HomeMy WebLinkAbout961135.tiffRESOLUTION
RE: APPROVE CHANGE OF OWNERSHIP REQUEST FOR LIQUOR LICENSE FROM
RICE ENTERPRISES, INC., DBA FORT 21, TO DEEANN WILHELM AND RICHARD
WILHELM, DBA FORT 21
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, DeeAnn Wilhelm and Richard Wilhelm, dba Fort 21, presented to the Board
of County Commissioners of Weld County, Colorado, an application for a Change of Ownership
of a Tavern Liquor License, with extended hours, for the sale of malt, vinous and spirituous
liquors for consumption by the drink on the premises only, said license previously held by Rice
Enterprises, Inc., dba Fort 21, 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 Liquor License for the sale of malt,
vinous and spirituous liquors for consumption by the drink on the premises only, outside the
corporate limits of any town or city in the County of Weld at the location described as follows:
985 East 18th Street, Greeley, Colorado 80631-6135
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 96-12 to said applicant to sell malt, vinous and
spirituous liquors for consumption by the drink on the premises only, only at retail at said
location and does hereby authorize and direct the issuance of said license by the 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 July 11, 1997, providing that said place where the
licensee is authorized to sell malt, vinous, and spirituous liquors for consumption by the drink on
the premises only, 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.
961135
LC0034
d-e:CO; ,SEC Lrgc) 1-c.eT;/
CHANGE OWNERSHIP OF TAVERN LIQUOR LICENSE - FORT 21
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 24th day of June, A.D., 1996.
Deputy Cler o the Board
APP
S TO F
unty Attorney
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORAD
Barbary J. Kirkmeyer C rman
�ir-eJ ..'1 bfi► t�Gl�
onstance L. Harbert
& 1.1 A7/ ��W.j�/k2
Wter
961135
LC0034
THIS LICENSE `MUST 'BE POSTE
IN PUBLIC VIEW
DR 8402
(10/921
DEPARTMENT
ALCOHOLIC
STATE
OF COLORADO
OF REVENUE
Liquor Enforcement Division
1375 Sherman Street
Denver, Colorado 80261
WILHELM DEEANN
WILHELM RICHARD
FORT 21
985 E 18TH ST
GREELEY CO 80631-5135
•
BEVERAGE LICENSE
Account Number
Liability Information
LICENSE EXPIRES AT MIDNIGHT
County City Indust. Type Liability Date
23-71779-0000
03 206 5813 P 071296
JUL 11, 1997
Type
Name and Description of License
Fee
2010
2190
TAVERN LIQUOR LICENSE -
MALT, VINOUS, AND
SPIRITUOUS •
COUNTY 85 PERCENT OAP FEE
$ 50.00
$ 276.25
EXTENDED
This license
provision
nontransferable
only valid
be addressed
Street, Denver,
testimony
Division Director
TOTALFEE(S)
HOURS
is issued subject to the laws of the State of Colorado and especially
of Title 12, Articles 46 or 47. CRS 1973, as amended.
and shall be conspicuously posted in the place above described.
through the expiration date shown above. Questions concerning
to the Department of Revenue, Liquor Enforcement Division.
CO 80261.
whereof, I have hereunto set my hand.
.t1c.,t.t4 L sw lean
JUL 1 5 1996
$ 326.25
under the
This license is
This license is
this license should
1375 Sherman
Cl
Executive Dire for
961135
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THIS LICENSE EXPIRES
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DR 8411 (03/94)
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1375 SHERMAN STREET
DENVER CO 80261
LIQUOR LICENSING PROCESSING DOCUMENT
RETAIL LIQUOR &
3.2% BEER LICENSE FEES
I. Name of Applicant(s (exactly as it appears on state application)
f td I I rl'1 (Lind i lend- 'd IA/ he --1
2. Trade Name of Establishment (DBA)
FoY�a1
3. Address of Premises (as it appears on the application)
State Sales Tax No
985 E. ►�+->, S+
Business Phone
35,)-9910
County
W rld
City
G r
State
o
ZIP Code
�CD1o31
DO NOT WRITE IN THIS SPACE
• ALL ANSWERS MUST BE PRINTED IN BLACK INK OR TYPE-
WRITTEN
• APPLICANT MUST CHECK THE APPROPRIATE BOX(ES)
• LOCAL LICENSE FEE $ _ 3 , 7.'
2320-750 (999) SECTION A
FEES
If applicant has a Beer and Wine, or Malt, Vinous and
Spirituous Liquor License, indicate your state Liquor
• License Account No. a 3 - 'f / BPS -00 6 O
❑ Retail Warehouse Storage Permit $50.00
H Request to Change, Alter or Modify Premises ....75.00
❑ Addition of Optional Premises to Existing
HoteURestaurant $50.00 x Total Fee _
❑ Request to Change Corporate or Trade Name ...25.00
❑ Request to Change Location 100.00
❑ Duplicate License 25.00
❑ Subpoena Testimony Fees 100.00
(use license no. 21-94214)
2330-750 (999) SECTION B
FEE
If applicant has a 3.2% Beer Retail license, indicate your
• state 3.2% License Account No.
El Request to Change, Alter or Modify Premises 75.00
J Request to Change Corporate or Trade Name 25.00
LI Request to Change Location 100.00
• Duplicate License 25.00
1970-750 (999)
SECTION C FEES
If applicant has a Hotel/Restaurant liquor license and is
registering a new manager, indicate your state Liquor
• License Account No.
❑ Manager's Registration $75.00
UAB
SECTION D, LIQUOR UCENSE FEES
2300 L1 Application Fee for New License $450.00
2310 Application Fee for Transfer of Ownership cTT4
1940 [1 Retail Liquor Store License (city) 202.50
1940.: [1 Retail Liquor Store License (county) 287.50
1950' 0 Liquor Licensed Drugstore (city) 202.50
1950 0 Liquor Licensed Drugstore (county) 287.50
1960.:; 0 Beer & Wine License (city) 177.50
1960 ❑ Beer & Wine License (county) 262.50
1970 ❑ H & R License I ]city ❑ county 326.25
1980 ❑ H & R License w/opt Prem ❑ city [] county 326.25
1990 [-J Club License ❑ city ❑ county 135.00
2010 Tavern License ❑ city Igcounty ... 26.25,
2020 ❑ Arts License ❑city ❑ county 135.00
2030 ❑ Racetrack License ❑ city ❑ county 326.25
2040 ❑ Optional Premises License ❑ city ❑ county 326.25
1905 ❑ Retail Gaming Tavern Lic ❑ city L lcounty 326.25
2110 0 BWS Special Event Permit each 25.00
❑ Manager's Registraticn (hotel & restaurant only) .... 75.00
Extended Hours?0•acr
2300
2310
2121
2121
2122
2122
2123
2123
2170
SECTION E 3.2% BEER LICENSE FEES
❑ Application Fee for New License $450.00
❑ Application Fee for Transfer of Ownership 450.00
❑ 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
❑ Retail 3.2% Beer Off Premises - (county] 92.50
Retail 3.2% Beer On/Off Premises - (city) 71.25
I ] Retail 3.2% Beer On/Off Premises - (county) 92.50
C: 3.2% Beer Special Event Permit each 10.00
DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY
UABIUTY INFORMATION
County
City
Industry Type
Liability Date
License Issued Through
(Expiration Date)
License Account Number
Fee paid for 3.2% Beer
Fee paid for Beer, Wine, and Spirituous Liquor
State:..:.:
-750{999)
City
2180-100 (999)
County
2190-100 (999)
Stale
-750 (999)
City
2180-100 (999)
County
2190-100 (999)
Managers Reg
1970-755 (999)
Cash Fund New Linen**
2300-100
(999)
Cash Fund hens er Lies**
2310-100
(999)
TOTAL
Cash Furl rim LbwW
2300-100
(999)
Cash Fund Transfer
2310-100
999)
Ext Hours City
2180-100
(999)
Ext Hours County
2190-100
(999)
TOTAL
White Copy - Department of Revenue Canary Copy - Liquor Enforcement Division
Pink Copy - Local Authority 16r 135Applfcant
DR 8404 (02/94)
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1375 SHERMAN STREET
DENVER CO 80261
COLORADO LIQUOR OR 3.2 % FERMENTED MALT BEVERAGE
LICENSE APPLICATION
1. Applicant is a
Corporation (Attach DR 8177) Individual (Attach DR 8404-I)
Lg Partnership (Attach DR 8441) Limited Liability Company (Attach DR 8405)
Date filed witb Local i)utho ity /1"--//q6
F.E.I.N.
la. t�lame of Applicant(s), If partnership,
(vlee/ ;:r1 L,.;'I
list pa ners' names (at least, two); if corporation, name of corporation
Ihe--Jrn l Wtra inJi Ihe-Im
Social Security No.
2. Trade Name of Establishment (DBA)
State Sales Tax No.
a.�� — 7/ r, �9
Business Telephone
e 1
3. Address of Premises (specify exact location of premises)
City
County
State
ZIP Code
4. Mailing Address (Number and Street)
=',' 6.I .1 ,.;In S;
City or Town
e-e(ey
State
rt)
ZIP Code
6631
5. If the premises currently have a liquor or beer license, you MUST answer the following question:
Present Trade Name of That Establishment (DBA)
Present State License No.
