HomeMy WebLinkAbout982243.tiffRESOLUTION
RE: APPROVE CHANGE OF OWNERSHIP REQUEST FOR 3.2 PERCENT BEER LICENSE
FROM LINDA FANGMEIER, DBA OUR LITTLE STORE
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, Linda Fangmeier, dba Our Little Store, has presented to the Board of
County Commissioners of Weld County, Colorado, an application for a Change of Ownership of
a County Retail License for the sale of fermented malt beverages, containing not more than
3.2% of alcohol by weight, in sealed containers not for consumption at the place where sold,
said license previously held by Ken's Market, Inc., dba Our Little Store, 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 3.2% fermented
malt beverages in sealed containers not for consumption at the place where sold, outside the
corporate limits of any town or city in the County of Weld at the location described as follows:
4821 Yellowstone Drive, Greeley, Colorado 80634
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 98-10 to said applicant to sell 3.2% fermented
malt beverages in sealed containers not for consumption at the place where sold, only at retail at
said location and does hereby authorize and direct the issuance of said license by the Chair of
the Board of County Commissioners, attested to by the Clerk to the Board of Weld County,
Colorado, which license shall be in effect until providing that said place where the licensee is
authorized to sell 3.2% fermented malt beverages in sealed containers not for consumption at
the place where sold, shall be conducted in strict conformity to all of the laws of the State of
Colorado and the rules and regulations relating thereto, heretofore passed by the Board of
County Commissioners of Weld County, Colorado, and any violations thereof shall be cause for
revocation of the license.
e6: SO, dpi.
982243
LC0021
CHANGE OWNERSHIP OF 3.2% BEER LICENSE - OUR LITTLE STORE
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 18th day of November, A.D., 1998.
ATTEST:
Weld County Clerk to
BY:
Deputy Clerk to t
ounty Atto
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
Constance L. r rt, Chair
I!� k.21n13`o
W. H. 4Zebster, rq�Tem
eorge E. Baxter
Dale K. Ha
EXCUSED
Barbara J. Kirkmeyer
982243
LC0021
SOLD HERE
ONLY 3.2% B
THIS LICENSE EXPIRES
THIS LICENSE MUST BE POSTED IN PUBLIC VIEW
'll
DR 8402
L-qlc,—titlG
1101921
STATE
DEPARTMENT
ALCOHOLIC
OF COLORADO
OF REVENUE
Liquor Enforcement Division
1 375 Sherman Street
Denver, Colorado 80261
FANGMEIER LINDA A
OUR LITTLE STORE
4821 YELLOWSTONE DR
GREELEY CO 80634-9119
BEVERAGE LICENSE
Account Number
Liability Information
LICENSE EXPIRES AT MIDNIGHT
;County City Indust. Type Liability Date
24-91662-0000 I 03 206 5411 I 120198
NOV 30, 1999
Type IName and Description of License
Fee
2122
2190
3.2 PERCENT BEER RETAIL
LICENSE (OFF PREMISES)
COUNTY 85 PERCENT OAP FEE
$ 50.00
$ 42.50
TOTAL FEEISI
This license is issued subject to the laws of the State of Colorado and especially
provision of Title 12, Articles 46 or 47, CRS 1973, as amended.
nontransferable and shall be conspicuously posted in the place above described.
only valid through the expiration date shown above. Questions concerning
be addressed to the Department of Revenue, Liquor Enforcement Division,
Street, Denver, CO 80261. .
testimony whereof, I have hereunto set my hand.
M.M.K. 1/414/t14
DEC 0 3 199D
Division Director (/ Executive
$ 92.50
under the
This license is
This license is
this license should
1375 Sherman
el
Director
CdAAJC4e. or Oc_JA)e-e> i"
DR 8404 (06/97) Page 1 21
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION COLORADO LIQUOR
1375 SHERMAN STREET OR 3.2% FERMENTED MALT BEVERAGE
DENVER CO 80261
RETAIL LICENSE APPLICATION
vr�1.t_eta 4O
3-fra-it
I I�1 q /9?
DO NOT WRITE IN THIS SPACE
❑ NEW LICENSE Q TRANSFER OF OWNERSHIP ❑ LICENSE RENEWAL
• ALL ANSWERS MUST BE PRINTED IN BLACK INK OR TYPEWRITTEN
• APPLICANT MUST CHECK THE APPROPRIATE BOX(ES)
• LOCAL LICENSE FEE $
• APPLICANT SHOULD OBTAIN A COPY OF THE COLORADO LIQUOR AND BEER CODE (Call 303-321-4164)
1.
Applicant
a
S
is applying as a
Corporation
Partnership (includes Limited Liability and Husband and Wife Partnerships)
❑
In
Individual
Limited Liability Company
Association or Other
2. Name of Applicant(s) If partnership, list partners' names (at least two); if corporation, name of corporation
1{" Jgel /7 /7, (19119' 77"e/c,<
2a.Trade Name of Establishment (f3BA)
KC(//:.L,'/j/-t' _Sftf2_e
State Sales Tax No. .)
.7y.%/644
Business Telephone
C7.7C) 3$et- 5...2C`.4
3. Address of Premises (specify exact location of premises
;LiCity
.
r
County
State
ZIP Code
_,
4. Mailing Address (Number and Street)
_? ,�(/ /C.'(...1 _3L1/N
City,or Town
XI' -1.1x_7
State
UG
ZIP Code
5'e'4,cfLI
5. If the premises currently have a liquor or beer license, you MUST answer the following questions:
Present Trade / Name of Establishment (DBA)
C'ui: I, /tic k/r. t.
Present State License No.
23.2,`/--7`�CGrci
Present Class of License
),1)).
Present Expiration Date
1777 /C', /L/'%j'
SECTION A APPLECATION FEES
LIAR
1940
1940
1950
1950
1960
1960
,1970;
1980
2010
<2020.
2040
1905
1.975
SECTION a LIQUOR LICENSE' ES'.
2360
2300
2300
2310
• Late Renewal Application Fee $500.00
■ Application Fee for New License 650.00
❑ Application Fee -New License Concurrent Review 750.00
Application Fee for Transfer of Ownership 650.00
❑ Retail Liquor Store License (city) $202.50
❑ Retail Liquor Store License (county) 287.50
❑ Liquor Licensed Drugstore (city) 202.50
❑ Liquor Licensed Drugstore (county) 287.50
❑ Beer & Wine License (city) 326.25
❑ Beer & Wine License (county) 411.25
❑ H & R License • city ■ county 475.00
❑ H & R License w/opt Prem ■ city Li county 475.00
❑ Club License ❑ city ■ county 283.75
❑ Tavern License • city ■ county 475.00
❑ Arts License ❑ city • county 283.75
❑ Racetrack License Elcity ■ county 475.00
❑ Optional Premises License ❑ city ❑ county 475.00
❑ Retail Gaming Tavern Lic ■ city • county 475.00
Ii Brew -Pub License 725.00
❑ Other
SECTION B 3.2%BEER LICENSE.FEES
2121
2121
2122
2122
2123
2123
❑ Retail 3.2% Beer On Premises - (city) $71.25
❑ Retail 3.2% Beer On Premises - (county) 92.50
• Retail 3.2% Beer Off Premises - (city) 71.25
5i1 Retail 3.2% Beer Off Premises - (county) 92.50
❑ Retail 3.2% Beer On/Off Premises - (city) 71.25
• Retail 3.2% Beer On/Off Premises - (county) 92.50
SECTION C '. RELATEQ FEES AND PERMITS2030
2210-100 (999) ■ Retail Warehouse Storage Permit $75.00
1980-100 (999) ■ Addition of Optional Premises to existing hotel/restaurant
$75.00 x Total Fee
1970-750 (999) ❑ Manager's Registration (hotel & restaurant only) $75.00
No Fee • 3.2% Beer On/Off Premises Only Delivery Permit
No Fee ❑ Retail Liquor Store Delivery Permit
DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY
LIABILITY INFORMATION
County
City
Industry Type
License Issued Through
(Expiration Date)
License Account Number
Liability Date
State
-750(999)
City
218D-100 (999)
County
2190.1D0(999)
Managers Reg.
1970-750(999)
Cash Fund New License
2300-100
(999)
Cash Fund Transfer License
2310-100
(999)
TOTAL
A
DR 8404 (06/97) Page 2
APPLICATION DOCUMENTS
CHECKLIST AND WORKSHEET
instructions: This check list should be utilized to assist applicants with filing all required documents for licensure. All documents must
be properly signed and correspond with the name of the applicant exactly. All documents must be typed or legibly printed. Upon final State
approval the license will be mailed to the local licensing authority.
ITEMS SUBMITTED, PLEASE CHECK ALL APPROPRIATE BOXES COMPLETED OR DOCUMENTS SUBMITTED
I.
APPLICANT INFORMATION
❑ A. Applicant/Licensee identified.
❑ B. State sales tax license number listed or applied for at time of application.
• C. License type or other transaction identified.
• D. Return original & 2 copies to local authority.
■ E. Additional information may be required by the local licensing authority.
II.
DIAGRAM OF THE PREMISES
• A. No larger than 8 1/2" X 11".
❑ B. Dimensions included (doesn't have to be to scale). Exterior areas should show control (fences, walls, etc.).
❑ C. Separate diagram for each floor (if multiple levels).
❑ D. Kitchen - identified if Hotel and Restaurant.
