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Home My WebLink About980940.tiffFINDINGS AND RESOLUTION RE: FINDINGS AND RESOLUTION CONCERNING APPLICATION OF DOROTHY ZITEK, DBA HEREFORD PACKAGE LIQUOR, FOR RETAIL LIQUOR STORE LICENSE, AND AUTHORIZATION FOR CHAIR TO SIGN The application of Dorothy Zitek, dba Hereford Package Liquor, 39520 Weld County Road 136, Hereford, Colorado 80732, for a Retail Liquor Store License, came on for hearing on the 1st day of June, 1998, at 9:00 a.m., and the Board of County Commissioners of Weld County, Colorado, having heard the testimony and evidence adduced at said hearing, having considered the testimony, evidence and remonstrances filed with said Board, and having carefully weighed the same, now makes the following findings: 1. The evidence discloses that the applicant has sustained the burden of proof as to the desires of the inhabitants. 2. The applicant is of good character and reputation. 3. The applicant has proven the reasonable requirements of the neighborhood. RESOLUTION 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, the Board has considered the application of Dorothy Zitek, dba Hereford Package Liquor, 39520 Weld County Road 136, Hereford, Colorado 80732, for a Retail Liquor Store License, in sealed containers not for consumption at the place where sold, and WHEREAS, said applicant has paid to the County of Weld the sum of $500.00 for the hearing fee, in addition to the other required fees, and WHEREAS, due to the Findings of the Board of County Commissioners in this matter as stated herein, the Board deems it advisable to approve said application for a Retail Liquor Store License for Dorothy Zitek, dba Hereford Package Liquor. 980940 LC0024-B NEW RETAIL LIQUOR STORE - HEREFORD PACKAGE LIQUOR PAGE 2 NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld County, Colorado, that having examined said application, the qualifications of the applicant, and the testimony of those present at the hearing, does hereby approve the application of Dorothy Zitek, dba Hereford Package Liquor to sell sealed containers not for consumption at the place where sold; providing that said place where the licensee is authorized to sell 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; and the Board does hereby authorize and direct the submittal of said license to the State of Colorado, Department of Revenue, by the Clerk to the Board of Weld County, Colorado. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 1st day of June, A.D., 1998. BOARD OF COUNTY COMMISSIONERS ATTEST: Weld County Cler BY - Deputy Clerk to WE,D COUNTY, COLORADO Constance L. Harbrt, Chair W. H. Webstbr, Pro-TWm rge`E. Baxter Barbara J. Kirkmeyer 980940 LC0024-B THIS LICENSE MUST BE POSTED IN PUBLIC VIEW DR 8402 C (10/92) STATE OF COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division 1375 Sherman Street Denver, Colorado 80261 ALCOHOLIC ZITEK DOROTHY M HEREFORD PACKAGE LIQUOR 39520 WCR 136 HEREFORD CO 80732 DUPLICATE BEVERAGE LICENSE Account Number Liability Information LICENSE EXPIRES AT MIDNIGHT County City Indust. Type Liability Date 24-77634-0000 03 206 5921 I 061998 JUN 18, 1999 Type Name and Description of License Fee 1940 2190 RETAIL LIQUOR STORE LICENSE - MALT, VINOUS AND SPIRITUOUS COUNTY 85 PERCENT OAP FEE- $ 75.00 $ 212.50 This license is issued provision of Title nontransferable only valid through be addressed to Street. Denver, testimony whereof, TOTAL FEE(S) subject to the laws of the State of Colorado and especially 12, Articles 46 or 47, CRS 1973, as amended. and shall be conspicuously posted in the place above described. the expiration date shown above. Questions concerning the Department of Revenue, Liquor Enforcement Division, CO 80261. I have hereunto set my hand. ..,j SW V tan, JUN 1 9 1998 $ 287.50 under the This license is This license is this license should 1375 Sherman Executive Dire for 4 Division Director o i o c•5�° -d Q ' o o > V a O O ..32.0 CO ~-7 Ca ZC t—+ .s a y o a 55 :5 m v w y' N o g Pa H Cl'J h g o pt., x, s a w i s Ca 3 x oo a� C) a cd c i B -.a co H mo d° GI d W tl a Q O +�-' [x7 N QJ ' V -01 �j O F4 0. qqti a) co F C7 6 O ❑ F4 O coS.' a k0 r-, ,moo p O N o m a v. Lrl, m W Vey' W ,b t c, �i v Q q W W ZZ y0 1 0 q 6 til C.1 x W .-x cd p a' 0 Q pN 51 C, ,Zy ' a e 2' O O o c l J a H 7 W H a 0 b H O r141- ,� O �c-"! p. I, H 54 a W [ p p [HH O .-^ �i p F7 J 0 1 ce r�pQ]j vs � W S � I '� ti 6 a c-, .�.