.�.,&".'CCo
Present Type of License
Present Expiration Date
'-)-:r-t rt
6. Is the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or officers, stockhold- Yes No
ers or directors if a corporation) or manager under the age of twenty-one years? ❑ ®'
7. Has the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or officers, stockhold-
ers or directors if a corporation) or manager ever; ❑
(a) been denied an alcoholic beverage license? DI -
(b) had an alcoholic beverage license suspended or revoked? • ®'
(c) had interest in another entity that had an alcoholic beverage license suspended or revoked? ❑ EA
If you answered yes to 7a, b or c, explain in detail on a separate sheet.
8. Has a liquor license for the premises to be licensed been refused within the preceding two years? If "yes," explain in detail. i1
Ba. Has a 3.2 beer license for the premises to be licensed been refused within the preceding one year? If "yes," explain in detail. III Q
9. Are the premises to be licensed within 500 feet of any public or parochial school, or the principal campus of any college, university or II(�-
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. Does the Applicant, as listed on line 1 a of this application, have legal possession of the premises for at least 1 year from the date that
this license will be issued by virtue of ownership or under a lease? (If yes, attach a signed copy of deed or lease.) EA. Q
M Ownership ❑ Lease ❑ Other (Explain in Detail)
a. If leased, list name of landlord and tenant, and date of expiration, EXACTLY as they appear on.the lease:
Landlord
Tenant
Expires
Attach a diagram of the area to be licensed (including dimensions) which shows the bars, walls, partitions, entrances, exits and 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 sca e)
12. Who has (including persons, firms, partnerships, corporations, limited liability companies) or 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
ADDRESS
INTEREST
hi/N
Attach copies of all notes and security instruments, and 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. Optional Premises or Hotel and Restaurant Licenses with Optional Premises
All Optional Premises applicants must attach a copy of the local ordinance or resolution authorizing the issuance of Optional Premises
licenses.
Number of separate Optional Premises areas requested
LO-D3t1
DR 8404 (2/94) Page 2
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
❑ ■
15. Club Liquor License applicants answer the
(a) Is the applicant organization operated
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)
following and attach DR 8177:
solely for a national, social, fraternal, patriotic, political or athletic purpose and
chartered branch, lodge or chapter of a national organization which is
or fraternal organization or society, but not for pecuniary gain?
(d) How long has applicant occupied the premises
to be licensed as a club?
• •
• ❑
16. Colorado Manufacturer, Wholesaler or Limited Winery applicants, answer the following:
(a) Will the applicant store or sell alcoholic beverages at more than one location in Colorado? If "yes,' provide the
address of each location and explain the activity to be conducted at each location (e.g., warehouse, salesroom, etc.)
(Attach DR 8438 for each location)
(b) If applicant is a wholesaler, does or did any owner, partner, shareholder, director, officer, member or manager have any
or indirect financial interest in a wholesaler, retailer, manufacturer or importer already licensed by the State of Colorado
malt, vinous or spirituous liquor? If yes, attach explanation in detail.
(c) Does the applicant have a valid Federal Basic Permit or Brewers Notice? If "yes; attach a copy; If 'no," explain whether
one has been applied for.
• •
direct
to sell
❑ ❑
• ■
17. Nonresident Manufacturer (3.2% beer or malt liquor) or Importer
the following:
(a) To what Colorado licensed wholesaler do you intend to
(b) Does or did any owner, partner, shareholder, director, officer,
interest in a wholesaler, retailer, manufacturer or importer
spirituous liquor? If yes, attach explanation in detail.
(c) Does the applicant have a valid Federal Basic Permit or
(d) Are you the primary source of supply in the U.S.? If "no,"
(e) Are all your products registered in Colorado? If "no," attach
(3.2% beer, malt, vinous or spirituous liquor) applicants, answer
ship your merchandise?
member or manager have any direct or indirect financial
already licensed by the State of Colorado to sell malt, vinous
Brewers Notice? If 'yes,' attach a copy; if "no,' explain in detail.
explain.
DR 8440 and register said products.
or
❑ •
5 ■
■ ❑
• ❑
18. Name of Manager (If this is an application for a Hotel and Restaurant License, the manager must also submit a Manager Registration Form
(DR 8367) and Individual History Record (DR 8404-I).
Date of Birth
OATH CF APPLICANT.
I declare under penalty of perjury in the se d degree h /t t ii ap licatio-n and / all attachments are true, correct, and
complete to the best of my knowledge. 4#//i14,-/74 /7/ ,vs,(�'
Authorized Signature
Ti 777
0Wn f-S/par{-ile_r6
Dew
toilll96
REPORT
(Manufacturers, nonresident manufacturers,
AND APPROVAL OF'LOCAL LICENSiNG A f' ORITY:'
Importers, Whpte:SSISISb wlnerl a 1 N€4 �'
disregatdthe Section below) a . .
Is this application for a: U New License g Transfer
Each person required to file DR 8404-I:
Has been fingerprinted
Background, NCIC and CCIC checked
The liquor licensed premises is ready for occupancy and has
If "no," the building will be completed and ready for inspection
of Ownership ❑ Other (specify)
been inspected by the Local Licensing Authority.
by
Yes No
■
■
g ■
(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 the provisions of Title12 license, if g
with nArticle willthe r requirements desires o the inhabitants, and will comply
l46or RE, THIS APPLICATION S APPROVED
Local Licensing Authority for
WE'D COUNTY, COLOMBO
■
TOWN, CITY
COUNTY
r
sag re
I e r-
�<4A.1
0. COT
WELD
WFLD C01FNTY BOARD
ISSIUNERS
Date
06/24/96
1gn ur (attest j
/rn
•I>>
i
M�1 .�+
THE BOARD
C%ylc WA_/ , DEPUTY
Date
06/24/96
in !4`•+l'
Ir premises are located within a town or city, v o uld signed by the mayor and clerk, if in a county, then by the chairman of the
board of county commissioners and the clerk to a ordinance or otherwise, the local licensing authority is some other official, then such
approval should be given by such official.
961135
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961135
PLAIN'S REAL ESTATE
The printed portions of this form have been approsed
by the Colorado Real Estate Commission. (CBS 2-9-95)
'11115 FORM HAS IMPISH IAN ILEGALCONSEQUENCES AND 'lilt PAR' i4S SI IUtll.n CONSUL LEGAI. AND I AX OR U 1111.11( (ANSEL BEFORE; SIGNING.
COMMERCIAL,
CON'I'RAC'I''I't) BUY ANI) SELL REAL ES'FA'I'1':
I. PAHLIRS AND PROPERTY.
J(jne 10
, 19 96
__Ri char_d1ea_ Wi l het m_ and_-DeeAnn /Wi/l/hel m
buyers) I"t(ycul. (as joint tenants/Immnls in common)
agrees to buy, and the undersigned seller(s) ISih(e/L agrees to sell, on the terms and conditions set forth in this contract, the following described real
estate in the County of _.__Wells----._— _-._—___, Colorado, to wit:
PT E2 L7 NW4Se4 & PT W2A L3 NE4SE4 9 5 65 BEG 40'W OF SE C0R 0 F W2A L3 N180'
W260' S180' E26 0' TO BEG LOT -A REC EXEMPT RE -333
known as No. _9$3 & 975 F 18th Street _reeley CO 0631
Sired Address (_1'y
Stan to
together with all interest of Seller in vacated streets and alleys adjacent thereto, all casements and other appurtenances thereto, all improvements
thereon and all attached fixtures thereon, except as herein excluded (collectively the Properly).
2. INCLUSIONS/EXCLUSIONS. The purchase price includes the following items (a) if attached to the Property on the date of this con-
tract: lighting, heating, plumbing, ventilating, and air conditioning fixtures, TV antennas, water softeners, smoke/fire/burghs alarms, security
devices, inside telephone wiring and connecting blocks/jacks, plants, mirrors, floor coverings, intercom systems, built-in kitchen appliances, sprinkler
systems and cunt ruts; (b) if un the Property whether alluched or not on the date of this contract: storm windows, storm doors. window and porch
shades, awnings, blinds, screens, curtain rods, drapery rods, all keys and (c)
All things currently on premises owned by sellers including but not limited to
all inventory, supplies, equipment, etc.
The above -described included items (Inclusions) are to be conveyed to Buyer by Seller by bill of sale at the closing, free and clear of all taxes, liens and
encumbrances, except as provided in Section 12. 1lte following attached fixtures are excluded from Ibis Sale:
None
G
$ in the form of CkP�C , as eernest money deposit and part payment of the purchase
price, payable to and held by _Plains_ _ Real Estate, I rics broker, in its trust
account on behalf of both Seller and Buyer. Broker is authorized to deliver the earnest money deposit to the closing agent, if any, at or before closing.
The balance of $ 159,110.0_ 00 (purchase price less earnest money) shall be paid as follows:
(h) Cash at Closing.
$ _9_,.000.-00___._ _ , plus closing costs, to be paid by Buyer at dosing in funds which comply with all applicable Colorado haws, which
include cash, electronic transfer finds, colitied check, savings and loan teller's check, and cashier's check ((loud funds). Subject to the provisions of
Section 4, if the existing loan balance at the time of closing shall be different from the loan balance in Section 3, the adjustment shall be made in
Good Funds at closing or paid as follows- none other
3. l'IIItCIIASE PRICE AND TERMS. The purchase price shall be $, payable in U.S. dollars by Buyer as
follows: (Complete the applicable terms below.)
r - 6--1(-96
(a) Earnest Money.