III.
PROOF OF PROPERTY POSSESSION
❑ A. Deed in name of the Applicant ONLY (or)
• B. Lease in the name of the Applicant ONLY.
❑ C. Lease Assignment in the name of the Applicant (ONLY) with proper consent from the Landlord and acceptance by the Applicant.
❑ D. Other Agreement if not deed or lease.
IV.
BACKGROUND INFORMATION AND FINANCIAL DOCUMENTS
■ A. Individual History Record(s) (Form DR 8404-1).
❑ B. Fingerprints taken and submitted to local authority. (State authority for master file applicants.)
■ C. Purchase agreement, stock transfer agreement, and or authorization to transfer license.
• D. List of all notes and loans.
V.
CORPORATE APPLICANT INFORMATION (If Applicable)
• A. Certificate of Incorporation (and/or)
■ B. Certificate of Good Standing if incorporated more than 2 years ago.
• C. Certificate of Authorization if foreign corporation.
• D. List of officers, directors and stockholders of parent corporation (designate 1 person as "principal officer").
VI.
PARTNERSHIP APPLICANT INFORMATION (If Applicable)
A. Partnership Agreement (general or limited). Not needed if husband and wife.
VII.
LIMITED LIABILITY COMPANY APPLICANT INFORMATION (If Applicable)
Ix
■ A. Copy of articles of organization (date stamped by Colorado Secretary of State's Office).
■ B. Copy of operating agreement.
❑ C. Certificate of Authority (if foreign company).
VIII.
MANAGER REGISTRATION FOR HOTEL AND RESTAURANT LICENSES WHEN INCLUDED WITH THIS APPLICATION
• A. $75.00 fee.
❑ B. Individual History Record (DR 8404-I).
DR 8404'06/97) Page 3
6. Is the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or
holders or directors if a corporation) or manager under the age of twenty-one years?
officers, stock- Yes No
■
El
7. Has the applicant (including any of the partners, if a partnership; members or manager if a limited liability company;
stockholders or directors if a corporation) or manager ever (in Colorado or any other state);
(a) been denied an alcoholic beverage license?
(b) had an alcoholic beverage license suspended or revoked?
(c) had interest in another entity that had an alcoholic beverage license suspended or revoked?
you answered yes to 7a, b or c, explain in detail on a separate sheet.
or officers,
❑ CI
■ El
x-4
❑ ti-
8a. Has a liquor license application (same license class), that was located within 500 feet of the proposed premises, been denied within the
preceding two years? If "yes," explain in detail.
8b. Has a 3.2 beer license for the premises to be licensed been denied within the preceding one year? if "yes," explain in detail.
❑ .1
❑ r
9. Are the premises to be licensed within 500 feet of any public or private school that meets compulsory education requirements of ❑ El
Colorado law, or the principal campus of any college, university or seminary?
10. Has a liquor or beer license ever been issued to the applicant (including any of the partners, if a partnership; members or manager if a
limited liability company; or officers, stockholders or directors if a corporation)? If yes, identify the name of the business and list any ❑
current financial interest in said business including any loans to or from a licensee.
11.
a.
Attach
and
Does the Applicant, as listed on line 2 of this application,
this license will be issued by virtue of ownership,
lease
in
of
have legal possession of the premises for at least 1 year from the date that
or other arrangement?
Detail)
® O
• Ownership Lease ❑ Other (Explain
If leased, list name of landlord and tenant, and date
expiration, EXACTLY as they appear on the lease:
Landlord
�(',rlceAi4.11eK., L'11�: Apt11,1. L•i-rf.
Tenant
1-Inear. Fri Ill .,.ic.,,.•r
Expires
%/ft�% C'c':
a diagram and outline the area to be licensed (including dimensions) which shows the bars, brewery, walls, partitions, entrances, exits
what each room shall be utilized for in this business. This diagram should be no larger than 8 1/2" X 11". (Doesn't have to be to scale)
12. Who, besides the owners listed in this application (including persons, firms, partnerships, corporations, limited liability companies),
will loan or give money, inventory, furniture or equipment to or for use in this business; or who will receive money from this business.
Attach a separate sheet if necessary.
NAME
DATE OF BIRTH
FEIN OR SSN
INTEREST
is i /r' .1ir l'', "J" / %";',; / f ,:
. '
Attach copies of all notes and security instrurrre'Wnd any written agreement, or details of any oral agreement, by which
any person (including partnerships, corporations, limited liability companies, etc.) 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.
13.E Optional Premises or Hotel and Restaurant Licenses
A local ordinance or resolution authorizing optional
Number of separate Optional Premises areas requested.
with Optional Premises
premises has been adopted.
Yes No
■ 21
14. Liquor Licensed Drug Store applicants, answer the following:
(a) Does the applicant for a Liquor Licensed Drug Store have a license issued by the Colorado Board of
;' Pharmacy? COPY MUST BE ATTACHED.
Yes No
■ IN
15.
.,
Club Liquor License applicants answer the following
i'C (a) Is the applicant organization operated solely
., not for pecuniary gain?
(b) Is the applicant organization a regularly
operated solely for the object of a patriotic
(c) How long has the club been incorporated?
(Three years required)
and attach:
for a national, social, fraternal, patriotic, political or athletic purpose
chartered branch, lodge or chapter of a national organization which
or fraternal organization or society, but not for pecuniary gain?
(d) How long has applicant occupied the premises
to be licensed as a club? (Three years required)
and
is
❑ O
❑ ■
16. ; Brew -Pub License Applicants answer the following:
`'r. (a) Has the applicant received or applied for a Federal Brewers Notice?
(Copy of notice or application must be attached)
• ■
17a.
17b.
Name of Manager 1': ,`I:.c;.'' ,-,- -'(If this is an application for a
9 � z PP
Hotel
number.
Date of Birth ' Hotel & Restr.
eLic.
Yes No
and Restaurant License, the manager must also submit an Individual History Record (DR 8404-I).
Does this manager act as the manager of, or have a financial interest in, any other liquor
licensed establishment in the State of Colorado? If yes, provide name, type of license and account
■ El
Yes No
❑ m
18. Tax Distraint Information. Does the applicant or any other person listed on this application and including its partners, officers,
directors, stockholders, members (LLC) or managing members (LLC) and any other persons with a 10% or greater financial interest
in the applicant currently have an outstanding tax distraint issued to them by the Colorado Department of Revenue?
If yes, provide an explanation and include copies of any payment agreements.
Yes No
■ IN
DR 8404 (06/97) Page 4
19. If applicant is a corporation, partnership, association or a limited liability company, it is required to list by position all officers and directors,
r general partners, managing members, all stockholders, partners (including limited partners) and members who have a 10% or greater
T. financial interest in the applicant. All persons listed here or by attachment must submit and attach a DR 8404-1 (Individual History Record)
and provide fingerprint cards to their local licensing authority.
NAME
HOME ADDRESS, CITY & STATE
DATE OF
BIRTH
POSITION
% OWNED
Additional Documents to be submitted by type of entity
❑ CORPORATION ❑ Cert. of Incorp. ❑ Cert. of Good Standing (if more than 2 yrs. old) ❑ Cert. of Auth. (if a foreign corp.)
E PARTNERSHIP O Partnership Agreement (General or Limited) 0 Husband and Wife partnership (no written agreement)
❑ LIMITED LIABILITY COMPANY ❑ Articles of Organization ❑ Cert. of Authority (if foreign company) ❑ Operating Agrmt.
❑ ASSOCIATION OR OTHER Attach copy of agreements creating association or relationship between the parties
Registered Agent (if applicable)
Address for Service
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. 1 also acknowledge that it is my responsibility and the responsibility of my agents and employees
to comply with the provisions of the Colorado Liquor or Beer Code which affect my license.
Authorized Signature
r' -/•t L. ,. /'•'.....LL'<c --
Title
O' et• /tc' 1,
Date
///y1/ `;'Y'
1///;?/
REPORT AND APPROVAL OF LOCAL LICENSING AUTHORITY (CITY/COUNTY)
Date application filed with local authority
Date of local authority hearing (for new license applicants; cannot be less
than 30 days from date of application 12-47-311 (1)) C.R.S.
Each person required to file DR 8404-I: Yes
a. Has been fingerprinted
b. Background investigation and NCIC and CCIC check for outstanding warrants conducted
c. The liquor licensed premises is ready for occupancy and has been inspected by the Local Licensing Authority.
If "no", the building will be completed and ready for inspection by
a
ili
IM
No
MI
El
II
(date)
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 adult inhabitants,
and will comply with the provisions of Title 12, Article 46 or 47, C.R.S. THEREFORE, THIS APPLICATION IS APPROVED.
r
Local Licensing Authority for , r^ ~
Weld Coun mot. . _ :'• + �
Telephone Number
970) 356-4000
li
TOWN, CITY
COUNTY
Signatur. - }
' �; l ;
�, '' `,,.
TAtte '•
,rro't.ertL''iChair, Weld County Board
`i:6 O'ammtissioner•s
Date
11/18/98
Signature : tt St / - t.,
„r,i�I l , ,
i
`' ,..t< U "�.:24 c Deputy
Date
11/18/98
If premises are located within a town or i ctil.4hpr..aPiif-dVaestiould be signed by the mayor and clerk, if in a county, then by the chairman
of the board of county commissioners and the IdhoytL Y If, by ordinance or otherwise, the local licensing authority is some other official,
then such approval should be given by such officiaaf:--r
R 8404-I (02/94)
COLORADO DEPARTMENT OF REVENUE
LIQUOR 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
Date
Social Security Number(s)
2. Your Full Name (last, first, middle)
// / .
