Citizen?
® Yes ❑ No
if Naturalized, state where
N/A
When
Name of U.S. District Court
Naturalization Certificate Number
Date of Certificate
Ilan Alien, Give Alien's Registration Card Number
Permanent Residence Card Number
8. Height
5'11"
Weight
200
Hair Color
Grey
Eye Color
Brown
Sex
Male
Race
Caucasiaia
9. Do You Have a current
Yes ❑
Driver's License? II yes, give number, & state
No
10. Name of Present Employer
Diamond Shamrock Refining & Marketing
11. Type of Business or
Refining/Marketing
Employment
Business Telephone
'2. Address of Business Where Employed (street number, city, state, ZIP)
i 0000 N. Loon 1604 W. San Antonio, TX.
:3. Present Position
V.P. Retail Operations- East
14. Marital Status
Married
16. Spouse's Oate of Birth
17. Spouse's residence address, if different than yours (street and number, city, state, ZIP)
N/A
18. Spouse's Present Employer
N/A
' 3. Address of Spouse's Present Employer
15. Name of Spouse (include maiden name if applicable)
Mary Elizabeth Eaton ( Fortney )
Spouse's Place of Birth
Enid, Oklahoma
N/A
20.
Occupation
N/A
List the name(s) of all relatives working in or having a financial interest in the liquor industry.
NAME OF RELATIVE
ri/A
RELATIONSHIP TO YOU
POSITION HELD
NAME OF EMPLOYER
LOCATION OF EMPLOYER
21. Do you now, or have you ever held a Slate of Colorado Liquor or Beer License, or loaned money, furniture. fixtures, equipment or inventory, to any Colorado Liquor or Beer
Licensee? If yes, answer in detail
❑ Yes ® No
972461
n nnua•I l ii 4l Page 2
22. Have you ever been convicted of a crime, or received a suspended sentence, deferred 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 drugs or alcoholic beverages.) If yes,
explain in detail.
❑ Yes , No
23. Have you ever received a violation notice, suspension or revocation for a liquor taw violation, or been denied a liquor or beer license anywhere in the U.S.? If
Cl Yesyes, explain in detail.
KA No Note: I am an officer of Texas Corporations which get notices of sales
to minors and other violations of liquor laws.
24. Military Service (branch)
Army
From
To Serial Number
1958 �
Type of Discharge
Honorable
25.
List all addresses where you have lived for the past five years. (Attach separate sheet if necessary)
STREET AND NUMBER
19206 Birdsong West
26.
CITY, STATE. ZIP
San Antonio, TX. 78258
FROM
8/89
TO
Presen
List all former employers or businesses engaged in within the last five years. (Attach separate sheet if necessary.)
NAME OF EMPLOYER
Diamond Shamrock Refining & Mktg
ADDRESS (STREET, NUMBER, CITY, STATE, ZIP)
6000 N. Loop 1604 W.
San Antonio, TX, 78242
POSITION HELD
V.P.
FROM
4/72
TO
Presen
27. What is your relationship to the applicant? (sole owner, partner, corporate officer, director, stockholder, member or manager)
Corporate Officer
28. If stockholder, number of shares owned beneficially or of record
I Percent of outstanding stock owned
N/A
N/A
N/A IIf Limited Liability Company (percent owned)
N/A
30. Total amount you will invest in this business, including notes, loans, cash. services or equipment, and operating capital. (Reg. 46-106.1 and Reg. 47.107.1)
Amount S N/A
29. If partner, state whether
❑ General ❑ Limited Percent at Partnership Owned
N/A
31. Identify the sources of all funds you will invest in this business as listed in 30 above. List all bank names,
account numbers and the amount derived from such source. Also identify all persons authorized to sign on,
or who are part owners of said account. (Attach copies of all your notes or loans used in or for this business.)
Amounts
N/A
Sources - Account Numbers
Names on accounts or person who can
sign on this account
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.