(e) New luau. _—____._—______
.- . -
$ by Buyer obtaining a new loan. This loan will be secured by a (IsC, 2nd, etc.) deed of Gust.
The loan shall be amortized over a period of years at approximately $ per month including principal and
interest not to exceed % per annum, plus, if required by Buyer's lender, a 'notably deposit of V: of the estimated annual real estate
taxes, property insurance premium, and mortgage insurance premium. If the loan is an adjustable interest rate or graduated payment loan, the
monthly payments and interest rare initially shall not exceed the figures set forth above.
Loan discount points, if any, shall be paid to lender at closing and shall not exceed % of the total loan amount Notwithstanding
the loan's interest rate, the first loan discount points shall he paid by
and the balance, if any, shall be paid by
Buyer shall timely pay a loan origination fee not to exceed % of the loan amount and Buyer's loan costs.
(d) Assumption. -
$ by Buyer's assuming and agreeing to pay an existing loan in Ibis approximate amount, presently payable at
pe
r er annum, and including escrow for the
$ per month principal, interest presently al 1
following as indicated: U real estate taxes, U property insurance premium, CI mortgage insurance premium and
. Buyer agrees
to pay a loan transfer lee not to exceed $— At the time of assumption, the new interest rate shall not exceed %
per annum and the new monthly paYtttent shall nol exceed $ principal :and interest, plus escrow, if any.
Seller U shall Ll shall not be released from liability on said loan. If applicable, contplia see with the requirements for release from liability
shall be evidenced by delivery al closing of an appropriate letter from lender. Cost payable for release of liability shall be paid by — in an amount nut to exceed $
No.CBS2-9-95. CUNINII'.R( IALI'11NTRACE I U n111' AND.SF:1.1. REAL. ESIAFE Page I of4
acritold Bibb-mo'i I ill R'ertt' Si.. 1)Cn'rl, I U 511211' (11'02'x_25011 -10t
�IIIj-)
111,111
961135
(e) Seller or Private. 1Lird-Tarty Financing.
$-20.,000-_UII by Buyer executing a promissory note payable hr Rice Enterprises InCs._
_ ______ ___._—_ on the note form as indicated: (Check one box only.)
1 I RighA(o-Clue Nil) 82-I I-83 IX No Right to -(tile N I D 81-11-83 I L.
�s�eyul seem by a (IM, 2nd, etc.) _ ... 1St__ -.. deed of lutist encuulbering the homily, using the limn as indicated: (('beck one box only.)
YNStrict Due -on -Sale (11) 72-I1-8)) I I Creditworthy (ED 73 -I1 -X3) I I Assumable - Not due on sale (AI) 74-I1-83)
I1
The promissory nose shall he amortized on the basis of 19— years, payable at $ ___14013.41-_— -_-_. ___ per month including principal and
interest at the rate of 9 'Yu per annual. I`)ymenls shall commence —__ August 1 L 1 996
and shall be due on the 1 St_ day of each succeeding month. If not sooner paid, the balance of principal and
accrued interest shall be due and payable._ J111 y 1 , 2006 alter closing. Payments El shall U shall not be
Increased by kb of estimated annual real estate taxes, and I I shall XI shall not be Ina eased by VI, of estimated annual properly insurance premium.
The loan shall also contain the following terms as indicated: If any payment is not received within 15 calendar days after its due date, a late charge of
5 96 of such monthly payment shall be due. Interest on lender disbursements under the deed of trust shall be 7 % per annum.
Default interest tate shall be 1— . % per annual.
Buyer may prepay without a penalty except nn._ prepa yment._penalty
4, FINANCING C/ .. In.IGAIIONs _.. __. . ______ .__—____ -__ _ ___
(a) Loan Application(s). If Buyer is to pay all or part of the purchase pace as set forth in Section 3 by obtaining a new loan or if an existing loan is not to be
released at closing, Buyet, if required by such lender, shall make written application within calendar days horn acceptance of this contract. Buyer shall
cooperate with Seller and lender to obtain loan approval, diligently and timely pursue same in good faith, exearte all documents and furnish all information and
documents required by the lender, and, subject to Section 3, timely pay the costs of obtaining such hian or lender consent. - -
(b) Ivan Approval. If Buyer is to pay all or part of the purchase price by obtaining a new loan as specified ill Section 3, this contract is conditional upon tender's
19 -- If not so approved by said date, this contract shall terminate.
approval of the new loan on or before i
(c) Existing IAtoll Review. If all existing has is not to be released at closing, SCI Icr shat) Provide copies of the loan documents (including note, deed of trust,
nadificatu ns) to Buyer within _ _—_ caloular days from acceptance 9f this contract. this cuntI act is conditional upon Buyer's review and approval of the
provisions of such loan documents. Buyer consents to the pr ovisionx of such loan duce owns if no written objection is received by Seller IFum Buyer within .-
calendar days from Buyer's receipt of such documents. If the lender's approval of a transfer of the Property is required, this contract is conditional upon Buyer's
obtaining such approval without change in the terms of such loan, except as set forth in Section 3, If lender's approval is not obtained on or before
, l9 , this contract shall be ter nlin:lied on such date. If Seller is to be released from liability under such existing loan and
Buyer does nut obtain such compliance as set forth in Section 3, this contract may be ten nitiated at Seller's option.
(d) Assumption BBlanre. If Buyer is to pay all or part nl the purchase price by assuming: n existing loan and if the actual principal balance of the existing loan at
the date of dasitig is less than the amount in Section 3 and Ire amount of cash required li nto Iluyer at dosing is increased by more than $
Theni3lhyef may terminate this contract ellclive upon receipt by Seller 111 liuysr5 wflhert notice of termination...
s ... ( ___ _._..
(e) Credit Information. If Buyer is to pay all or part of the purchase price by excc'uling a Vronussnry mule in, lirvnr of Seller or if al existing loan is not to be
released at closing, this contract is conditional upon Seller's approval of Buyer's financial ability and creditworthiness, which ahploval shall be at Seller's sole and
absolute discretion. In such case; (I) Buyer shall supply to Seller on or befiire—_._aline 24 ,19 ____g6 , at Buyer's expense, information and
documents concerning Buyer's financial, employment and credit condition; (2) Buyer consents that Seller may verify Buyer's financial ability and r redil worthiness;
(3) arty such inlOrntation and documents received by Seller .shall be held by Seller in confidence, and not released to others except to pi elect Seller's interest Sein lles
r
transaction; (4) if Seller does not provide written notice of Seller's disapproval to Buyer on or before �
waives this condition, If Seller does provide written notice of disapproval to Buyer on or before said date, this contract shall terminate.
5. APPRAISAL PROVISION. (Check only one box.) This Section 5 shall Ll shall not apply.
If this Section 5 applies, as indicated above, Buyer shall have the sole option and election to terminate this contract if the purchase price exceeds the Property's
valuation determined by all appraiser engaged by __ -
buyers_—_— — , The contract shall terminate by the ProBuyer causing the Seller to receive written notice of termination and a copy of such appraisal or wiitien notice lion lender which confirms the (nl,l raks:d Deadline).
p rty's valuation is
less than the purchase price, on or before
June 26�_J99�_ —
If Seller does not receive such written notice of termination on or before the appraisal deadline, Buyer waives any right to terminateunder this securn.
6. COST OF APPRAISAL. Cost of any appraisal to be obtained after the date of this contract shill be timely paid by
7. NOT' ASSIGNA III.E. This contract shall not be assignable by Buyer without Seller's prior written consent. Except as so restricted, this contract shall inure
to the benefit of and be binding upon the heirs, personal representatives, successors and assigns of the parties.
8. EVIDENCE OF 'RILE. Seller shall furnish to Buyer, at Seller's expense, either a current commitment owner's letle insurance policy in an amount
to a re equal to the purchase price or at Seller's choice, an abstract of line ee(P it dl )eadlhc). Iatitleinsuralccommitment is ffu
lf ate, hn or ures?r-nnished, Buyer may require of Seller that
copies of instruments (or abstracts of instruments) listed in the schedule of exceptions (Exceptions) its the title insurance commitment also be furnished to Buyer at
Seller's expense. This requirement shall pertain only to instmmnons shown of record in the office of the clerk and recd der of the designated county or counties. The
title insurance commitment, together with any copies or abstracts of instruments furnished pursuant to this Section 8. constitute the title docuI ileitis (Title Docu-
ments). Buyer, or Buyer's designee, must request Seller, in writing, to furnish copies or abstracts of instruments listed in the schedule of exceptions no later than
calendar days after Title Deadline. If Seller furnishes a title insurance conunitnlent, Seller will pay the premium at closing and have the title insurance
policy delivered to Buyer as soon as practicable after closing.
(a)Tide Review. Buyer shall have the right to inspect the Mille Documents or abstract. Wither notice by Buyer of unmenchanlabUity of title or of any other
unsatisfactory title condition shown by the Title Documents or abstract shall be signed by or on behalf of Buyer and givers 3 calendar
to Seller on or before _
days after Title Deadline, or within five (5) calendar days after receipt by Buyer of ally Title Document(s) or endorsement(s) adding new Exception(s) to the title
commitment together with a copy of the Title Document adding new Exception(s) to title. If Seller does not receive Buyer's notice by the date(s) specified above, Buyer
accepts the condition of title as disclosed by the Title Documents .1> .:tkr:tu ory.