�^%`4 / i ci t11:I El i /,:l. / L / /l G - f • _
3. Also Known As (maiden name/nickname, etc.)
i1
14 ei / Le -./-t;
4. Mailing Address {if different from residence)
Home Telephone
5. Residence Address (street and number, city, state, ZIP)
6. Date of Birth
_.:� _. !
Place of Birth
f��,4,/( i r f-_ 't.!„
7. U.S. Citizen?
Yes ❑ No
If Naturalized, state where
)) li.
When
):1
Name of U.S. District Court
�.1C..
Naturalization Certificate Number
Date of Certii)
Han an Alien, Giv7e Alien's Registration Card Number
Permanent Residence Card Number
8. Height
:,:
Weight
/_�t.
Hair Color
l; ��r,�.
Eye Color
/.. r
Sex
,- r�
Race
t;•Fr_t:t
9. Do You Have a current Drivers License? If yes, give number, & state
, Yes ❑ No < .
10. Name of Present Employer
:':{/?i,•' ...-/::-.1....
f t3ii i• r criZ`:: ',7, r'l1l /:•f: • • i - - l:
11. Type of Business or Employment
i . /J,'_ 1-3.!--/-44,74.': S /,/J
12. Address of Business Where Employed (street number, city, state, ZIP) 7(..' u
-,.c / -, C.' %, ./..*: t.• ' /.."/..".:?. Ci /,•4 {-'r-'-r•r...1.c../ i ' 5 ,
Business`Teiephone
r
( ./.-7e. } .% Sr'%C'i'
13. Present Position
=-, (.77-:1 / L. /(///v,-'/
/'
14. Marital Status
;'
.'4I. /`. {
15. Name of Spouse (include maiden name if applicable)
/-- .r �C 1 . '-Jif//./�/fir../rL/C
16. Spouse's Date of Birth
/ _
Spouse's Place of Birth i
/
17. Spouse's residence address, if different than yours (street and number. city, state, ZIP)
18. Spouse's Present Employer
1 4 =!':?/
Occupation
/{%/.a/ j' 14: J.,/.3/. ! Z._-
19. Address of Spouse's Present Employer
it -4- 7'`'.",/,' .('...
2D. List the name(s) of all relatives working in or having a financial interest in the liquor industry.
NAME OF RELATIVE
I RELATIONSHIP TO YOU POSITION HELD] NAME OF EMPLOYER
LOCATION OF EMPLOYER
Ji• 4 ''lLy.•�
I 1
! J
21. Do you now, or have you
Licensee? If yes, answer
❑ Yes I.I
ever held a State of Colorado Liquor or Beer License. or loaned money, furniture, fixtures, equipment or inventory. to any Colorado Liquor or Beer
in detail
No
CONTINUED ON REVERSE SIDE
DR 8404-I (2/94) 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 law violation, or been denied a liquor or beer license anywhere in the U.S.? If yes, explain in detail.
❑ Yes K No
24. MilitaryService(branch)
11 ' 14
From
To
Selal 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
5;c( f:..t:f---`_>`ircj
{�
N lrI')Li/ re' LrCW
'
List ail former employers or businesses engaged in within the last five years. (Attach separate sheet
if necessary.)
NAME OF EMPLOYER
ADDRESS
DRESS (STREET, -NU BF -.R, CITY .ST,A3E ZIP)
POSITION HELD
FROM
TO
./1...1,
�^' / / ,
f l ) I''' . i-- ,..1,..--12. � LL'r'/d Lt (L'/1
-�r
�. 75/1. L. ,..L A` 1-r ,P-Itr.
t
' rte• 1.l.4 e , 1•
'_ , M ~t 4e L ♦i ra. .� /
.� �«• ; l;. a�; ��: �
,, r/ '' f
, ,�. �� ��:r..
/Yid,/
i�. �
/..:
afr~d- 4�
'1 , t. r ./•j:j c',.,,.
!_ r -I / 4: L.<: :.t:l°;«/ �� �` i
f�%{'�1 #t'
�.r't
i'fi7
27. What is your relationship to the applicant? (sole oymer, partner, corporate officer, director, stockholder, member or manager)
28. if stockholder, number of shares owned beneficially or of record !Percent
/ t /"'
of outstanding stock owned
I .?'}%
29. If partner, state whether 0 General ❑ Limited
Percent of Partnership Owned
y
If Limite f Liability Company (percent owned)
30. Total amount you will invest in this business, including notes, loans, cash, services or equipmert• and operating capital. (Reg. 46-106.1 and Reg. 47-107.1)
Amount $ 7.'' b •'i • .
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
3 yzy
7 - !lit ..`•-, _.•
$
i
$
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
j Title ; Date
I
OUR LITTLE STORE
Linda A. Fangmeier
Owner
4821 Yellowstone Dr.
Greeley, Co. 80634
Telephone (970) 339-9202
Fax N/A
November 17, 1998
Dear Weld County Board of Commissioners
I respectfully request a temporary Liquor / Beer License for for the purpose of selling
3.2% beer at "Our Little Store" located at 4821 Yellowstone Dr. , Greeley, Co.
On Monday, November 16, I purchased the business from Ken & Connie Spooner and
desire to the continue the business in the same manor as the Spooner's. It will be helpful
to my business to have a minimum of changes and for this reason I would like to return to
selling beer as soon as possible.
Thank You for consideration.
Sincerely
Our Little Store
Linda A. Fangmeier
Owner
November 13, 1998
Fred and Linda Fangmeier
24701 WCR 54
Kersey, Co 80644
RE: Financing for the Purchase of Convenience Store and inventory of store located at
4821 Yellowstone Dr., Greeley, Co.
Dear Fred and Linda:
The following is a list of the financing approved for the purchase of the convenience store located
at 4821 Yellowstone Drive in Greeley, Colorado. There are two loans which will be used for the
purchase of the business and inventory of the convenience store as mentioned above.
$30,000 TERM LOAN
• Five year term loan
• 10% fixed interest rate
• 1% loan fee
• Monthly principal and interest payments
• Collateral will include all inventory of the store, a 1959 Ford T -Bird, and 1 acre of
undeveloped land near Kersey.
$20,000 LINE OF CREDIT
• One year maturity
• Rate of Prime + 2.00% (currently at 10.00%)
• 1.00% loan fee
• Monthly interest payments
• Collateral is the same as discussed for the previous loan.
These loans will be prepared to close on Monday, November 16, 1998. If you or any other
persons with questions or concerns on this matter, please call me at (970) 356 — 7700 or (970)
— 6324.
rs truly,
sc
Cr
Member F.D.I.C.
OFFER TO PURCHASE BUSINESS
To: Ken and Connie Spooner 903 Broad St. Milliken, Co 80543
Linda A. Fangmeier, referred to herein as BUYER, offers to purchase
the following described business from Ken. and Connie Spooner, referred
to herein as SELLER, upon the terms and conditions stated herein.
This offer shall expire unless accepted by 5:00 p.m. on October 27,
1998 and it is contingent on the acceptance by Convenience Plus to the
modifications to the lease as per attachment to this offer and BUYER
obtaining bank financing. SELLER shall signify acceptance by executing
the attached form of acceptance.
The gross purchase price of the business shall be $ 20,000.00 ( twenty
thousand & no/100 dollars) plus purchase of present inventory, at cost,
with approximate value of $20,000.00 ( twenty thousand & no/100
dollars)but no to exceed $25,000.00 ( twenty five thousand & no/100
dollars) and personal property stated in lease. The description of the
business is:
"Our Little Store" located at 4821 Yellow Stone Greeley, Co. 80634
under lease with Convenience Plus.
Payment for business and inventory shall be:
$1,000.00 ( one thousand dollars & no/100) down and balance of purchase
price plus payment for inventory shall be paid in cash at closing.
The closing will be held within 30 days days of the acceptance of
this offer to the SELLER, but in no event in less than 20 days from the
notice. Within 20 days of acceptance, the SELLER shall provide a lease
from Convenience Plus acceptable to the Buyer. Should their be any
defects in the lease, the SELLER shall have 30 days to clear the same.
If the SELLER is unable to do so, BUYER shall have the option of
closing or rescinding this contract. Should BUYER rescind the contract,
then the SELLER shall refund as liquidated damages, and not a penalty,
the funds paid for the option to BUYER.
The BUYER and SELLER shall make a mutual agreement as to when
physical inventory will be taken and books will be transferred but in no
event will it be later than 5:00 P M on the day preceeding closing.
The SELLER shall maintain the property and all improvements in the
same condition as that which exists on the date of acceptance of this
agreement, and shall deliver the same to the BUYER in the same
condition, ordinary wear and tear excepted.
During the period between exercise of the option by the buyer and the
closing the premises shall be adequately insured for fire and other
perils.
5
All taxes for the current year shall be prorated between the
parties as of the date of closing.
At the time of closing SELLER shall provide an affidavit to BUYER
that either:
a) there have been no improvements made which would subject the
property to the filing of mechanic's, materialman, labor or other such
liens; or
b) that there were improvements made to the subject property and all
persons having the right under law to lien the property were paid or
lien waivers obtained.