AuthonZed Signature
Title
Date
/1- 7O-77
t
4€ 1
ivJv-c.-1557 12.45
l.L s...V'55k GYFD 5EPIEY LiJ
LLJ LL4: . CL/V:'
STATE OF COLORADO
LIQUOR ENFORCEMENT DIVISION
Department of Revenue
Business Location
1841 Pierce Street • Lakewood, Colorado 80214
Phone 303.205.2300
FAX 303.205.2341
Mailing Address
Liquor Enforcement Division • Denver, Colorado 80261
November 20, 1997
Metro Oil Company
D/B/A Total
PO Box 500
Denver, CO 80201
Re: Chain Store Application for Metro Oil Company, D/B/A Total
Dear Sir or Madam:
Roy Romer
Governor
Renny Fagan
Executive Director
David C. Reitz
Division Direcror
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:
Kenneth K. Eaton DOB
2. Fingerprint cards bearing the names and birth dates of the persons listed in
paragraph 1, above. All the fingerprint cards have been submitted by us to
the Colorado Bureau of Investigation on November 20, 1997. We will advise
by letter of the results from the CBI and FBI.
3. Certificate of Authority or a Certificate of Good Corporate standing from the
Colorado Secretary of State which indicates that Metro Oil Company, D/B/A
Total is a corporation authorized to do business in Colorado.
You must check with the local licensing authority to determine what documents they may
require 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.
DR 8481 (07/0h)
972461
NOV-21-19S? 10:46 CG L:CJOR ENFORCE -._C
Metro Oil Company, D/B/A Total
November 20, 1997
Page 2
Finally, once the local authority has approved your new license or transfer of ownership
application, it must be sent to the Liquor Enforcement Division.
The local authority need not send change of corporate structure
information previously reported to the Liquor Enforcement Division, as
fisted in and approved by this letter.
The only documents which are needed for a new or transfer of
ownership application 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 8442, if managers registration is required.
Sincerely,
Matt D. Cook
Licensing Administrator
metrol .mas
9/'211eA63
NOV-93-1997 10:26
DILL DILL CARR STONBRAKER 393 777 3623 8.02/94
METRO OIL, INC. DENIALS AND VIOLATIONS
NO November 3, 1997
DENIALS TO TOTAL PETROLEUM, INC. (Stockholder of Metro Oil Co., Inc.):
March, 1983 - License denied in Durango based on local needs and desires.
1984 - Two (2) licenses denied in Denver because "Applicant did not have right
to possession of property for intended use."
DENIALS TO METRO OIL CO., INC.:
July, '1987 - License denied in Durango based on local needs and desires.
February, 1989 - License denied in Lakewood due to local ordinance concerning
"500' Rule".
October, 1995 - License denied in Loveland based on local needs and desires.
METRO OIL COMPANY VIOLATIONS:
June, 1990 - Acknowledged a 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.
September, 1990 - Acknowledged a violation of failure to post beer licenses at
7607 East Iliff, Arapahoe County,and paid a $200.00 fine in connection with same
to the Sate Department of Revenue -Liquor Enforcement Division.
October, 1990 - Acknowledged a 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 - Stipulated to one (1) violation of the Colorado Beer Code
(possession of three (3) bottles of wine coolers not labeled as 3.2% alcohol by
weight). License suspension totally held in abeyance.
December, 1991 - Stipulated to one (1) violation of failure to post license at its
store number #2485 - 1794 South Academy Blvd., Colorado Springs, CO.
Licensee paid a minimum fine of $200.00.
January, 1992 - Stipulated to two (2) violations of sale to a person not twenty one
(21) years of age, in connection with a "sting" operation in the City of Thornton,
paid a $900.00 fine, served two (2) days in connection with each violation, all
other penalties held in abeyance.
May, 1992 - Stipulated to one (1) violation of sale to a person not twenty one
years (21) years of age, in connection with a "sting" operation in the City of
Greenwood Village, served three (3) days of suspension with four (4) days held
9724C1
NOV-03-1997 10:27
DILL DILL CARR ST0NBRAKER 303 777 3823 P.03/214
in abeyance.
September, 1992 - Stipulated to two (2) violations of sale to a person not twenty one (21)
years of age, in connection with a "sting" operation in Denver. Ten (10) days assessed,
all suspensions totally held in abeyance for one (1) year.
August, 1993 - Stipulated to one (1) violation of sale to a person not twenty one
(21) years of age in the City of Aurora. A fine of $200 was paid in lieu of
suspension and ten (10) days were held in abeyance for one (1) year.