(b) Matters Nut Shown by the Public Records. Seller shall deliver buyer, on or before the Mlle Deadline lie set Itlnth iii Section 8, Itue copies of all lease(s) and
survey(s) in Seller's possession pertaining to the Property and shall disclose to Buyer all easements, liens or other title matters not shown by the public records of
which Seller has actual knowledge. Buyer shall have the right to inspect the Property to determine if any third part yes) has any right in the Properly not shown by the
public records (such as an unrecorded easement, unrecorded lease, or boundary line discrepancy). Written notice of any un atislacttrry condilionys) discloIf Seller
sed by
or revealed by such inspection shall be signed by or on behalf of Buyer and given to Seller on or before June �_
does not receive Buyer's notice by said date, Buyer accepts title subject to such nights, if any, of third parties of which Buyer has actual knowledge.
(c) Special Taxing Districts. SPECIAL TAXING 0151 RICIS MAY BE SUIIJ EOI"It(;ENERAL OBLIGAtION 1NDKUI EDNESS-thAf IS PAID IIY RE\ F.NIIES PRODUCED
FROM ANNUAL TAX LEVIES ON THE TAXABLE PROPER IV \\ LIMN SUCH 1)151RWIS PROPER FY OWNERS IN WO' DISIRI(TS MAY BE PLACID Al RISK FOR
INCREASED MILLLEVIES AND EXCESSIVE TAX RIIRDENS TO SIIPPORI Il1F SERVICING OF Sliril DEBT' WIIFFIE: CIRC11MSl AN( ES ARISE R4stnl,t1NC IN THE INABILITY
OF SUCH A DlSMICf TO DISCHARGE S(I(.11 UNDER' EoNESS WICHOUI MICII AN INCREASE IN MILL LEVIES. DU\ER SHOULD INVESntGAli. tin', DFltf FINANCING
RFQUIREMEN IS OF THE AII'I'IONIZED GENF:BA'. 11111 u;AIION INDEBTEDNESS OF SUCH DIS'I RIMS, EXISTING NMI. LEVIES 01' SUCH DISIRlt't SERVICING SUCH
INIIFBI EDNE:SS, AND )LIE Pot EN IIAI. FOR AN INCREASE IN SG('ll FIILI, LEVIES. 961135
nl,, (11\0 0 n5 P:OO' 7 of I '
In the event the Property is located within a special taxing district and Buyer desires to terminate this contract as a Iesull, if written notice is given to Seller on or
before the dale set forth in -subsection 9 (b), this contract shall then terminate. If Seller does not receive Buyer's notice by the date specified above, Buyer accepts the
effect of the Property's inclusion in suet, special taxing district(s) and waives the right to so lei ntinale.
(d) Right to Cure. If Seller receives notice of u snterchantability of title or any other unsatisfactory title condition(s) as provided in subsection (a) or (b) above,
Seller shall use reasonable ellint to correct said unsatisfactory title conditions) prior to the date of closing. If Seller fails to correct said unsatisfactory title condition(s)
on or before the date of closing, this contract shall then terminate; provided, however, Buyer may, by written notice received by Seller, on or before closing, waive
objection to said unsatisfacuuy title condition(s).
It). INSPECIION. Buyer or any designee, shall have the right to have inspection(s) of the physical condition of the Property and Inclusions, at Buyer's
expense. If written notice of any unsatisfactory condition, signed by or on behalf of Buyer, is not received by Seller on or before June_24
19 96 (Objection Deadline), the physical condition of the Prnpert y and Inclusions shall be deemed to be satisfactory to Buyer. If such notice is received by Seller
as set forth above, and if Buyer and Seller have not agreed, in writing, to a settlement thereof on or before JunP 26 19 96 (Resolution
Deadline), this contract shall terminate three calendar days hollowing the Resolution Deadline; unless, within the three calendar days, Seller receives written notice
from Buyer waiving objection to any unsatisfactory condition. Buyer is responsible linr and shall pay for any damage which occurs to the Property and Inclusions as a
result of such inspection.
II. DATE OF CLOSING. The date of closing shall he Anne__2B T 19_9_6 or by mutual agreement at an earlier date. The hour
and place of closing shall be as designated by Plains ns Real Estnta,_lhc
12. TRANSFER OF TITLE. Subject to tender or payment at closing as required herein and compliance by Buyer with the other terms and provisions hereof,
Seller shall execute and deliver a good and sufficient fienera l Warranty deed to Buyer, on closing, conveying the Property free and
clear of all taxes except the general taxes for the year of closing, and except nonE_e_that
title shall be conveyed free and clear of all liens fur special improvements
installed as of the date of Buyer's signature hetcon, whether assessed or not; except (i) distribution utility easements (including cable IV), (ii) those matters reflected
by the Title Documents accepted by Buyer in accordance with subsection 9(a), (iii) those rights, if any, of third parties in the Property not shown by the public records
in accordance with subsection 9(b), (iv) inclusion of the Pauper y within any special taxing district, and ( v) subject to building and toning regulations.
O. PAYMENT OF ENCUMBRANCES. Any encumbrance required to be paid shall be paid at or before closing from the proceeds of this-lransaction or
from any other source.
14. CLOSING COSTS, IIOCUIIIENTS AND SERVICES. Buyer and Seller shall pay, in Good Funds, their respective dosing costs and all other items
required to be paid at closing, except as otherwise provided herein. Buyer and Seller shall sign and complete all customary or required documents at or beIi re
closing. Fees for real estate closing services shall not exceed $ -- 125..00 and shall be paid at closing by 1-/2 sal ler
__I/2 buyers— The local transfer tax of __Ilia_ %of the purchase price shall be paid at closing
by buyers Any sales and use tax that may acct ue because of this transaction shall
be paid when due by
IS. PROBATIONS. General taxes for the year of closing, based on the taxes for the calendar year immediately preceding closing, rents, water and sewer
charges, owner's association dues, and interest ran cunt iniiing loan(s), if any, and . _ _.__— — none_other _ ---
... _. shall be inprate l to dale of dosing.
16. POSSESSION. Possession of the Property shall be delivered to Buyer as billows:
Date of closing
, subject to the following lease(s) or tenancy(s):
those currently in existence
If Seller, after closing, fails to deliver possession on the date herein specified, Seller shall be subject to eviction and shall be additionally liable to Buyer for payment of
$ per day from the date of agreed possession until possession is delivered.
17. CONDI ZION OF AND DAMAGE TO PROPERTY Except as otherwise provided in this contract, the Property and Inclusions shall be delivered in the
condition existing as of the date of this contract, ordinary wear and tear excepted. In the event the Property shall be damaged by fire or other casualty prior to time of
closing, in an amount of not more than ten percent of the total purchase price. Seller shall be obligated to repair the same before the date of closing. In the event such
damage is not repaired within said time or if the damages exceed such suns, this cunt, act may be terminated al the option of Buyer. Should Buyer elect to carry out
this contract despite such damage, Buyer shall be entitled to credit for all the insurance proceeds resulting from such damage to the Property and Inclusions, not
exceeding, however, the total purchase price. Should any Inchrsion(s) or service(s) fail or be damaged between the date of this contract and the dale of closing or the
date of possession, whichever shall be earlier, then Seller shall be liable for the repair or replacement of such Inelusiun(s) or services) with a unit of similar size, age
and quality, or an equivalent credit, less any insurance proceeds received by Buyer covering such repair or replacement.
18. TIME OF ESSENCE/REMEDIES. Time is of the essence hereof If any note or check received as car nest money hereunder or any other payment due
hereunder is not paid, honored or tendered when due, or if any other obligation hereunder is not performed or waived as herein provided, there shall be the following
remedies:
(a) IF BUYER IS IN DEFAUI:1:
(Check one box only.)
[(I (I) Specific Performance.
Seller may elect to Beat this coil lad as cancelled, in which case all payments and things of value received hereunder shall be forfeited and retained on behalf
of Seller, and Seller may recover such damages as may be proper, or Seller may elect to treat this contract as being in full force and ellect and Seller shall have
the right to specific performance or damages, or both.
U (2) Liquidated Damages.
All payments and things of value received hereunder shall be forfeited by Buyer and retained on behalf of Seller and both parties shall thereafter be released
front all obligations hereunder. It is agreed that such payments and things of value arc LIQUIDATED DAMAGES and (except as provided in subsection (c))
are SELLER'S SOLE AND ONLY REMEDY for Buyer's failure to perform the obligations of this contract. Seller expressly waives the remedies of specific
performance and additional damages.
(b) IF SELLER IS IN DEFAIJUle
Buyer may elect to treat this contract as cancelled, in which case all payments and things of value rend red hereunder shall be returned and Buyer may
recover such damages as may be proper, or Buyer may elect to treat this contract as being in full force and effect and Buyer shall have Ilse right to specific
performance or damages, or both.
(c) COSIS AND EXPENSES.
Anything to the contrary herein notwithstanding, in the event of any arbitration or litigation arising out of this contract, 0warbitrator for or court shall award
to the prevailing party all reasonable costs and expenses, including attorney lies.
19. EARNEST MONEY DISI'U'fE. Notwithstanding any lerrninaliun of this control, Buyer and Seller agi re that, in the event of anyconhoversy regarding
the earnest money and things of value held by broker or dosing agent, unless mutual written instructions are received by the holder of the earnest money and things of
value, broker or closing agent shall not be required to take any action but may await any proceeding, or at broker's or closing agent's option aid sole discretion, may
interplead all parties and deposit any limners or things of value into a court of competent jurisdiction and shall Iccnner court costs and reasonable attorney fees.