The SELLER represents to the BUYER that the present use of the
property is lawful and complies with all zoning, governmental
regulations and restrictive covenants and other similar contracts in
effect.
Dated:
/p -z6 -9f'
Linda A. Fangm er, ,BUYER/OFFEROR
'13',,-/3
ACCEPTANCE OF OFFER
I hereby accept the offer set forth above.
Dated:
Ken Spooner , Connie Spooner / SELLER/OFFEREE
Witnesses as to Seller's acceptance:
91 2 2413
SE BUSINESS
S
Attachment to OF n^ T0 PURCI?_�,.,. i.�_I_��S.,
Paragraph 2 should be modified to read:
Condition: Lessor warrants that the Premises currently has all .loenses and ern -
to operate as an oil and gasoline filling gasoline station and a i ,:neergrone gasoline
tanks are appropriately registered and meet ail standards sit, tits, State o:
Colorado and the Federal agencies of the government of the Gn,ted States. Eased
on Lessors warranty Lessee hereby accepts the Premises in its condition. e xistln.
as of the date of the execution hereof. subject to all appiioable zoning,
county and state laws, ordinances and regulations covering and regulating the use
Premises. If, during the term oflease,^ renewal i thereof, the ren-,is s. this or any , - t✓a. the use of
the said premises for an oil and gasoline filling station be prevented, suspended cr
limited by any zoning statute, or ordinance, or any other municipal or governmental
action or law, or regulation; or if the use of said premises be effected or innnai ed oy
the widening, altering or improving of any streets fronting or adjoining said premises,
then Lessee may cancel this lease by giving thirty (30) days' written notice to Lessor.
Paragraph 3 should be expanded to provide for an option to renew t ,e term of the [ease
as follows:
The Lessee shall have and is hereby given one (1) option to renew. the within lease
for a period of five (5) years, to follow consecutively upon the expiration o the terns
hereof, upon the same terms and conditions contained herein. The option to renew
shall be exercised by Lessee giving written notice to Lessor Of its intention to renew
not less than sixty (60) days prior to the expiration date of the initial term as provided
in the lease.
Paragraph 10 (a) should insert the following language after "written consent" in the first line:
"which shall not be unreasonable withheld"
Paragraph 41 should be modified to read as follows:
Attorneys' Fees: It is hereby agreed to and understood by the pates to this Lease
that if either party hereto seeks to enforce the terms of this Lease th cugn the coins an,dior
obtains a judgment against the other for breach of any provisions ... -::0 .. 'ter^S 1u'.ln
parties' contract damages include all attorneys' fees and otherct10 aXpe7:2S2 incurred
by such prevailing party in obtaining enforcement or such judoment.
A schedule of all personal property included in this Lease should be attached to the Lease
as an exhibit.
oct-23-98 07249A
P,03
ACCEPIANC2 OP OFFER
hereby er•,rcpt the other set forth. above.
Dated: ! D )-C^ ??
a /// t --- (iti`—
P2rrtorkr l GGlG
Ken Spoo er , nnie Spoonat SELLS OPYE ...E
Witnesses as to Seller's acceptance:
Tel WULC:TT 8661 2C '100 0£85 8SE 8C8 : 'ON 9NOMd
J1uowl0onuj Oouof pur'rp9 : WOd.]
Station Lease
This Lease agreement is made this January 6, 1998 between Convenience Plus Partners, Ltd.,
(hereinafter "Lessor") and Linda Fangmeier (hereinafter "Lessee").
WITNESSETH
Lease of Premises: Lessor hereby leases to Lessee the premises located at 4821 Yellowstone
Drive in the City of Greeley, in the County of Weld, in the State of Colorado ("Premises"),
which Premises are to be employed in connection with the sale, consignment or distribution
of motor fuel under the signs, brands, trademarks or trade names of Sinclair. It is understood
and agreed that Lessor neither owns nor controls the signs, brands, trademarks or trade names
of Sinclair which are to be used at the above Premises, but that Lessor may supply those to
Lessee only with the authorization of Sinclair, which retains the right, subject to requirements
of law, to withdraw these from Lessee at any time notwithstanding any request or demand
by Lessor to the contrary. Lessor owns all equipment on the Premises, with the exception
of items enumerated in Attachment "A".
Condition: Lessor warrants that the Premises currently has all licenses and permits to
operate as gasoline filling station and all underground gasoline storage tanks are appropriately
registered and meet all standards set forth by the State of Colorado and the Federal agencies
of the United States. Based on Lessor's warranty, Lessee hereby accepts the Premised in its
condition existing as of the date of the execution hereof, subject to applicable zoning,
municipal, county and state laws ordinances and regulations covering and regulating the use
of the said Premises. If during the term of this lease, or any renewal thereof, the use of the
said premises for a gasoline filling station be prevented by any zoning statute, or ordinance
or any other municipal or governmental action or law, or regulation or if the legal access from
Yellowstone Drive be permanently denied by any zoning statute, or ordinance or any other
municipal or governmental action or law, or regulation, Lessee may cancel this lease by giving
sixty (60) days written notice to Lessor.
3. Term: The term of this Lease shall commence on November 16, 1998 and end on November
15, 2003.
Lessee shall have, and is thereby granted, one (1) option to renew this Lease for a period of
five (5) years, to follow consecutively upon the expiration of the term hereof, upon the same
terms and conditions contained herein. The option to renew shall be exercised by lessee
giving written notice to lessor of the intention to renew not less than one hundred twenty
(120) days prior to the initial term as provided in the Lease
1
Rent:Lessee shall pay a gallonage rental equal to the gross profit from all fuel sales. Such
rental shall be paid on motor fuel dispensed from the station, and computed during each lease
period. Unless otherwise agreed in writing, gallonage rental shall be due and payable monthly
Independent Business: Lessee is an independent businessman with the exclusive right to
direct and control the business operation at the above Premises, including the establishment
of the prices at which products and merchandise are sold. Lessor reserves no control over
the business at the above Premises. Lessee has no authority to employ anyone as an
employee or agent of Lessor for any purpose.
Mutual Satisfaction: The parties to this Lease have discussed the provisions herein and find
them fair and mutually satisfactory, and further agree that, in all respects, the provisions are
reasonable and of material significance to the relationship of the parties hereunder. Any
breach of a provision of this Lease shall be grounds for termination or non -renewal of the
relationship.
Surrender of Premises: Lessee shall surrender possession of the Premises immediately upon
termination, cancellation or non -renewal of this Lease. Lessor shall have the right to
repossess the Premises immediately upon termination, cancellation or non -renewal of this
Lease.
Lessee shall leave the Premises in the same condition as it was at the commencement of this
Lease or in the same condition to which it was brought by the efforts of Lessor after the
commencement of this Lease, except for normal wear and tear.
If damage to or destruction of the Premises (including fixtures) was caused by the negligent
or willful acts or omissions of Lessee, Lessee will pay Lessor the cost of repair or
replacement.
8. Inspection: Lessor retains the right to enter and inspect the Premises at reasonable times and
in a reasonable manner with such employees and equipment as Lessor may deem necessary
to determine if the obligations assumed by Lessee under this Lease are being fulfilled.
9. Indemnity: Lessee, to the maximum extent permitted by law, shall defend, protect,
indemnify and hold harmless Lessor, its parent, affiliate and subsidiary companies, and their
respective officers, employees and agents ("Indemnified Parties"), against all claims,
demands or causes of action, suits, damages, liabilities, judgements, losses, and expenses
(including, without limitation, attorneys' fees and costs of litigation, whether incurred for
an Indemnified Party's primary defense or for enforcement of its indemnification rights)
which may be incurred by an Indemnified Party or asserted by Lessee (including, without
limitation, Lessee's employees, contractors and agents) or by any third party on account of
(i) any personal injury, disease or death of any person(s), damage to or loss of any property,
or money damages or specific performance owed to third party (by contract or operation of
law), and any fines, penalties, assessments, environmental response costs or injunctive
obligations caused by, arising out of, or in any way incidental to or in connection with,
actions or omissions of Lessee (including, without limitation, its employees, contractors and
agents) or any third party including, without limitation, (1) the sole negligence, fault or
strict liability of Lessee and, (2) the concurrent negligence, fault or strict liability in any
combination of the Indemnified Parties, Lessee or any third party, and (3) where liability
with or without fault is strictly imposed by operation of law; and (ii) any breach of any
representation, obligation, warranty or covenant of Lessee contained in this Lease.
It is the intention of the parties that obligations of Lessee under this Paragraph are without
regard to whether the negligence, fault or strict liability of an Indemnified Parry is a
contributory factor, and such obligations are intended to protect the Indemnified Parties
against the consequences of their own negligence, fault or strict liability. Only those matters
which are determined by a final nonappealable judgement to be a result of the sole
negligence, fault or strict liability of Indemnified Party and not caused or contributed to by
the negligence, fault or strict liability of Lessee or any third party shall be excluded from
Lessee's duty to indemnify and hold harmless the Indemnified Parties. In such cases, Lessor
agrees to reimburse Lessee for its reasonable attorney's fees, litigation expenses and court
costs. The Indemnified Parties expressly reserve the right to participate in their defense with
counsel of their own choosing. Lessee's obligations under this Paragraph shall survive the
expiration, termination or nonrenewal of this Lease.