February, 1994 - Stipulated to one (1) failure to post beer license at a Denver
location, (with State Liquor Enforcement Division), paid a $200 fine in lieu of
actual suspension.
July, 1994 - Stipulated to two (2) violations of sale to a person not twenty one (21)
years of age in the City and County of Denver, in connection with "sting"
operations. A fine of $200 was paid in lieu of suspension for each violation and
twenty (20) days were held in abeyance for one (1) year for each violation.
February, 1995 - Stipulated to one (1) violation of failure to obtain written consent
of Local and State Licensing Authorities prior to modifying the premises in
Thornton, CO. A fine of $450 was paid in lieu of suspension and four (4) days
were held in abeyance for one (1) year.
July, 1995 - Stipulated to one (1) violation of sale to a person not twenty one (21)
years of age, in connection with a "sting" operation in the City of Boulder. One
(1) day served, and two (2) days held in abeyance for one (1) year.
July, 1995 - Stipulated to one (1) violation of sale to a person not twenty one (21)
years of age, in connection with a "sting" operation in the City of Greenwood
Village. Sixty (60) days served.
July, 1995 - Stipulated to one (1) violation of sale to a person not twenty one (21)
years of age, in connection with a "sting" operation in the City of Lakewood. Paid
a fine in lieu of serving two (2) days. Two (2) days held in abeyance for one (1)
year.
September, 1995 - Stipulated to one (1) 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. Three (3) days held in abeyance for one (1) year.
September, 1995 - Stipulated to one (1) violation of sale to a person not twenty
one (21) years of age, in connection with a "sting" operation in the City of
Thornton. Fourteen (14) days served, and seven (7) day held in abeyance for
one (1) year.
November. 1995 - Stipulated to 2 (two) violations of sale to a person not twenty
one (21) for two (2) stores in Aurora, in connection with a sting operation in the
City of Aurora. Served five (5) and three (3) days respectively, at each location.
9724,,C1
N0V-03-1997 10:2?
DILL DILL CRRR. ST0NBRRKER 303 777 3823 x'.04/04
December, 1995 - Stipulated to one (1) violation of sale to a person not twenty
one (21) for one (1) store in Douglas County received fifteen (15) days served,
and fifteen (15) days held in abeyance.
May, 1996 - Stipulated to one (1) violation of sale to a person not twenty one (21)
for one (1) store in Littleton . Received one (1) day suspension.
June, 1996 - Stipulated to one (1) violation of sale to a person not twenty one (21)
years of age in Boulder (#2461). Received a one (1) day suspension with two (2)
days held in abeyance for one (1) year.
September, 1996 - Stipulated to one (1) violation of sale to a person not twenty
one (21) years of age in Thornton (#2730). License suspended for fourteen (14)
days, served seven (7) days, and seven (7) days held in abeyance for one (1)
year.
May, 1997 - Stipulated to one (1) violation of sale to a person not twenty-one (21)
years of age in Arapahoe County (#2496). Thirty (30) days, twenty-five (25) held
in abeyance for one (1) year, and five (5) days suspension served.