20. Al:h ERNAI'I YE DISPUTE RESOLUTION: MEDIATION. If a dispute arises relating to this contract, and is not resolved, the parties and brokers)
involved in such dispute (Disputants) shall first proceed in good faith to submit the matter to mediation. The Disputants will jointly appoint an acceptable mediator
and will share equally in the cost of such mediation. In the event the entire dispute is not resolved within thirty (31)) calendar days from the date written notice
requesting mediation is sent by one Disputant to the other(s), the mediation, unless otherwise agreed, shall lei urinate. ibis section shall not alter any date in this
contract, unless otherwise agreed.
r
NO. (1152-9-95. I 'age 3 of -1 _ c /r% la to
961135
D. ADDIIIONAI. PROVISIONS: (1 he language of Ibcsc additional tam pions has not been apprurcd by the I1-0wad,, Kcal fsmte Conunissiun)
The language in this section has not been approved by the Colorado Real Estate Cmmission. It has
been prepared by Plains Real Estate, Inc.
1. N/A in this contract shall mean non -applicable.
2. Right -To -Buy Addendum attached hereto and made a part hereof.
3. Sellers and Buyers agree to use attornies to 1. Review these contracts prior
to closing and pay for same, as well as 2. Write and approve the business
portion of this transaction.
4. Jack V. Rice and Carol L. Rice will Quit Claim the real estate portion of this
property to Rice Enterprises Inc., Jack V. Rice, President, as per their CPA's
instructions, then sell it to Richard Lee Wilhelm and DeeAnn Wilhelm along with
the business.
22. RECONI1 IENDAlION O1' LEGAL COUNSEL. By signing this document, Buyer and Seller acknowledge that the Selling Company or the Listing
Company has advised that this document has important legal consequences and has recommended the examination of tide and consultation with legal and tax or
23. 'FERMI NATION. In the event this contract is terminated, all payments and things of value received hereunder shall be returned and the parties shat e
other counsel before signing this contract.
relieved of all obligations hereunder, subject 10 Section 19. P131 O S Rea-1—(=5tatE Inc.
24. SELLING COMPANY BROKER RFI.A IIONSIIDt 1 h selling broker, ,
,and its salespersons have been engaged as _—trangac-ti-on—broker
Selling Company has previously disclosed in writing to the Buyer that dilt''erent relauouships arc available which include buyer agency, seller agency, subagency, or
25. NOTICE TO BUYER. Any notice to Buyer shall be elieclive when received by Buyer, or, if this box is checked Ltransaction-broker.
I when received by Selling Company.
26. NOTICE TO SELLER. Any notice to Seller shall be effective when received by Seller or Listing Company.
2'). MODIFICATION OF II IIS CONTRACL No subsequent modification of any of the terms of this contract shall he valid, binding upon the parties, or
enforceable unless made in writing and signed by the parties.
28. ENTIRE AGREEMENT. This contract constitutes the entire contract between the parties relating to the subject hereof, and any prior agreements
pertaining thereto, whether oral or written, have been merged and integrated into this contract.
29. NOTICE OF ACCEPTANCE.: COUNTERPARTS. 1his proposal shall expire unless accepted in writing, by Buyer and Seller, as evidenced idencedcby their
signatures below, and the offering party receives notice of such acceptance on or before Jslne 12
Deadline). II accepted, this document shall become a contract between Seller and Buyer. A copy of this document may be executed by each party, separately, and
h .. .. rty has executed a copy thereof, such copies taken together shall be deemed to be a full and complete contract between the parties.
i .1 nd aLe gayer DeeAnn Wilhelm
gayer c and e• Wit elm,/
19 Date of Buyer's signature i es - I
Date of Buyer's signature N '1
Buyer's Address
Rice Enterprises Inc.
Seller
Date of Seller's signature
b- /2
,19—`Q
selkr by Jack V. Rice President
p
, 1')1 l/ Dale of Seller's signature_—
,I976
Seller's Address
The undersigned Broker(s) acknowledges receipt of the earnest money deposit specified in Section 3, and Selling Company confirms its Broker Relationship as set
forth in Section 24.
Selling Company?lslins.-deal Eatate. Inc. 3700 W. 1NOthame an� StreetAddress
By:
Sign
James H. Dech
Listing Company
By:
Greeley, CO 80634
Dice
th-Street. Greeley, CO 80634
Name and Addicts
Dale
/,6
19
,19
Signairc
ices
H. Dech
NOTE: Closing Inslruclinns should be signed at the time this contract is signed.
961135
Nn t It ', ,I -OS I`.nn' 1 HI •I
THIS ADDENDUM IIAS NOT BEEN APPROVED -BY TIIE COLORADO REAL ESTATE COMMISSION. IT WAS
PREPARED BY LEGAL COUNSEL., -FRASCONA, JOINER AND GOODMAN, Y.C. FOR USE BY COLIIWELL
BANKER PLAINS REAL ESTATE, INC.
THIS IS A LEGAL INSTRUMENT. IF NOT UNDERSTOOD, LEGAL, TAX OR OTHER COUNSEL SHOULD BE CONSULTED BEFORE SIGNING.
RIGHT -TO -BUY ADDENDUM
(Delete as Appropriate)
Unless stricken, the following provisions are hereby incorporated into the right -to -buy agreement dated
June 10. 1996 , between Broker and Richard I PP Wi 1 helm and DPPAnn Wilhelm as Buyer.
A. Broker and its agents (collectively hereinafter "Broker") have been consulted only for assistance in locating
real property for purchase and in negotiating the terms and conditions of such transaction. Buyer has been advised
to seek the advice of professionals, (e.g. attorneys, appraisers, surveyors, contractors, engineers, property
inspectors, environmental hazard and radon gas experts, etc.) for all other information related to any real estate
transaction.
B. It is recommended by Broker that Buyer obtain a general inspection of any Property and Inclusions and
a written report related thereto from a reputable inspection company, and a separate written report from specialists,
if recommended by the general inspector, or if there is concern on the part of Buyer regarding the Property and
Inclusions before irrevocably committing to its purchase. Buyer should obtain written cost quotations for all work
recommended so as to be fully aware of the potential costs of repairs, maintenance, improvements and/or upgrades
which may be needed.
C. Buyer acknowledges that it has been made aware that homeowners warranty insurance programs are
available and may be purchased. Buyer is encouraged to evaluate the terms of coverage and financial strength of
any company offering to issue such a warranty.
D. Broker recommends that Buyer obtain an improvement location certificate and/or survey of any Property
before irrevocably committing to its purchase to determine lot size, location of improvements, square footage, and
any encroachments that may exist. Buyer acknowledges that the square footage advertised is generally the amount
shown in the county records or an estimate determined by the listing agent or the seller and should be verified by
Buyer. Information presented concerning financing terms, schools, zoning and other features of Property may be
incorrect. Buyer should verify all information using experts of their own choosing, complying with the dates of
inspection.
E. Buyer shall independently research the present value and future marketability of properties, commodities,
notes, and things of value to be given or received.
F. Buyer acknowledges that Buyer's financial ability to close a proposed transaction will be a material
consideration for a seller who receives an offer to purchase from Buyer. Broker, al a seller's request, may obtain
and provide Buyer's credit report to such a seller.
G. On new loans, Buyer should obtain a written commitment from the lender concerning interest rate, points,
and other costs.
H. State and federal laws prohibit discrimination. Broker offers equal service to everyone regardless of race,
creed, color, religion, national origin, ancestry, sex, marital or family status, sexual preference, or physical or
mental handicap. No such information, comments, or opinions will be discussed about a seller, the Buyer, or the
neighborhood in which any Property is located.
I. Broker shall have no responsibility for payment or collection of notes and checks delivered in connection
with any real estate transaction.
J. If possession is not to be given by a seller to Buyer on the closing date, Buyer should consult its attorney
concerning the additional documentation that may be required in connection with such an arrangement.
K. Real estate salespersons working under Broker buy property from time to time for themselves. Buyer
hereby consents to allow agents of Broker to buy properties without first informing Buyer of these opportunities.
L. Facsimile signatures of the parties on this right -to -buy agreement shall be treated as original signatures.
v id/1�-01Broker: plains Real Estate, Inc.
uyer Date
tC- h. L
Buyer
(- I q Co By:
Date dames H. Dech
6../z -9b
Date
Right -To -Buy Addendum 7/95
961135
.✓.
r-tM
PLAINS
REAL ESTATE, INC.'
'I M1e printed portions of this form hate been approird
by the Colorado Real Estate Commission. (C18-9-95) J
1111S FORM BIAS INP(IR FAN r I EDAI.(ONSF,titlr:N( FS AND IDE PAR I ICSSHOO, lII('(INSIIBS I FGAI.AND lAX OR nrIIFR COIINSFI. BEFORE SIGNING.