10. Alterations and Additions:
(a) Lessee shall not, without Lessor's prior written consent, which shall not be
unreasonably withheld, make any alterations, improvements, additions or utility
installations in, on or about the Premises. As used in this paragraph 10, the term
"utility installations" shall include bus ducting, power panels, fluorescent fixtures,
spaces, heaters, conduits and wiring. As a condition to eivine such consent, Lessor
may require that Lessee agree to remove any such alterations, improvements, additions
or utility installations at the expiration of the term and to restore the Premises to its
prior condition. As a further condition to giving such consent, Lessor may require
Lessee to provide Lessor, at Lessee's sole cost and expense, a lien and completion
bond in an amount equal to one and one-half times the estimated cost of such
improvements to insure Lessor against any liability for mechanics' and materialmen's
liens and to insure completion of the work.
(b) Lessee shall pay, when due, all claims for labor or materials furnished or alleged to
have been furnished to or for Lessee at or for use in the Premises, which claims are
or may be secured by any mechanics' or materialmen's lien against the Premises or any
interest therein. Lessee shall give Lessor not less than ten (10) days notice prior to
the commencement of any work in the Premises and Lessor shall have the right to
post notices of non -responsibility in or on the Premises as provided by the law
3
` s ,W 41,3
(c) Unless Lessor requires their removal, as set forth in paragraph 10(a), all alterations,
improvements, additions and utility installations (whether or not such utility
installations constitute trade fixtures of Lessee) which may be made on the Premises
shall become the property of Lessor and remain upon and be surrendered with the
Premises at the expiration of the term. Notwithstanding the provisions of this
paragraph 10(c), Lessee's machinery and equipment, other than that which is affixed
to the Premises so that it cannot be removed without material damage to the
Premises, shall remain the property of Lessee and may be removed by Lessee subject
to the provisions of paragraph 10(c).
11 Notice: Any notice required by this Lease shall be in writing. It shall be deemed served
when delivered to the other party personally or when mailed via certified mail to the other
party at the address indicated at the end of this Lease.
12. Defaults; Remedies:
(a) Defaults: The occurrence of any one or more of the following events shall
constitute a material default and breach of this Lease by Lessee.
(i)
The failure by Lessee to make any payment of rent or any other payment
required to be made by Lessee hereunder, as and when due, where such failure
shall continue for a period of five (5) days after written notice thereof from
Lessor to Lessee.
(ii) The failure by Lessee to materially observe or perform any of the covenants,
conditions or provisions of this Lease to be observed or performed by Lessee,
other than described in paragraph (a) above, where such failure shall continue
for a period of thirty (30) days after written notice hereof from Lessor to
Lessee; provided, however, that if the nature of Lessee's default is such that
more than 30 days are reasonably required for its cure, then Lessee shall not
be deemed to be in default if Lessee commenced such cure within said 30 -day
period and thereafter diligently prosecutes such cure to completion.
(iii) Lessee making any general assignment or general arrangement for the benefit
of creditors; (ii) the filing by or against Lessee of a petition to have Lessee
adjudged a bankrupt or a petition for reorganization or arrangement under
any law relating to bankruptcy (unless, in the case of a petition filed against
Lessee, the same is dismissed within sixty (60) days; (iii) the appointment of
a trustee or receiver to take possession of substantially all of Lessee's assets
located at the Premises or of Lessee's interest in this Lease, where possession
is not restored to Lessee within 30 days: or (iv) the attachment, execution or
other judicial seizure of substantially all of Lessee's assets located at the
Premises or of Lessee's interest in this Lease. where such seizure is not
4
9'2A�3
discharged within 30 days.
(b) Remedies: In the event of any such material default or breach by Lessee, Lessor may,
at any time thereafter, with or without notice or demand and without limiting Lessor
may have by reason of such default or breach:
(i)
Terminate Lessee's right to possession of the Premises by any lawful means,
in which case this Lease shall terminate and Lessee shall immediately
surrender possession of the premises to Lessor. In such event, Lessor shall
be entitled to recover from Lessee all damage incurred by Lessor by reason
of Lessee's default, including, but not limited to, the cost of recovering
possession of the Premises; expenses of reletting, including necessary
renovation and alteration, of the Premises, reasonable attorneys' fees; the
worth at the time of award by the court having jurisdiction thereof of the
amount by which the unpaid rent for the balance of the term after the time of
such award exceeds the amount of such rental loss for the same period that
Lessee proves could be reasonably avoided. Unpaid installments of rent or
other sums shall bear interest from the date at the rate of ten percent (10%)
per annum. In the event Lessee shall have abandoned the Premises, Lessor
shall have the option of (i) retaking possession of the Premises and recovering
from Lessee the amount specified in this paragraph 12(b)(1); or (ii)
proceeding under paragraph 12(b)(2).
(ii) Maintain Lessee's right to possession, in which case this Lease shall continue
in effect whether or not Lessee shall have abandoned the remises. In such
event, Lessor shall be entitled to enforce all of Lessor's rights and remedies
under this Lease, including the right to recover the rent as it becomes due
hereunder until the end of the term.
(c) Default by Lessor: Lessor shall not be in default unless Lessor fails to perform
obligations required of Lessor within a reasonable time, but in no event later than 30
days after written notice by Lessee to Lessor and to the holder of any first mortgage
or deed of trust covering the Premises whose name and address shall have theretofore
been furnished to Lessee in writing, specifying wherein Lessor has failed to perform
such obligations: provided, however, that if the nature of i ecsor's obligation is such
that more than 30 days are required for performance, then Lessor shall not be in
default if Lessor commences performance within such 30 -day period and thereafter
diligently prosecute the same to completion.
(d) Late Charges: Lessee hereby acknowledges that late payment by Lessee to
Lessor of rent and other sums due hereunder will cause Lessor to incur cost not
contemplated by this Lease, the exact amount of which will be extremely difficult to
ascertain. Such costs include, but are not limited to. processing and accounting
5
9,313
charges, and late charges which may be imposed on Lessor by the terms of any
mortgage or deed of trust covering the Premises. Accordingly, if any installment of
rent or any other sum due from Lessee shall not be received by Lessor or Lessor's
designee within five days after such amount shall be due, Lessee shall pay to Lessor
a late charge equal to five percent (5%) of such overdue amount. The parties hereby
agree that such late charge represents a fair and reasonable estimate of the costs
Lessor will incur by reason of late payment by Lessee. Acceptance of such late
charge by Lessor shall in no event constitute a waiver of Lessee's default with respect
to such overdue amount, nor prevent Lessor from exercising any of the other rights
and remedies granted hereunder.
13. Sublease; Assignment:
(a) Lessor's Consent Required: Lessee shall not voluntarily or by operation of law
assign, transfer, mortgage, sublet or encumber all or any part of Lessee's interest in
this Lease or in the Premises without Lessor's prior written consent which shall not
be unreasonably withheld. Any attempted assignment, transfer mortgage,
encumbrance or subletting without such consent shall be void and shall constitute a
breach of this Lease.
(b) No Release of Lessee: Regardless of Lessor's consent, no subletting or assignment
shall release Lessee of Lessee's obligation or alter the primary liability of Lessee to
pay the rent and to perform all other obligations to be performed by Lessee
hereunder. The acceptance of rent by Lessor from any other person shall not be
deemed to be a waiver by Lessor of any provision hereof Consent to one assignment
or subletting shall not be deemed consent to any subsequent assignment or subletting.
(c) The assignee or sublessee shall take subject to the provisions of this Lease and shall
agree in writing, in recordable form, to be bound by all terms, covenants and
conditions of this Lease and as a condition to Lessor's approval of such assignment
or sublease, Lessee shall pay Lessor's reasonable attorneys' fees incurred to effect
such assignment or sublease.
14 Condemnation: If the Premises or any portion thereof are taken under the power of eminent
domain or sold under the threat of the exercise of said power (all of which are herein called
"condemnation"), this Lease shall terminate as to the part so taken as of the date the
condemning authority takes title or possession, whichever first occurs. If more than 10% of
the floor area of the improvement on the Premises or more than twenty-five percent (25%)
of the land area of the Premises which is not occupied by any improvements is taken by
condemnation, Lessee may, at Lessee's option, to be exercised in writing only within ten days
after Lessor shall have given Lessee written notice of such taking (or in the absence of such
notice within ten days after the condemning authonty shall have taken possession), terminate
6
this Lease as of the date the condemning authority takes such possession. If Lessee does not
terminate this Lease in accordance with the foregoing, this Lease shall remain in full force
and effect as to the portion of the Premises remaining, except that the rent shall be reduced
in the proportion that the floor area taken bears to the total floor area of the building situated
on the Premises. Any award for the taking of all or any part of the Premises under the power
of eminent domain or any payment made under threat of the exercise of such power shall be
the property of Lessor, whether such award shall be made as compensation for diminution
in value of the leasehold or for the taking of the fee, or as severance damages; provided,
however, that Lessee shall be entitled to any award for loss of or damage to Lessee's trade
fixtures and removal of personal property. In the event that this Lease is not terminated by
reason of such condemnation, Lessor shall, to the extent of severance damages received by
Lessor in connection with such condemnation, repair any damage to the Premises caused by
such condemnation, except to the extent that Lessee has been reimbursed therefor by the
condemning authority. Lessee shall pay any amount in excess of such severance damages
required to complete such repair.