K:ti000RTNE'nTOTALM OLATION
TOTAL# 2187
TOTAL # 2327
TOTAL # 2331
TOTAL # 2335
TOTAL # 2361
TOTAL # 2402
TOTAL # 2481
TOTAL # 2485
TOTAL # 2732
TOTAL # 2183
TOTAL# 2184
TOTAL # 2326
TOTAL # 2186
TOTAL # 2737
TOTAL# 2188
TOTAL # 2189
TOTAL # 2192
TOTAL # 2190
TOTAL # 2196
TOTAL # 2320
TOTAL # 2334
TOTAL # 2336
TOTAL # 2337
TOTAL# 2338
TOTAL # 2339
TOTAL # 2355
TOTAL # 2356
TOTAL # 2359
TOTAL # 2366
TOTAL# 2455
TOTAL# 2458
TOTAL # 2498
TOTAL # 2191
TOTAL # 2200
TOTAL # 2300
TOTAL # 2301 3202 E ROAD CLIFTON, CO. 81520
CITY OF COLORADO SPRINGS
302 W. BIJOU COLORADO SPRINGS, CO. 80905
429 S. NEVADA COLORADO SPRINGS, CO. 80903
432 N CIRCLE COLORADO SPRINGS, CO. 80909
3808 E. LASALLE COLORADO SPRINGS, CO. 80909
4295 N. ACADEMY BLVD. COLORADO SPRINGS, CO. 80918
8105 N. ACADEMY BLVD. COLORADO SPRINGS, CO. 80920
5790 CAREFREE CR, COLORADO SPRINGS, CO. 80917
1794 S. ACADEMY BLVD. COLORADO SPRINGS. CO. 80916
3115 SINTON RD. COLORADO SPRINGS, CO. 80907
CITY OF CASTLE ROCK
310 S. WILCOX CASTLE ROCK, CO. 80104
CITY OF WESTMINSTER
505 W. 120TH WESTMINSTER, CO. 80234
8150 N. SHERIDAN WESTMINSTER, CO. 80033
JEFFERSON COUNTY
6800 S. PIERCE LITTLETON, CO. 80123
685 INDIANA AVE. GOLDEN, CO 80401
CITY OF LITTLETON
1599 W. LITTLETON BLVD. LITTLETON, CO. 80120
CITY OF ARVADA
5790 WARD RD. ARVADA, CO. 80002
6802 WADSWORTH ARVADA, CO. 80003
- CITY AND COUNTY OF DENVER
6900 LEETSDALE DENVER, CO. 80224
1945 FEDERAL BLVD. DENVER, CO. 80204
255 SPEER BLVD. DENVER, CO. 80203
5455 E. COLFAX AVE. DENVER, CO. 80220
1401 S. FEDERAL BLVD. DENVER, CO. 80219
1001 BROADWAY DENVER, CO. 80203
7045 E. HAMPDEN DENVER, CO. 80224
2210 5. COLORADO BLVD. DENVER, CO. 80222
330 5. KALAMATH DENVER, CO. 80223
3490 COLORADO BLVD. DENVER CO. 80205
3860 PEORIA DENVER, CO. 80239
5301 E. YALE DENVER, CO. 80222
4490 S. KIPLING DENVER, CO. 80123
300 S. DOWNING DENVER, CO. 80209
8500 W. CRESTLINE DENVER, CO. 80123
CITY OF GOLDEN
300 WEST STREET GOLDEN, CO. 80401
CITY OF COMMERCE CITY
5601 QUEBEC COMMERCE CITY, CO. 80022
CITY OF GRAND JUNCTION
599 29 1/2 RD. GRAND JUNCTION, CC. 81501
MESA COUNTY
LOCALADD
719-630-7855
719-635-5781
719-633-2962
719-596-5673
719-598.5214
719-264-0991
719-637-9513
719-597-3492
719-630.7920
303-688-2090
303-280-0919
303-426-6241
303-932-8708
303-279-8777
303-730-8350
302-425-1570
303-423-7755
303-388-2874
303-480-5388
303-863-7576
303-388-2307
303-922-3379
303-892-0174
303-756-4061
303-756-8611
303-777-0611
303-333-2371
303-373-1620
303-756-7400
303-933-2078
303-698-1834
303-933-2076
303-279-4783
303-288-2060
970-241-6005
970-434-6427
#21-79919-0070
#21-79919-0009
#21-79919-0083
#21-79919-0010
#21-79919-0033
#21-79919-0086
#21-79919-0032
#21-79919-0038
#21-79919-0043
#21-79919-0087
#21-79919-0069
#21-79919-0039
#21-79919-0076
#21-79919-0059
#21-79919-0074
#21-79919-0073
#21-79919-0072
#21-79919-0077
#21-79919-0075
#21-79919-0062
#21-79919-0027
#21-79919-0030
#21-79919-0016
#21-79919-0018
#21-79919-0028
#21-79919-0014
#21-79919-0029
#21-79919-0015