CIA)SING INS'I RUCTIONS
June_ 10 19 96
I. Rice Enterprises inc., Jack V. Rice, _President_—__— --_ ---- (Seller)
and __I?ichard t,ee_.Wilhel in_ and DeeAnn.. Wilhelm - __ . ..__ (Buyer)
Tr a n 5 n a.LQR�Lt_l-e__Coll' . (('losing Company),
engage _Company_ _._ __.._.
who agrees to provide closing and settlement services in connection with the closing of the following described teal estate in the County of
Wel d Colorado, to wit: CO 80631
also known as: 985 & 975 E. 18th Street Greet e� Zip
Sited Address r Ilr
2. Closing Company is authorized to obtain information, and agrees to prepare, obtain, deliver and record all documents, excluding
preparation of legal documents, necessary to carry out the lei ors and conditions of the Contract to Buy and Sell (teal Fslale, dated
,tune 10 19 b with any counterproposals and amendments attached (Contract).
3. Closing Company will receive a fee not to exceed $ 125..00 _. . for providing these dosing and settlement services to he the
expenseof1/2 set l en_ 1/2 buyer -
4. Closing Company is authorized to receive funds and to disburse when all funds received are either: available for immediate withdrawal
as a matter of right from the financial institution in which the funds have been deposited or are available for immediate withdrawal as a
consequence of an agreement of a financial institution in which the funds are to be deposited or a financial institution upon which the funds are
to be drawn (Good Funds). _
5. Closing Company is not authorized to release any documents or things of value prior to reedpI and disbursement of Good Funds, except
as provided in Sections 10 and II.
6. Closing Company shall disburse all funds, including real estate commissions, except those funds as may be separately disclosed in
writing to Buyer and Seller by Closing Company or Buyer's lender on or berme closing. All parties agree that no one other than the disburser call
assure that payoff of loans and other disbursements will actually be made.
7. Seller will receive the net proceeds of closing as indicated: [I cashier's check at Seller's expense I I funds electronically transferred
(wire transfer) to an account specified by the Seller, al Seller's expense; or rki (losing Company's Bust account check.
8. Buyer and Seller will furnish any additional information and documents required by Closing Company which will be necessary to
complete this transaction.
9. Closing Company will prepare and deliver an accurate, complete and detailed dosing statement to Buyer and Seller al time of closing.
10. If closing does not occur, Closing Company, except as provided herein, is authorized and agrees to return all documents, monies, and
things of value to the depositing party and Closing Company will be relieved from any further duly, responsibility or liability in connection with
these instructions. In addition, any pnnn isms note, deed of trust, or other evidence of indebtedness signed by Buyer, shall be voided by Closing
Company, with the origi nails) returned to Buyer and a copy to Buyer's lender.
II. If any conflicting demands arc made on the (losing Company, at its .sole discretion, (losing Company may hold any monies, docu-
ments, and things of value received from any party except Buyer's lender. (losing Company shall retain such ileitis until (I) receipt of mutual
written instruction from Buyer and -Seller; or (2) until a civil action between Buyer and Seller shall have been resolved in a Court of competent
jurisdiction; or (3) in the alternative, Closing Company may, in its sole discretion, commence a civil action to inlerplead, or, interplead in any
existing civil action, any documents, monies or other things of value received by Closing Company. Such deposit with the ('our t shall relieve
Closing Company of all further liability and responsibility and ('losing Company shall be entitled to all court costs and reasonable attorneys fees.
12. These closing instructions may only be amended or terminated by written instructions signed by Buyer, Seller and Closing Company.
I). The Internal Revenue Service and the Colorado Department of Revenue 'tray require (.losing company to withhold a substantial
portion of the proceeds of this sale when Seller either (a) is a foreign person or (b) will not Ise a ('olol ado resident after dosing. Seller should
inquire of Seller's tax advisor to determine if withholding applies or if an exemption exists.
K. Special Instructions: _.._NeQd_- note ., _.Ds9>_I ..r—Bi1L of—aa.l e—prejaare. -_.
IS. these ('.losing Instructions may be executed by each Buyer, Seller and ('losing Company individually and when each Buyer, Seller and
Closing Company has executed a copy of these Closing Instructions, midi copies taken together shall be deemed to be a full and complete
contract between the parties.
APPROVED AND ACCEP I El)
Seller
Social Security No.
Buyer
Social Security Number L( ' 5- Number 5 (--)(-7 '
sac. _. eah.0.5L. rC.( /07 -
Date
Social Security Number
( —tile yet 011_!L1l0' =(%%
Closing Company: Transnati on Title Company
By:
l We
Date
OO11E ttE COI111'LE'-ED ONLY BY BROKER AND CLOSING COMPANY)
Plains Real Estate • Inc. (Broker) engages
Closing Company as Broker's Scrivener to complete, for a fee not to exceed $ 15.00 at the sole expense of Broker, the
following legal documents: IXl Deed [XI Bill of Sale II Colorado Real Estate Commission Approved Promissory Note and L) Colorado
Real Estate Commission Approved Deed of 'Bust.
The documents stated above shall be subject to Broker's review and approval and Bicker acknowledges that Broker is responsible for the
accuracy of the above documents.
Closing Company shall pay real estate commissions at disbursement as follows:
Listing Company, Plains Real Estate, Inc.
Selling Company, Plains Real Estate, Inc.
Other
Broker Plains Real Estate, Inc.
//-- 11< -t C -/) %G
By. Dam
. Dech-__-_-
paid by Seller 1
1
9fi
paid by _.Seller
Closing Company
By.
Date
Nn. C1,8-9-95. ('LOSING INS I RII('IIONS
Il,.uilh,ACalLthinrILIIAA''rraSt. Dann. ill Pu>O' 11O;1 202. 751115 ,''
961135
PLAINS
REAL ESTATE, INC.
The printed portions of this form approved by the
Colorado Real Estate Commission. (LCIL-9-95)
SELLER'S PROPER 'I'Y DISCLOSURE
THIS DISCLOSURE -SHOULD BE
COMPLETED BY THE SELLER.
-?u,.P Z0 9�
Date: ____ -----L-
Seller states that the information contained in this Disclosure is correct to the best of Seller's C'tJRRENII. ACUAL KNOWLEDGE as of the above
date. Broker may deliver a copy of this Disclosure to prospective buyers. TTG•�?e:2'i. E"y ��'d ,T
PROPERTY ADDRESS Aim y r L ` /8 -f
h r FOLLOWING ARE IN 171E CONDITIONS INDICATED:
a. APPLIANCES
NONE/NOT
INCLUDED
—
NIIT
WORKING
WORKING
DO Nfrf
KNOW
Built-in Vacuum System
T
Clothes Dryer
V
Clothes Washer
Dishwasher
✓
Disposal
V
Freezer
_.
✓
-
_--.-
Gas Grill
✓
I rood
V -
-
Microwave Oven
_
Oven
✓
Range
—V
V
V
Refrigerator
Room Air Conditioner
TV. Antenna/Dish
✓
Trash Compactor
b. ELECTRICAL SYS IEM
Air Purifier
t+!
But glar Alarm
Ceiling Pan
✓
Garage Door Opener/Control(s)
✓
Inside Telephone Wiring
and Blocks/Jacks
Intercom
✓
'
Light Fixtures
/
Sauna
r�
Smoke/Fire Alarm
V
Switches & Outlets
-✓
Telephone Instruments
Vent Fan
Si
220 Volt Service
c. HEATING AND COOLING SYSTEM
Attic Pan
✓,
Central Air Conditioning
Evaporative Cooler
Fireplace/Wood
✓
Fireplace/Gas
✓
Fireplace/Insert
Furnace/Heat-Electric
J
Furnace/I teat -Gas
t/
Humidifier
✓
Pi panc lank
V
Solar I louse-IleLing✓
oodburning Stove
V.
d. WATER SYSTEMS
Cistern
✓
'lot "rub
✓
✓
Plumbing
Pool
Septic/Leaching Field
✓
Sump Pump
✓,
—
Underground Sprinkler
✓
Water Heater/Electric
✓
Water Heater/Gas
✓
Water Heater/Solar
V
Water Purifier
I//
Water Softener
V
Well
V
Well Permit N
The information contained in this Disclosure has been furnished by the
Seller, who certifies to the truth thereof based on the Seller's current actual
knowledge. Any important changes will be disclosed by Seller to buyet
prior to closing. Seller hereby receipts for a copy of this Disclosure.
e..w...
Age (if known): —..—.---}ears
YES
NO
DO NOT
KNOW
a. Does the roof leak?
T
-- ✓ -_
,..
h. Is there present damage to the roof?
— __..
c. Is the roof under warranty?
✓
d. Is the warranty transferable?
f/
c. Expiration date of warranty:
i. ENERGY EFFICIENCY:
I las the Property had an Energy Rated
I Wales of Colorado (ERIK) Certificate?
If yes, when "vas the Property rated?
If yes, what was the rating? I 2 3
4. I IAZARDOUS CONDI DONS:
Are there any hazardous conditions on the Property sock as:
Methane gas?
Lead -based paint?
Radon gas in house or well?
Radioactivc material?-_ _
Landfill?
Mineshaft or runnel?
Expansive soil?
'toxic materials?
l lrea-formaldehyde foam insulation?
______ Asbestos insulation? insul:dion? _ If yes to any of the above. explain under addition d comments.
I he EPA encourages all buyers to test the Property for radon.
5. Or I IF R DISCLOSU It ES:
r✓
a. Are the improvements connector to public:
water system?
✓
'
sewer system?✓
-LR1 va to/eont m unity water system?
private/community sewer system?
b. Do improvements have aluminum wiring?