15. Duties of Lessee:
Lessee shall:
(a) operate the station at the Premises responsibly, with due care, prudence, good
judgment and skill;
(b) treat all customers of the station at the Premises courteously;
(c) not engage in dishonest, fraudulent or scare -selling practices;
(d) promote diligently the sale of motor fuel by the station at the Premises;
(e) perform all services in a good, workmanlike manner;
(f) maintain the restrooms in a clean, sanitary and well -lighted condition with necessary
supplies;
(c) provide sufficient trained and courteous personnel to serve the needs and desires of
the motoring public;
(h) keep the station at the Premises, including driveways, yards, lawns, shrubs and other
plantings, neat and free from weeds, debris, snow, ice and rubbish; and
(i) keep the station at the Premises open for business and properly lighted during all
hours of operation specified in Attachment "B"
16. Operation of Station at the Premises:
Lessee shall:
(a) at all times operate and maintain the station in a manner that will allow the station to
obtain a passing score on any inspection using the predetermined criteria, as set forth
in the attached Exhibit C and the current Sinclair retail facility standards, receipt of
which is hereby acknowledged, or Lessor's criteria whichever is more stringent.
Lessor and Sinclair may, at any time, at their sole discretion develop and disseminate
criteria for appearance and image.
(b) use the station solely for the purpose of operating a first-class motor vehicle service
station for the sale of motor fuel and, upon approval of Lessor, for the operation of
a first-class convenience store offering for sale items customarily sold at convenience
stores, unless otherwise agreed in writing by Lessor and Lessee;
(c) not use the station for storage ofjunk, disabled vehicles, used tires or batteries, other
than on a temporary basis in connection with servicing customers of the station;
(d) not use the station, without the prior written consent of Lessor, for auto, truck or
equipment rentals or as a parking lot;
(e) not construct any entrance, exit, pump island or service area so as to deny free access
to the motoring public or block delivery carriers access to storage fill pipes;
(f) if the construction, maintenance and/or operation of the station is pursuant to a
conditional use permit or other approval ("permit") by a zoning board or other
governmental agency, use the station in accordance with all requirements contained
in such permit. If the station is subject to such a permit, a copy will be delivered to
Lessee and Lessee agrees to acknowledge receipt of the copy on a form provided by
Lessor;
(g) conduct all operations lawfully and in strict compliance with all statutes and all
ordinances, regulations and other requirements of governmental authorities;
(h) except as required by law or as agreed to in writing by Lessor and Lessee, not display
signs, except those usual and customary to advertise products and services offered
for sale at the station by Lessee;
(i) not store or sell intoxicating liquors, unless so permitted by law, or illegal drugs, or
permit the same to be used or consumed at the station
8
2,2Y3
17. Obligations of Lessee:
(a) Lessee shall, at his expense: (i) maintain the station at the Premises in accordance
with the standards enumerated in paragraph 15; (ii) make all repairs and replacements
Ln accordance with Attachment "C"; (iii) pay ail water, gas, electricity, telephone and
other utility bills; (iv) pay all real estate taxes prorated to the term of this Lease; (v)
pay all premiums contributions required by workmen's compensation, unemployment
insurance, old age benefits and other programs measured by the remuneration paid
by Lessee to his employees; (vi) pay all license, occupation and business fees
connected with Lessee's operation of the station at the Premises; and (vii) pay all
costs of withdrawing, distributing and selling products at the station at the Premises.
If Lessee fails to fulfill the obligations set forth in (i), (ii), (iii) or(iv)above,Lessor
may, in cases of urgency, without waiving any other remedy allowable under law,
take care of such maintenance, make such repairs and replacements or otherwise
perform such obligations Lessee shall reimburse Lessor upon demand Wit is necessary
for Lessor to fulfill Lessee's obligations in (i), (ii), (iii) or (iv) above.
(b) Lessee shall be responsible for all maintenance, repairs and replacements not
specifically covered above.
18. Taxes: Lessee shall pay all taxes levied or imposed on (i) Lessee's property located at the
Premises; and (ii) Lessee's operations pursuant to this Lease, including the withdrawal,
distribution, sale or delivery of the products handled at the station.
19. Termination of Contract of Sale: If the accompanying Contract of Sale is terminated or
not renewed for any lawful reason, this Lease shall also terminate or not be renewed at the
same time as such termination or non -renewal.
20. Lessee's Insurance Requirements:
(a) Lessee shall obtain and maintain in force continually during the term of this Lease
insurance equivalent to the following:
(i) For Lessees engaged in automotive repair, garage keepers legal liability
insurance covering fire, theft or an entire automobile and collision with limits
adequate to cover the number of vehicles normally in the Lessee's possession.
(ii) For Lessees engaged in the operation of an automotive repair facility, garage
general liability insurance covering operations and Premises, complete
operations and covering all owned, hired or otherwise operated non -owned
vehicles with minimum limits of 8 1.004000 00 for each occurrence and
$2,000,000 00 general aggregate.
9
(iii) For Lessees other than those engaged in the operation of an automotive repair
facility, comprehensive general liability insurance with minimum limits of
$1,000,000.00 each occurrence and $2,000,000.00 general aggregate.
(iv) Business income insurance adequate to provide for payment of rents and other
amounts owed Lessor in case of covered business interruption.
(v) Business personal property insurance adequate to cover replacement costs of
improvements added to the Premises naming Lessor as a loss payee.
(vi) Workers' compensation insurance as required by laws and regulations
applicable to and covering employees of Lessee. Lessor shall not be named
as additional insured on loss payee of these policies.
(vii) During the term of this Lease, Lessee agrees to reimburse Lessor for the cost
of property, fire and casualty insurance carried on the Premises by Lessor.
Such insurance shall be at full replacement value and cost shall be allocated
by Lessor to reflect cost at the leased Premises only.
(b) Insurance required hereunder shall be in companies rated AAA or better in "Best
Insurance Guide." Lessee shall deliver to Lessor copies of policies of liability
insurance required under paragraph 20 or certificates evidencing the existence and
amounts of such insurance with loss payable clauses satisfactory to Lessor. No such
policy shall be cancelable or subject to reduction of coverage or other modification
except after ten days prior written notice to Lessor. Lessee shall, within ten days
prior to the expiration of such policies, furnish Lessor with renewals or "binders"
thereof, or Lessor may order such insurance and charge the cost thereof to Lessee,
which amount shall be payable by Lessee upon demand. Lessee shall not do or permit
to be done anything which shall invalidate the insurance policies referred to in
paragraph 20.
Certificates of insurance for all such policies shall be furnished to Lessor at Lessor's
place of business.
Lessor and Lessee agree to waive any right of subrogation for any property loss or
damage covered by the above -listed policies.
(c) The foregoing are minimum insurance requirements only and may or may not
adequately meet the entire insurance needs of Lessee. If Lessor requires, before
Lessor delivers possession of the Premises to Lessee, Lessee shall furnish Lessor with
certificates of such insurance. The insurance required hereunder in no way limits or
restricts Lessee's obligation under paragraphs 9 and 22(a) as to indemnification of
Lessor. Further. the insurance to be carried shall be in no way limited by any
10
limitation placed upon the indemnity therein given as a matter of law.
21. Records of Lessee; Audit: Lessee shall maintain at the Premises, in a form to permit
calculation of rentals due under this or any underlying lease, accurate records, including
dates, volumes and prices of (i) all deliveries and sales of motor fuel; and (ii) gross revenue
from sales of all products (including motor fuel) and services. Lessor and/or its agent may
examine, copy and audit the foregoing records at any reasonable time and Lessor agrees to
keep the records confidential. Lessee shall, on request from Lessor, provide a verified
statement of deliveries, sales and gross revenue within five days after the end of each calendar
month, twelve- (12) month lease period and/or any cancellation or termination of this Lease.
At Lessor's option, Lessor may prescribe a written form which Lessee shall complete in
submission of such statements.
Hazardous Substances:
(a) Lessee recognizes that it is handling hazardous substances and agrees that, in
receiving, storing, handling, offering for sale, selling, delivering for use, exchanging
in trade or using itself product(s) purchased from Lessor, Lessee will in all respects
exercise the strictest care required by law and that it will comply with any and all of
Lessor's applicable safety procedures as well as all applicable federal, state and local
laws, ordinances, regulations, rules and orders, as exist now or as may hereinafter
come into force, including, but not limited to, those governing dispensing equipment;
pollution; the maximum sulfur content of fuel; the maximum reid vapor pressure of
motor fuel; the oxygen content of motor fuel; and the labeling of pump stands and
dispensers of motor fuel; the use, maintenance and labeling of product containers or
storage tanks; the prevention of spills, leaks, venting or other improper escape from
product containers or storage tanks and the method of cleanup or disposal of product
which has leaked, spilled, vented or otherwise improperly escaped from containers
or storage tanks. Lessee understands that it is an "operator" for purposes of 40
C.F.R. Parts 280-81, any state underground storage tank law or regulation and any
other applicable federal, state and/or local laws, regulations or ordinances related to
the prevention of pollution from storage tanks or the taking of corrective action
therefor. Lessee will indemnify and Hold Lessor, its successors and assigns
harmless against all losses, claims, causes of action, penalties, fines, liabilities
and attorneys' fees and interest arising out of Lessee's failure to comply with this
subparagraph, and such failure by Lessee shall entitle Lessor to cancel this
Lease immediately.