#21-79919-0001
#21-79919-0024
#21-79919-0049
#21-79919-0002
#21-79919-0071
#21-79919-0088
#21-79919-0066
#21-79919-0067
Pace 1
9724f 1
TOTAL # 2305
TOTAL # 2322
TOTAL # 2468
TOTAL# 2484
TOTAL# 2736
TOTAL# 2329
TOTAL# 2738
TOTAL# 2341
TOTAL# 2462
TOTAL # 2344
TOTAL # 2348
TOTAL # 2735
TOTAL # 2345
TOTAL # 2347
TOTAL # 2349
TOTAL # 2358
TOTAL# 2351
TOTAL# 2353
TOTAL # 2380
TOTAL # 2362
TOTAL # 2363
TOTAL# 2730
TOTAL # 2364
TOTAL # 2369
TOTAL# 2448
TOTAL # 2452
TOTAL # 2487
TOTAL # 2622
TOTAL # 2623
CITY OF AURORA
1101 S. BUCKLEY RD. AURORA, CO. 80017
12796 E. COLFAX AVE. AURORA, CO. 80011
1190 S. CHAMBERS RD. AURORA, CO. 80017
2639 S. PARKER RD. AURORA, CO. 80014
3790 N. CHAMBERS RD. AURORA, CO. 80011
EL PASO COUNTY
205 MAIN ST. SECURITY, CO. 80911
1310 W. BAPTIST RD. MONUMENT, CO. 80132
DOUGLAS COUNTY
506 CASTLE PINES PKWY CASTLE ROCK, CO. 80104
2020 COUNTY LINE RD. HIGHLANDS RANCH, CO. 80126
ADAMS COUNTY
7285 N. PECOS WESTMINSTER, CO. 80221
6140 FEDERAL BLVD. DENVER, CO. 80221
5810 N. BROADWAY DENVER, CO. 80216
CITY OF LAKEWOOD
715 WADSWORTH LAKEWOOD, CO. 80215
CITY OF LOVELAND
1401 S. LINCOLN LOVELAND, CO. 80537
CITY OF WHEATRIDGE
6601 W 44TH AVE WHEATRIDGE, CO. 80033
12300 W. 44TH AVE WHEATRIDGE, CO. 80033
TOWN OF PARKER
19302 E. P1 A7A DR. PARKER, CO. 80134
CITY OF ENGLEWOOD
4596 S. BROADWAY ENGLEWOOD, CO. 80110
CITY OF GLENWOOD SPRINGS
2119 GRAND AVE. GLENWOOD SPRINGS, CO. 81601
CITY OF FEDERAL HEIGHTS
801 W. 84TH FEDERAL HEIGHTS, CO. 80221
CITY OF THORNTON
410 E. 104TH THORNTON, CO. 80229
8801 N. WASHINGTON THORNTON, CO. 80229
CITY OF GREENWOOD VILLAGE
7296 E. BELLEVIEW ENGLEWOOD, CO. 80110
CITY OF FORT COLLINS
803 RIVERSIDE FORT COLLINS, CO. 80524
4701 S. LEMAY FORT COLLINS, CO. 80525
2501 S. SHIELDS FORT COLLINS, CO. 80525
2025 S. COLLEGE FORT COLLINS, CO. 80525
200 W. HORSETOOTH FORT COLLINS, CO. 80525
221 W. PROSPECT FORT COLLINS, CO. 80526
LOCALADD
303-743-9575
303-366-3607
303-751-1129
303-671-8319
303-344-3810
#21-79919-0078
#21-79919-0058
#21-79919-0023
#21-79919-0065
#21-79919-0052
719-392-4547 #21-79919-0011
719-481-3110 #21-79919-0048
303-688-2220 #21-79919-0064
303-730-0948 #21-79919-0061
303-429-7515 #21-79919-0019
303-428-7818 #21-79919-0013
303-294-9068 #21-79919-0046
303-237-7493
303-669-0435
303-421-2835
303-423-7321
303-840-2115
303-789-0649
970-945-8419
303-427-4963
303-452-4531
303-288-5419
303-770-6190
970-482-0302'
970-204-4524
970-416-5718
970-482-9235
970-223-7107
970-484-3451
#21-79919-0021
#21-79919-0007
#21-79919-0020
#21-79919-0004
#21-79919-0068
#21-79919-0017
#21-79919-0008
#21-79919-0003
#21-79919-0026
#21-79919-0057
#21-79919-0005
#21-79919-0036
#21-79919-0084
#21.79919-0085
#21-79919-0034
#21-79919-0035
#21-79919-0006
Page 2
9724€
TOTAL # 2456
TOTAL # 2457
TOTAL# 2459
TOTAL# 2461
TOTAL# 2621
TOTAL # 2463
TOTAL# 2496
TOTAL # 2499
TOTAL # 2747
TOTAL # 2733
TOTAL # 2734
TOTAL # 2744
TOWN OF SILVERTHORNE
180 STEPHENS WAY SILVERTHORNE, CC. 80498
CITY OF LONGMONT