V
e. Are any tees or shrubs diseased or dead?
d. Are there any encroachments?
e. Are there any:
zoning violations?
✓
building code violations?
V
restrictive covenant violations?
✓
f. Is the present use a non -conforming use?
✓
g. Have you received any notices of any adverse
conditions about the properly from any gov-
ernmental or quasi -governmental agency?
/i/
h. Are there any structural problems with
improvements?
IV
i. I lave any substantial additions or altera-
tions been made to the Property without
a required building permit?
✓
j. Are there moisture and/or water
problems in basement or crawl space?
✓
k. Is there any damage due to wind, fire,
flood, termites or rodents?
I. I lave you kept pets in the Property?
in. When was fireplace/wood stove.
chimney/flue last cleaned? Dale: A. iir
6. ATARI ZONAL COM MEN IS AND/OR EXPLANATIONS: (Use additional
a may,....; r
edS (lao pi. us__;so
.27;pagco
is we*J' bay'-'•
_414_¢eL
Buyer hereby receipts for a copy -of this Disclosure.
I tin
i� /' /
�ti� [ ohs Chi -
Date Buyer
'„ /3 et
j'
Date
Date
Seller and Buyer understand that !_ t t%^ "CL 1Q Cf _≤ A/C -- _ _------ --_.. .-_ (Broken Firm Name)
in no way warrants or guarantees the above information on the Property. Property inspect ma wpm is and/or home protection plans may be purchased.
This form is not intended as a substitute for an inspection of the Property.
LC18-9-95. SFLEE:R'S PROPERLY IIISCLOSI IRE nia troid Publishing. 1741 waiec 51.. Oconee 1) Flrie — a ii'l1-'u' s'10— 2 45
961135
Recorded at o'clock
Reception No
M
WARRANTY DEED
Recorder.
THIS DEED, Made this 2 8th day of
between
Rice Enterprises, Inc.,
June ,N 96,
a Colorado Corporation
a corporation duly organized and existing under and by virtue of the laws of the State
of Colorado , grantor, and
Richard Lee Wilhelm and DeeAnn-Wilhelm
whose legal address is
of the *County of
Weld
and State of Colorado, grantees:
WITNESSETH: That the grantor, for and in consideration of the sum of ONE HUNDRED SIXTY THOUSAND
AND 00/100, ($160,000.00) DOLLARS,
the receipt and sufficiency of which is hereby acknowledged, has granted, bargained, sold and conveyed, and by these presents does
grant, bargain, sell, convey and confirm unto the grantees, not in tenancy in common but in joint tenancy, -the -survivor of them, their
assigns and the heirs and assigns of such survivor forever, all the real property, together with improvements, if any, situate, lying and
being in the *County of Weld .and State of Colorado, described as follows:
Lot A, according t
August 30, 1978 in
a portion of West
the E1/2 of Lot 7
North, Range 65 We
of Colorado.
o Exemption No. 0961-9-4-RE333, recorded
Book 843 as Reception No. 1765081, being
2 acres of Lot 3 of NE1/4 of SE1/4 and of
of NW1/4 of SE1/4 of Section 9, Township 5
st of the 6th P.M., County of Weld, State
.also known by street and number as: 985 & 975 East 18th Street, Greeley, CO 80631
TOGETHER with all and singular the hereditaments and appurtenances thereunto belonging, or in anywise appertaining, and the
reversion and reversions, remainder and remainders, rents, issues and profits thereof, and all the estate, right, title, interest, claim and
demand whatsoever of the grantor, either in law or equity, of, in and to the above bargain premises, with the hereditaments and
appurtenances.
TO HAVE AND TO HOLD the said premises above bargained and described, with the appurtenances, unto the grantees, the
survivor of them, their assigns, and the heirs and assigns of such survivor forever. And the grantor, for itself, its successors and assigns,
does covenant, grant, bargain and agree to and with the grantees, the survivor of them, their assigns and the heirs and assigns of such
survivor, that at the time of the ensealing and delivery of these presents, it is well seized of the premises above conveyed, has good, sure,
perfect, absolute and indefeasible estate of inheritance, in law, in fee simple, and has good right, full power and lawful authority to grant,
bargain, sell and convey the same in manner and form as aforesaid, and that the same are free and clear from all former and other grants,
bargains, sales, liens, taxes, assessments, encumbrances, and restrictions of whatever kind or nature soever, except
general taxes for 1996 and subsequent years; except easements,
restrictions, covenants, conditions, reservations and rights of
way of record, if any;
The grantor shall and will WARRANT AND FOREVER DEFEND the above -bargained premises in the quiet and peaceable
possession of the grantees, the survivor of them, their heirs and the heirs and assigns of such survivor, against all and every person or
persons lawfully claiming the whole or any part thereof. The singular number shall include the plural, the plural the singular, and the use
of any gender shall be applicable to all genders.
IN WITNESS WHEREOF, The said grantor has caused its corporate name to be hereunto subscribed by its President
and its corporate seal to be hereunto affixed, attested by its 3Catt4 ,X the day and year first above written.
lf(IIS47C
Secretary
STATE OF COLORADO,
County of W e 1 d
The fofegoing instrument was acknowledged before me this
by Jack- U • fJ
n
c
�-/J/ftp1/ _Jx `7 / Mil .1 6?
DARELLA L.
BLOCH
Rice Enterprises Inc., a
Colorado corporation
By O! k/ S✓ (/J v -f
4:7?V 11A
President
day of J 1 Q1&L
-as
as
&,Ma.(6 (()NEeVc .J1nw
Witness -my hand and seal
My com
n expires
�CCCri
Notary Public
iPresident and
Secretary of
, a corporation.
itG;i d:
961135
No. 929. Rev. 7-84
WARRANTY IWED I( orporation to Joint Tenants)
Bradford Pubi' hleg. 1743 Mice SI., Demo, CO 191202- (11131 292-2 5011-- 7 59
R100.(05/95)
-
DenverCO86281 ,-
COLORADO BUSINESS REGISTRATION
REGISTRATION ACCOUNT NUMBER ;- -
Check all reasons for submitting this form:
age Withholding 11 State Sales Tax License
yment Insurance Other (explain)
de Name Registration
Indicate Type of Ownership El
Individual ❑ General Partnership ❑
❑ Limited Partnership ❑ Corporation ❑❑
REASON FOR FILING THIS APPLICATION
❑ Original Apptrathn El Change Partners 0Change hype of
Do you have another business in Colorado? ❑ yes O no
IF YES. Registration Account #
Do you want this number assigned to new location? O yes 0 no
Association
Estate
Government
Joint Venture
o
3 RECEIVED
Trust
Non-profit 501 (C)(3) (Pleat,. enclose copy of the IRS letter of exemption
Other Non -Profit O Limited Liability Company i
5' Corporation ❑ Other
n14101996
101996
TC 'f#4/Afeni
z
O
a
cc
cc
Taxpayer Name (owner, partners or corporate name) (last, first, middle)
Trade Name/Doing Business As (if applicable
F c c -al d 1
Street Address of Principal Place of Business in Colorado
�. 1!( h `-1
County
City
State
ZIP r..
If business is within limits of a city, what city?
Telephone
( it--)
State
I C)
Z
WCounty
Mailing Address (if different from above) (include unit #)
City
ZIP
j Bank Name
03
L.
Telephone
( )
Bank Address
Federal Employer I.D.
Bank Account Number
Payroll Location (List Address )
Telephone
( )
First Day of Payroll (MO/DAY/YR)
't /c, - L
What do you sell and/or services provided?
Do you rent items to 30 days or less?
Do you sell woodstoves or fireplace inserts?
❑ Yes j -No
❑ Yes d No
a-
co
co
m
w
Z Address (residence or P.O. Box, street, city, state, ZIP)
If partner I
(1) Owner/Corp. Officers/Partners
Address (residence or P.O. Box, street, city, s
a corporation, give corporation name and Federal Employer Identification Number (FEIN). ff there are other partners, list on separate sheet using the same format.
Title Social Security k (Fed. Emp. k if applicable)
te, ZIP)
Telephone
( t': )
(2) Owner/Corp. Officers/Partners
Title Social Security it (Fed. Emp. it if applicable)
O
It you
Prior Owner's Name and Address
cc
acquired the business in whole or in part, complete the following
Date of Acquisition
Telephone
( )
Prior Owner's UI Tax Account Number
Street
City
State
ZIP
❑ If Seasonal, mark
each business month.
❑ JAN
❑ FEB
❑ MAR
❑ APR
❑ MAY
❑ JUN
a
I-
W
J
Q
Tin
C,
0
0
SIGNATURE of Owner, Partner or Corporate Officer REQUIRED
. i
UN FREQUENCY: It sales tax collected is
Under $300/month, file quarterly
Dmonth or more, file monthly
❑ Wholesale only, file annually
Indicate which applies to you:
Cl olesaler
Retailer
LING METHOD:
nerty- Al New Accounts •
thty - Optional
❑ Charitable
❑ Multiple Event
O Weekly - Optional (EFT only)
I First Day of Business (MO/DAY/YR)
J'/
❑ Single Event - Period Covered
(MO/DAYNR)
Location
Check all taxes to be paid
of State and Local Sales
O RTD/CD/BD
O County Lodging
O Retailer's Use
O Wage Withholding
❑ Oil & Gas Withholding
❑ JULY
❑ AUG
❑ SEPT
❑ OCT
❑ NOV
❑ DEC
PERIOD TO
BE COJERED'I
FROM:
MOIYR
FEES
-I
TO:
M0/YR
/�7
Make check payable to
the Colorado
Department of
Revenue
(0280- Trade Name
750) Registration (999
(0020- Sales Tax
810) Deposit (355) $
(0- Sales Tax
750) License (999) $
l pG
TOTAL
S�
I declare under penalty of perjury in the second degree that the statements made in this application are true and complete to the best of my knowledge.