(b) In the event that any spills, leaks, venting or other unintended discharge from product
containers, pumps, piping or storage tanks ("facilities") requires corrective action for
any reason or cause, Lessor is authorized to suspend immediately its supply and other
obligations under any related contracts until such time as all required corrective action
is completed, and Lessor is further authorized to enter the Premises at any time and
11
qy:9 VS
remove all motor fuels from any or all storage tanks owned by Lessor and, in its sole
discretion, remove storage tanks and related facilities owned by Lessor. Lessor shall
be under no obligation to replace, repair or restore storage tanks removed pursuant
to this provision and such suspension of obligations and/or removal of storage tanks
shall not constitute default hereunder or give rise to any claims for damages or other
compensation. When all required corrective action is completed, Lessor may demand
a renegotiation of any term of this or related agreements, including the rental terms,
in any reasonable manner that compensates Lessor for its out-of-pocket expenses and
additional necessary investments occasioned by the discharge or restoration of the
Premises.
23.
Damage or Destruction:
(a) Partial Damage - Insured: Subject to the provisions of paragraph 23(d), if the
Premises are damaged and such damage was caused by a casualty covered under an
insurance policy required to be maintained pursuant to paragraph 20, Lessor shall,
at Lessor's expense, repair such damage as soon as reasonably possible and this Lease
shall continue in full force and effect. Lessor's obligation under this paragraph shall
not exceed the amount of insurance proceeds actually received by Lessor.
(b) Partial Damage - Uninsured: Subject to the provisions of paragraph 23(d), if at any
time during the term hereof the Premises are damaged, except by a negligent or willful
act of Lessee, and such damage was caused by a casualty not covered under an
insurance policy required to be maintained by Lessor pursuant to paragraph 20,
Lessor may, at Lessor's option, either (i) repair such damage as soon as reasonably
possible at Lessor's expense, in which event this Lease shall continue in full force and
effect; or (ii) give written notice to Lessee within 30 days after the date of the
occurrence of such damage of Lessor's intention to cancel and terminate this Lease
as of the date of the occurrence of such damage. In the event Lessor elects to give
such notice of Lessor's intention to cancel and terminate this Lease, Lessee shall have
the right within ten days after the receipt of such notice to give written notice to
Lessor of Lessee's intention to repair such damage at Lessee's expense, without
reimbursement from Lessor, in which event this Lease shall continue in full force and
effect, and Lessee shall proceed to make such repairs as soon as reasonably possible.
Tf Lessee does not give such notice within such ten-day nerind. this Lease shall he
canceled and terminated as of the date of the occurrence of such damage.
(c) Total Destruction: If at any time during the term hereof the Premises are totally
destroyed from any cause, whether or not covered by the insurance required to be
maintained by Lessor pursuant to paragraph 20 (including any total destruction
required by any authorized public authority). this Lease shall automatically terminate
as of the date of such total destruction, and all insurance proceeds shall be paid to
Lessor.
12
(d) Damage Near End of Term: If the Premises are partially destroyed or damaged
during the last six (6) months of the term of this Lease, Lessor may, at Lessor's
option, cancel and terminate this Lease as of the date of occurrence of such damage
by giving written notice of Lessee's election to do so within 30 days after the date of
occurrence of such damage.
24. Security Improvements: Lessee shall be solely responsible for making all improvements to
the Premises, including, but not limited to, the installation of equipment and fixtures, which
Lessee deems necessary to secure the Premises against unlawful intrusion, vandalism and
criminal activity or to provide for the safety of Lessee's employees, customers or invitees
(hereinafter "Security Improvements"). In the event Lessee desires to make Security
Improvements, Lessee shall proceed to do so with the approval of Lessor, which approval
shall not unreasonably be withheld and subject to compliance with paragraph 10 of this
Lease. Lessor shall not be liable to any person for any claim or cause of action related to the
lack of security at the Premises or the inadequacy, deficiency or malfunctioning of any
security equipment at the Premises. Lessee shall protect, defend, indemnify and hold Lessor
harmless from and against any suits, causes of action, judgments, costs or penalties arising
out of or related in any way to the existence and/or level of security at the Premises.
25. Compliance With Laws and Severability of Provisions: Both parties expressly agree that
it is not the intention of either party to violate statutory or common law and that if any
sentence, paragraph, clause or combination of same is in violation of any law, such
sentences, paragraphs clauses or combinations of same shall be inoperative and the remainder
of this Lease shall remain binding upon the parties hereto.
26. Estoppel Certificate:
(a) Lessee shall, at any time upon not less than ten days prior written notice from Lessor,
execute, acknowledge and deliver to Lessor a statement in writing (i) certifying that
this Lease is unmodified and in full force and effect (or, if modified, stating the nature
of such modification and certifying that this Lease, as so modified, is in full force and
effect) and the date to which the rent and other charges are paid in advance, if any;
and (ii) acknowledging that there are not, to Lessee's knowledge, any uncured
defaults on the part of Lessor hereunder or specifying such defaults if any are claimed.
Any such statement may be conclusively relied upon by any prospective purchaser
or encumbrancer of the Premises.
(b) Lessee's failure to deliver such statement within such time shall be conclusive upon
Lessee (i) that this Lease is in full force and effect without modification, except as
may be represented by Lessor; (ii) that there are no uncured defaults in Lessor's
performance; and (iii) that not more than one month's rent has been paid in advance.
Severability: The invalidity of any provision of this Lease as determined by a court of
13
competent jurisdiction, shall in no way affect the validity of any other provision hereof
28. Interest on Past -due Obligations: Except as expressly herein provided, any amount due to
Lessor not paid when due shall bear interest at 10% per annum from the date due. Payment
of such interest shall not excuse or cure any default by Lessee under this Lease.
29. Time of Essence: Time is of the essence.
30. Captions: Paragraph captions are not a part hereof.
31. Incorporation of Prior Agreements; Amendments: This Lease contains all agreements of
the parties with respect to any matter mentioned herein. No prior agreement or understanding
pertaining to any such matter shall be effective. This Lease may be modified in writing only,
signed by the parties in interest at the time of the modification.
,,
Holding Over: If Lessee remains in possession of the Premises or any part thereof after the
expiration of the term hereof without the express written consent of Lessor, such occupancy
shall be a tenancy from month to month at a rental in the amount of the last monthly rental
plus all other charges payable hereunder and upon all the terms hereof applicable to a
month -to -month tenancy.
33. Cumulative Remedies: No remedy or election hereunder shall be deemed exclusive but
shall, wherever possible, be cumulative with all other remedies at law or in equity.
34. Covenants and Conditions: Each provision of this Lease performable by Lessee shall be
deemed both a covenant and a condition.
35. Binding Effect; Choice of Law: Subject to any provisions hereof restricting assignment or
subletting by Lessee and subletting by Lessee, this Lease shall bind the parties, their personal
representatives, successors and assigns. This Lease shall be governed by the laws of the
State of Colorado.
36. Subordination:
(a)
This Lease, at Lessor's option, shall he subordinate to any ground lease, mortgage,
deed of trust or any other hypothecation for security now or hereafter placed upon
the real property of which the Premises are a part, and to any and all advances
made on the security thereof and to all renewals, modifications, consolidations,
replacements and extensions thereof. Notwithstanding such subordination, Lessee's
right to quiet possession of the Premises shall not be disturbed if Lessee is not in
default and so long as Lessee shall pay rent and observe and perform all of the
provisions of this Lease, unless this Lease is otherwise terminated pursuant to its
terms. If any mortgagee, trustee or ground lessors shall elect to have this Lease prior
14
to the lien of its mortgage, deed of trust or ground lease and shall give written notice
thereof to Lessee, this Lease shall be deemed prior to such mortgage, deed of trust
or ground lease, whether this Lease is dated prior or subsequent to the date of said
mortgage, deed of trust or ground lease of the date of recording thereof.
(b) Lessee agrees to execute any documents required to effectuate such subordination
or to make this Lease prior to the lien of any mortgage, deed of trust or ground lease,
as the case may be, and failing to do so within ten days after written demand does
hereby make, constitute and irrevocably appoint Lessor as Lessee's attorney -in -fact
and in Lessee's name, place and stead, to do so.
37. Merger: The voluntary or other surrender of this Lease by Lessee or a mutual cancellation
thereof shall not work a merger, shall, at the option of Lessor, terminate all or any existing
subtenancies or may, at the option of Lessor, operate as an assignment to Lessor of any or
all of such subtenancies.
38. Corporate Authority: If Lessee is a corporation, each individual executing this Lease on
behalf of said corporation represents and warrants that he is duly authorized to execute and
deliver this Lease on behalf of said corporation, in accordance with a duly adopted resolution
of the Board of Directors of said corporation or in accordance with the Bylaws of said
corporation, and that this Lease is binding upon said corporation in accordance with its
terms. If Lessee is a corporation, Lessee shall, within 30 days after execution of this Lease,
deliver to Lessor a certified copy of a resolution of the Board of Directors of said corporation
authorizing or ratifying the execution of this Lease.
39. Waiver: The failure of Lessor or of Lessee to insist upon performance of any of the terms
or conditions of this Lease or to exercise any right or privilege herein conferred shall not be
construed as then or thereafter waiving any such terms, conditions, rights or privileges, etc.,
but the same shall continue and remain in full force and effect.
40. Lessor's Lien: Lessor shall have a landlord's lien upon all fixtures, equipment and movables
of Lessee upon the Premises for any sums due hereunder. Lessor may distrain Lessee's
property for any sums due hereunder.