902 MAIN STREET LONGMONT, CO. 80501
CITY OF BOULDER
5340 ARAPAHOE BOULDER, CO. 80303
2995 28TH STREET BOULDER, CO. 80301
1884 FOLSOM ST. BOULDER, CO. 80302
ARAPAHOE COUNTY
5171 E. ARAPAHOE RD. LITTLETON, CO. 80122
8263 S. QUEBEC ENGLEWOOD, CO. 80112
7607 E. ILIFF DENVER, CO. 80231
1495 MANILLA RD. BENNETT, CO. 80102
CITY OF PUEBLO
601 HWY 50 PUEBLO, CO. 81002
3201 LAKE AVE. PUEBLO, CO. 81002
300 W. NORTHERN PUEBLO, CO. 81002
CITY OF GUNNISON
TOTAL # 2739 134 E. TOMICHI GUNNISON, CO. 81230
CITY OF FORT MORGAN
TOTAL # 2740 1305 N MAIN FORT MORGAN, CO. 80701
TOWN OF GEORGETOWN
TOTAL # 2741 1501 ARGENTINE GEORGETOWN, CO. 80444
CITY OF FORT LUPTON
TOTAL # 2742 101 DENVER AVE. FORT LUPTON, CO. 80621
TOTAL # 2743 6150 E. HWY 34 LOVELSND, CO. 80537
WELD COUNTY
TOTAL # 2748 3979 HWY 119 LONGMONT, CO. 80501
PUEBLO COUNTY
TOTAL # 2884 I-25 8 CROW JCT. COLORADO CITY, CO. 81019
LARIMER COUNTY
LO CALADD
970-468-7719 #21-79919-0037
303-772-4904 #21-79919-0080
303-440-0113 #21-79919-0081
303-442-0224 #21-79919-0031
303-443-6455 #21-79919-0012
303-721-9187
303-721-0980
303-755-3878
303-644-3488
#21 -79919-0060
#21-79919-0025
#21-79919.0022
#21-79919-0054
719-545-9709 #21-79919-0053
719-561-4619 #21-79919-0051
719-561-1146 #21-79919-0050
970-641-3497
970-867-3856
970-674-0635
303-857-6066
970-663-7653
303-776-7101
719-676-3367
#21-79919-0044
#21-79919-0055
#21-79919-0056
#21-79919-0045
#21-79919-0040
#21-79919-0047
#21-79919-0063
9'721
NM _ rg
TOTAL
Total Petroleum, Inc.
, ROCKY MOUNTAIN RETAIL DIVISION
5590 HAVANA STREET
DENVER, COLORADO 80239-2005
November 13,1997
Department of Revenue
Attention: Sabrina
Liquor Enforcement Division'
1881 Pierce Street
Lakewood, CO. 80214
Re: MASTER FILE LETTER UPDATE
METRO OIL CO
Dear Sabrina,
TELEPHONE 303 373-6000
Enclosed herein please find application materials for a Corporate Report of Changes for the
above referenced application. As is standard procedure, we will be filing Individual Corporate
Report of Changes with each local authority, but ask that you modify the State Master File Letter.
As reflected on the enclosed application, we are reporting three (3) new officers for Metro Oil Co.
We, too, wish to request issuance of a "Preliminary Master File Letter" which will be included with
each packet sent to the local authorities.
Thank you for your assistance with this matter. Should you have any questions whatsoever,
please do not hesitate to contact me at 373-6024.
Regards,
C2-7
Tanya Leist
License Administrator
-1
9724C1
UNANIMOUS CONSENT OF THE DIRECTORS OF
METRO OIL CO.
TO ACT WITHOUT A MEETING
THE UNDERSIGNED, being all of the Directors of the above named corporation, do hereby
unanimously consent that the following resolutions shall be adopted, effective September 25, 1997, to the
same extent and to have the same force and effect as if adopted at a formal meeting of the Board of Directors
of said corporation duly called and held for the purpose of duly acting upon the resolutions of said corporation.