Title Date -
OFF CE USE,ONLY Account Type,
Sic. Org
IA. < Sig - N TR-1 _
(continue on reverse side of this page.)
KEEP THIS COPY
DR O61 0 119 41
COLORADO DEPARTMENT OF REVENUE
1375 SHERMAN STREET
DENVER CO 80261
THIS LICENSE IS
NOT TRANSFERABLE
WAGE WITHHOLDING LICENSE
USE ACCOUNT NUMBER
foraureferences '
LIABILITY INFORMATION
ISSUE DATE
23-71779-0000
03 206 5900 I 070196
JUN 10 1996
WILHELM DEEANN
FORT 21
985 E 18TH ST
GREELEY CO 80631
A DETACH HERE
GENERAL INFORMATION
.Executive Director
Department of Revenue
Please keep the attached license in a safe place; it will be valid as long as you are doing business under the
same name and ownership as shown on the license. Unless you are filing by electronic funds transfer
(EFT), you will receive coupons with which to file in a few weeks.
It's easy, fast,
tellable and
conf udentlat.
Tired of filling out coupon forms, writing checks and mailing payments?
Tired of worrying whether your payment arrived on time?
FILE YOUR WAGE
WITHHOLDING BY TELEPHONE
For information on Electronic Funds Transfer,
call DOR at (303) 832-6139.
Filing withholding tax by EFT can be as easy as picking up the phone!
961135
DR 8441 (10/93)
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1375 SHERMAN STREET
DENVER CO 80261
PARTNERSHIP APPLICANT
INFORMATION
•
This 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 answered. All supporting
documents must correspond with the exact name of the applicant.
Copy the names of the two (02) partners EXACTLY AS THEY ARE LISTED IN ITEM NUMBER la ON THE LICENSE
APPLICATION FORM NUMBER DR 8404 bec Ann 4J t I h4 -Li II 1 ''3d/lard IA( h€) ry)
NOTE: All General Partners, regardless of ownership interest, and all Limited Partners with a 10 percent or greater ownership interest must
complete an Individual History Record, DR 8404-I.
Attach the following documents to this applicant information:
L Partnership Agreement (except for husband -wife partnerships)
Ll Certificate of Co -partnership (if applicable)
1. If a limited liability company is a general partner, or a limited partner with 10 percent or more ownership interest,
attach a completed DR 8405, Limited Liability Company Information, and the following:
I 1 Articles of Organization
LJ Operating Agreement
_, Name of Responsible party
IL List of all members and managers
NOTE: All General Partners, regardless of ownership interest in the partnership; and all Limited Partners that have a 10% ownership interest
in the Applicant, must fill out a DR 8404-I (Individual History Record).
2. If a corporation is a general partner, or a limited partner with 10 percent or more ownership interest, attach a
completed DR 8177, Corporate Applicant Information, and the following:
Li Certificate of Incorporation
I Articles of Incorporation
n Minutes of corporate meetings reflecting election of current officers, directors and stockholders.
3. If a partnership is a general partner, or a limited partner with 10 percent or more ownership interest, attach the
following:
L! Partnership Agreement
L_; Certificate of Co -partnership (if applicable)
EJ Diagram, or flow chart explaining ownership, if multiple owners
NOTE: All General Partners, regardless of ownership interest in the partnership; and all Limited Partners that have a 10% ownership interest
in the Applicant, must fill out a DR 8404-I (Individual History Record).
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.
Authoriz e(s),
Title(s)
Date
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 forthe 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 regard ng the character of the applicant.
1. Name of Business
Date
Social Security Number(s)
2. Your Full Name (last, first, middle)
3. Also Known As (maiden name/nickname, etc.)
4. Mailing Address (if different from residence)
Home Telephone
5. Residence Address (street and number, city, state, ZIP)
S
6. Date of Birth
Place of Birth
7. U.S. Citizen?
N.Yes ❑ No
If Naturalized, state where
When
Name of U.S. District Court
Naturalization Certificate Number
Date of Certificate
If an Alien, Give Alien's Registration Card Number
Permanent Residence Card Number
8. Height
Weight
Hair Color
Eye Color
Sex
Race
9. Do You Have a current
®,Yes
Driver's License? If yes, give number, & state
No
10. Name of Present Employer
m
11. Type of Business or Employment
1,iC. 4 , ( H1 r._
12. Address of Business Where Employed (street number, city, state, ZIP)
„i r
w l (' _i r -{ l\ '')- r C '- m = . - ,- � P(-�� , m
Business Telephone
� C- i t.l C. 11
13. Present Position
14. Marital Status
15. Name of Spouse (include maiden name if applicable)
16. Spouse's Date of Birth
'
Spouse's Place of Birth
17. Spouse's residence address, if different than yours (street and number, city, state, ZIP)
18. Spouse's Present Employer
Occupation
19. Address of Spouses Present Employer
L( ... C l� ' r1 _ . ( lr l , ,
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
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 X No
pp6-1-1
3S
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.
21 Yes ❑ No ,
Iic,_,. c. ,o
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.
LJ Yes N No
24. Military Service (branch)
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
`1 t,. C-il. `?"�
! . ,f `(: k%.i�I-Itr
'1'i I
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
27. What is your relationship o the applicant?
SP USG Petrfner
(sole owner, partner, corporate officer, director, stockholder, member or manager)
28. If stockholder, number of shares owned beneficially or of record
Percent of outstanding stock owned
29. If partner, stpde whether General Ill Limited
Wt/t-
Percent of Partnership Owned
If Limited Liability Company (percent owned)
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$ /60)000'00
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
$0
$ r ,
$
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
Title 1
O401)erypar ne4-
Date
l',
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 regard ng the character of the applicant.
1. Name of Business
Date
Social Security Number(s)
2. Your Full Name (last, first, middle)
iII\r:l+ K' -.'.,r, LC C.
3. Also Known As (maiden name/nickname, etc.)
4. Mailing Address (if different from residence)
i"- _ -. I l'.:<.._L ?r'.�'.r
Home Telephone
- I-(f('if
5. Residence Address (street and number, city, state, ZIP)
,.ti!.
6. Date of Birth
Place of Birth
7. U.S. Citizen?
IV _ IYes H No
If Naturalized, state where
When
Name of U.S. District Court
Naturalization Certificate Number
Date of Certificate
If an Alien, Give Alien's Registration Card Number
Permanent Residence Card Number
e. Height
G '
Weight
Hair Color
Eye Color
Sex
Race
9. Do You Have a current Driver's License? If yes, give number, & state
XYes No '
10. Name of Present Employer
)
11. Type of Business or Employment
12. Address of Business Where Employed (street number, city, state, ZIP)
Business Telephone
13. Present Position
1
14. Marital Status
15. Name of Spouse (include maiden name if applicable)
16. Spouse's Date of Birth
Spouse's Place of Birth
17. Spouse's residence address, if different than yours (street and number, city, state, ZIP)
'r'' t,
18. Spouse's"Present Employer
�n i..
Occupation
m. F L—
19. Address of Spouse's Present Employer
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
21. Do you now, or have you
Licensee? If yes, answer
Yes 1M
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
aft Aar
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 offensein 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.
Li Yes A 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.
L.i Yes IA No
24. Military Seryice (branch)
NfA
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
. t t '.
t 19 S.
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
1: (- , 1:." IIitP'1.,, t(tr r, -,-:
_� I1-'\' f: ct ....3l.,.
I'.. ,'t( ''
I P
irt'1�
27. What is your relationship to the applicant? (sole owner, partner, corporate officer, director, stockholder, member or manager)
SPOiw,L/ par+nc_r.
28. If stockholder, number of shares owned beneficially or of record
Percent of outstanding stock owned
29. If partn r, state whether ■ General M Limited
/I uc" bek,r1 4
Percent of Partnership Owned
If Limited Liability Company (percent owned)
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. 41-107.1)
Amount $ f _' ...- ' , c'
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--NumbersNames
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.
Authorized Signature
Title
Date
961135 '
WELD COUNTY GOVERNMENT REVOLVING FUND
915 10TH STREET
GREELEY, CO 80631
356-4000, EXT4440
PAY TO THE
ORDER OF
/T\./41 O
FOR
BANK ON , COLORADO, N.A.
GREELEY, COLORADO
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P 387 472 C67
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED
NOT FOR INTERNATIONAL MAIL
(See Reverse)
Sent to
Os
Colorado Dept. Of Revenue
Liquor Enforcement Division
1375 Sherman Street
Denver, CO 80261
Return Receipt showing
to whom and Dale Delivered
Return Receipt showing to whom,
Date. and Address of Delivery
Postmark or Date
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961135
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P 357 472 064
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED
NOT FOR INTERNATIONAL MAIL
(See Reverse)
nI Sent to
DeeAnn And Richard Wilhelm
dba Fort 21
985 E. 18th St.
Greeley, CO 80631
PS Form 3800, June 1985
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
postmaster for fee.
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