41 Attorneys' Fees' It is hereby agreed to and and-rstood by the parties to this Lease that if
either party hereto seeks to enforce the terms of this Lease through the courts and/or obtains
a judgment against the other for breach of any provisions hereof, the prevailing parties'
contract damages include all attorneys' fees and other litigation expenses incurred by
the such prevailing party in obtaining such judgment.
15
W.273•73
LN WITNESS WHEREOF, the parties hereto have duly executed this Lease as of the date first above
written.
LESSOR:
Convenience Plus Partners, Ltd.
1055 Auraria Parkway
Denver, Colorado 80204
By: Gary A. Wetzbarger
Operations j:nager
Signa re
LESSEE:
Linda Fangmeier
25701 WCR 54 1/4
Kersey, Colorado 80644
16
NOVEMBER 13, 1998
TO WHOM IT MAY CONCERN:
PLEASE CONSIDER THIS LETTER AS A CHARACTER REFERENCE FOR LINDA
FANGMEIER.
I HAVE HAD,THE PLEASURE OF KNOWING AND WORKING WITH LINDA
SINCE 1989, TO CURRENT DATE. DURING THIS TIME PERIOD OF KNOWING
LINDA I HAVE SEEN NOTHING BUT HONESTY, LOYALITY AND
COMMITMENT IN WHATEVER LINDA ACCOMPLISHED IN BOTH PERSONAL
AND PROFESSIONAL ASPECTS.
IF THERE ARE ANY QUESTIONS, PLEASE FEEL FREE TO CONTACT ME.
VERY TRULY YOURS,
DEBBIE WILKINSON
819 42ND STREET
EVANS,CO 80620
NOVEMBER 13, 1998
TO WHOM IT MAY CONCERN:
I HAVE KNOWN LINDA FANGMEIER FOR 9 MONTHS.
SHE IS A VERY RESPONSIBLE PERSON AND WOULD BE VERY GOOD AT RUNNING ANY BUSINESS.
SINCERELY,
JUNE A SCHMIDT
3516 N MADISON AVE
LOVELAND, CO 80538
970-667-4949
November 13, 1998
TO WHOM IT MAY CONCERN:
I have known Linda Fangmeier since 1983 and have
found her to be an honest, hardworking and loyal
person. I would highly recommend Linda she accepts
any challenge.
�L✓ a/
Helen Claus
i'ertudu2Et.e4313 COLORADO BUSINESS REGISTRATION 1
PLEASE P-' ESE FIRMLY AND M INT CLEA€?L'Y
THIS FT r,,E1ft WILL SE REVIEWED FOR
UNEMPLOYMENT INSURANCE (UI) ummur,
• if trade name registration with the Department of
iovenue is regwr•fiii. the 'nicrrrxtion marred with a
aiamono will i;eccme public record.
1. REASON FOR FILING THIS APPLICATION
❑ Orirgnal Appicat n O Charge of Ormerstup
2. INDICATE TYPE OF ORGANIZATION Estate
Limited Liability Limited Other Non Profit
Individual C
g ❑ N ❑. Government
General Partnership Partnership'(t.LLP) 0 Joint Venture 0 Other
In Limited Partnership 0 Corporation
❑ Limited Liability Company (LC) S' Corporation
[] Limited Liability Partnership (t1P) ❑ Association
z
,o
CC
O
z
rz
0
z
i*r
Q
O
0
Trust
Non-profit 501(C)(3)
(Please enclose copy of the IRS letter of exemption.)
1. Taxpayer Name (owner, partners or corporate name) (last, first. middle)
2a. Trade Name/Doing Business As (inapplicable)
P. i... /t 5
3a. Street Address of PrincipalPlace o€ Business in Colorado
3b. County
4a. In Care Of (c/o)
City
5. • Bank Name (iii available)
)i 'A' ilt'r f
• Payroll Records Location (list. address ). .
Szi. kt) fr 4 4
7. What products and/or servicos do you provide? (compete sectiolr "H")
4
6. First Day of Payroll (MO/DAY/YR)•
I y 3/ 9�
00 NOT WRITE IN THIS SPACE
SIDE A
City :.:: , ,...
rem/�.�
If business is within limits of a city, what city?
!V 6.....
4b. Mailing Address (8 different front above) (indude
L 7rf tom' /1.54'/t)
,State
ZIP
Bank Address ..
9<<' rr' r '
,, r r
't r4ft � is
8a. Owner/Partner/Corp. Officer
i t r-) de._ tf r ri..4 -::7.:
8b. Address (residence or P.O. Box, street, city, state, ZIP)
7
2b: Federal Employer Identification Number (FEIN)
-state). .."' ZIP
Telephone..
unit If)
its
'Telephone
3,34 -.z 7
Bank Account Number I.
PayroitRecords Telephone
(?,' ) 3Et-- . 7
Do you sell motor vehicle tires? ❑ Yes 5 No
Do you rent out items for 30 days or less? ❑ YesI : No
Title I Social Security #
•
9a. Owner/Partner/Corp. Officer Title
9b. Address (residence or P.O. Box. street, city, state, ZIP)
4''W
Social Security at
Federal Employer Identification Number (FEIN)
Telephone
(-i;O) S.56 7 •
Federal Employer Identification Number (FEIN}
If you acquired the business in whole or in part, complete the following:
10a. Pnor Taxpayer Name
lob. Address
Date ot.Acquisition
V.
_..t?
• City
Telephone
( )
Prior Taxpayer UI Tax Account Number
State I ZIP
1. ❑ if Seasonal. mark
each business month.
0 JAN
❑ FEB
D MAR
• APR
❑ MAY
[] JUN.
2a. FILING FREQUENCY: If sales tax collected is:
a 0 $1 5.00/month or less - Annually
Under $300/month - Quarterly
en 0 $300/month or more - Monthly
0 Wholesale only - Annually
u) 3. Indicate wnich applies to you:
0 Wholesaler 0 Charitable
0--Retail-Sales 0 Multiple Event
0 Retailers -Use
2 1. FILING FREQUENCY: If wage withholding amount is
2 - $6,999/year - Quarterly ❑ $50.000+/year - Weekly
0 $7,000 - ;$49.999/year - Monthly Must file by Electronic Funds Transfer I
Do -you have a Dept of Revenue Account Number? ❑ yes gue no
IF YES, Account #
Do you want this number assigned to new location? G yes Eno
❑ JULY 0 OCT
❑ AUG ❑ NOV
❑ SEPT ❑ DEC
I 2b. First Day of Sales (MO/DAY/YR)
I, / , , e,;• /4'.i
PERIOD COVERED
FROM: TO:
MO/YR fulOtVR
FEES
(0280- Trade Name
750) Registration (999)
$ � 6
EVENUE REGISTRATION ACCOUNT NUMBER
Single Event - Period Covered
• (MO/DAY/YR)
Event Location
(0020- State Sales Tax -�
810 Deposit (355) $ _!
(0080- Sales Tax r
7501 License (999)I$ '� f
(1000• Wage
750) Withholding (999)1$
2.OILIGAS
❑ Withholding
0.00
TOTAL
declare under penalty of penury in the second degree that the statements made in this application are true and complete to the best of my Knowleoge.
, :.v°E . .., ... '� ..
Make cnedc payable to
�� Cob. Dept. of Revenue
. '+:55E:! i' :s 73E
='i^ -;.. F��t�c ':lL{:3 a u�"s .., .,: Sri -{NL: ss+'iTli ir6tt7Tc ?Atit; " FiETURNEr.
Title
Date
OFFICE USE ONLY Account Type
QD SC
Sic
Org LC
IA -- — — Sig ❑ N TR-1
Date
(continue on reverse side of this ,gage.)
LD
Tech Sig
OUR LITTLE STORE
Linda A. Fangmeier
Owner
4821 Yellowstone Dr.
Greeley, Co. 80634
FEIN 84-1353000
State Sales Tax No. 24 91662
Telephone (970) 3a9-9202
Fax N/A
OUR LITTLE STORE
Linda A. Fangmeler
Owner
4821 Yellowstone Dr.
Greeley, Co. 80634
Telephone (970) 339-9202
Fax N/A
Statement of storage of all beer being sold at "Our Little Store," located at 4821
Yellowstone Dr., Greeley, Co. 80634.
All beer inventory for sale at the above stated location will be stored in the walk-in cooler
at that location.
Our Little Store
Linda A. Fangmeier
Owner
9,�� 2 y3
U. S. G. P.O. 1989-234-555
PS Form 3800, June 1985
P 387 472 125
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED
NOT fOR INTERNATIONAL MAIL
(See Reverse)
LINDA FANGMEIER
dba OUR LITTLE STORE
4821 YELLOWSTONE
GREELEY CO 80634
Ilttltllttttllttttllttlttlltlttl
DRIVE
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 D 1
ICI1� I
Is your RETURN ADDRESS completed on the reverse side?
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Thank you for wing Return Receipt Service.
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This is a one room
Convenience Store that is
-2000-Sq. Ft. in size.
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Main Entrance
Service Entrance
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P 387 472 123
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED
NOT FOR INTERNATIONAL MAIL
(See Reverse)
Colorado Dept. Of Revenue
Liquor Enforcement Div.
- 1375 Sherman Street
Denver, CO 80261
Postage
g
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 Date
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