WHEREAS the resignations of David M. Books, as President ,and of David E. Hackett , as Secretary
and Treasurer, have been accepted; it is therefore
RESOLVED, that the following persons are hereby elected and appointed as Officers of the
corporation to serve until their respective successors are elected at the next annual meeting of the Board of
Directors:
K. K. Eaton
Michael Russell
Harold D. Mallory
President
Vice President, Assistant Secretary, and Assistant Treasurer
Secretary and Treasurer
FURTHER RESOLVED that the salaries, if any, to be payable to the officers, be deferred until a later
meeting of the Board of Directors.
DATED this 25th day of September, 1997.
'zt%Ae F
Michael Russell
97241'1
UNANIMOUS CONSENT OF THE SHAREHOLDER OF
METRO OIL CO.
TO ACT WITHOUT A MEETING
The undersigned, being the sole shareholder of the above -named corporation, does hereby consent
that the following resolution shall be deemed to be adopted, effective September 25, 1997, to the same extent
and to have the same force and effect as if adopted at a formal meeting of the shareholder of said corporation
duly called and held upon such date for the purpose of duly acting upon the resolutions of said shareholder.
WHEREAS the resignations of David M. Backs and David E. Hackett , as members of the board of
directors, have been accepted; it is therefore
RESOLVED that Harold D. Mallory, K. K. Eaton, and Michael Russell are unanimously elected
Directors of the corporation for the ensuing year.
DATED this 25th day of September, 1997.
TOTAL PETROLEUM, INC.
By: 1-4U
Vice President
,zo„t
972f 1
STAI'E'RADO
8
7
DEPARTMENT OF
STATE
CERIi1kICAI E
I, VICTORIA BUCKLEY, Secretary of State of the State of
Colorado hereby certify that
According to the records of this office
METRO OIL CO., INC.
(MICHIGAN CORPORATION)
file # 19871646843 was filed in this office on November 25, 1985
and 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: February 11, 1997
l/ C GiLait LRJ -t C C
SECRETARY OF STATE
e
9724C1
STATE L RADO
DEPARTMENT OF
STATE
CERI lt{ICATE
I, VICTORIA BUCKLEY, Secretary of State of the State of
Colorado hereby certify that
According to the records of this office
TOTAL PETROLEUM, INC.
(MICHIGAN CORPORATION)
file # 19871062952 was filed in this office on June 13, 1974
and 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: February 11, 1997
SECRETARY OF STATE
9%244'1
Ultramar Diamond Shamrock Corporation
i
3007152 Nova Scotia Company
1
Total Petroleum (North America) Ltd.
i
Total Petroleum, Inc.
i
Metro Oil Co.
972401
CBRTIFICATE OF AUTHORITY
STATE OF TEXAS §
COUNTY OF BEXAR §
I, HAROLD D. MALLORY, Secretary of METRO OIL CO. do hereby
certify that TANYA LEIST has been directed to and has the authority
to renew and file change of officer applications for all 3.2% Beer
Off Premises licenses for METRO OIL CO. in the State of Colorado,
and deliver on behalf of METRO OIL CO. all such other instruments
and documents as she may deem necessary or appropriate in
connection with the foregoing.
IN WITNESS WHEREOF, I have set my hand this the 2-02 day of
October, 1997.
19ryHAR LD D. MAL RY, Secretary
SUBSCRIBED AND SWORN TO BEFORE ME this Al day of October,
1997 by HAROLD D. MALLORY, Secretary of METRO OIL CO., on behalf of
said corporation.
NANCY L. PEELER
fptrp Put Snits of Thus
Yt Can a tfon Those 08/12/99
Notary /Public, State of Texas
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CO
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CO
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P 387 472 206
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED
NOT FOR INTERNATIONAL MAIL
(See Reverse)
Ser
str,Colorado Dept. Of Revenue
Liquor Enforcement Div.
P 01375 Sherman Street
Denver, CO 80261
POE
Cer
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
Postmark or Date
m ..•
_20
onal services.
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DOMESTIC RETURN RECEIPT
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9724471
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