� cell ' E. fr4 W Z H y a c p z m a) p N› , 3 0 �J w 6 z a x a` cr q `g a 1 o �° O 74 ') 8 of 0° a a0 I-4 F'H CD y a d ' a a ill. g -e+ a' x , o ,4 a o �Q b i H 9 aij Qi x w a'en'i.cE* �', W E w cai> d 6; v "I p 4.-• O >• d E :c. °p 75 A Hx�dH Ai o a o 2 a,�rn o-7 -;5 G ., w ao a `'-'114 p0'� a -6 mE d Lei O .C N .., O G C! o m �> H .0 rr Q Q 11.6 p W E cd cd O m o o > ow Vi m 10 -CI en 3562 23-7014/3020 f�. ,aboaeaa,ze . 8111 W. SA* Ave. • Littleton. coicracsig 8D1?3 DOROTHY M. ZITEK 01-96 JAMES J. ZITEK 59351 WCR R RT. 1 970-895-2338 GROVER, CO 80729 Pay to the Order of 6 • 1998. , � J $ • 7j7, 5`-C7 11401 AND I NI J Wiaz; �Yc COLORADO May 26, 1998 Dorothy Zitek dba Hereford Package Liquor 39520 Weld County Road 136 Hereford, Colorado 80732 BOARD OF COUNTY COMMISSIONERS PHONE (970) 356-4000, EXT.4200 FAX: (970) 352-0242 P.O. BOX 758 GREELEY, COLORADO 80632 RE: Report of Investigation for Colorado Liquor License Application - Hereford Package Liquor Dear Ms. Zitek: On Thursday, May 21, 1998, I traveled to the proposed licensed premises known as Hereford Package Liquor, located at 39520 Weld County Road 136, Hereford, Colorado. While there I made an on -site inspection regarding the Liquor License Application filed for Hereford Package Liquor. The application is for a Retail Liquor Store License. It will be heard by the Board of County Commissioners as the liquor licensing authority for Weld County on Monday, June 1, 1998, at 9:00 a.m. My inspection revealed the following: The proposed licensed premises IS not directly connected to a different licensed premises. Section 12-47-301(3)(a), C.R.S., as amended. 2. The diagram of the proposed licensed premises is correct. Section 12-47-309(3), C.R.S., as amended. 3. There is one Tavern Liquor licensed establishment located in the immediate area operated by Mark Zitek, Hereford Bar and Grill, Inc., dba Hereford Bar and Grill. CC , ai2p The sign noticing the place, date, and time of the hearing for the liquor license application was posted by the applicant in such a manner that the notice was conspicuous and plainly visible to the public, when I was there on Thursday, May 21, 1998. 9/0 LC0024-B REPORT OF INVESTIGATION - HEREFORD PACKAGE LIQUOR PAGE 2 5. There are no public or parochial schools, or principal campus of any college, university, or seminary within 500 feet of the proposed licensed premises. Section 12-47-313(1)(d)(I), C.R.S., as amended. Very truly yours, BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO 4. 7 el. (e, George E. Baxter cc: Bruce Barker, County Attorney 9yo LC0024-B f \ TO: Weld County Board of County Commissioners 1 FROM: Bruce T. Barker, Weld County Attorney WilDeDATE: May 14, 1998 . RE: Checklist and Procedures for Liquor Licenses COLORADO The following are checklists to follow in the course of consideration of liquor license applications. These checklists have been updated to reflect the current Liquor Code provisions. Let me know if you have any questions. CHECKLIST FOR ON -SITE INSPECTIONS OF PREMISES FOR APPLICATIONS PURSUANT TO THE COLORADO LIQUOR CODE 1. Establish that the applicant's premises are not connected to a different licensed premise. Although they may share a common wall, they may not share the same entrance. C.R.S., § 12-47-301(3)(a). 2. Check the applicant's diagram of the premises to verify that it is correct. C.R.S., § 12-47-309(3). 3. Observe the other liquor stores, taverns, restaurants, etc., within the neighborhood in order to determine the reasonable requirements of the neighborhood in which the proposed liquor establishment is to be located. C.R.S., § 12-47-301(2)(a). 4. Check to see that the premises has posted on it in a "conspicuous place" a sign providing notice of the hearing before the Board of County Commissioners. C.R.S., § 12-47- 311(1). 5. The premises must be a distance of at least five hundred (500) feet from any public or parochial school, or principle campus of any college, university, or seminary. C.R.S., § 12-47-313(1)(d)(I), C.R.S. Measurement of the five hundred (500) feet is as follows: The distance is computed by direct measurement from the nearest property line of the land used for school purposes to the nearest portion of the building in which liquor is to be sold, using a route of direct pedestrian access, measured as a person would walk safely and properly, without trespassing, with right angles at crossings and with the observance of traffic regulations and lights. Regulation 47-326, C.C.R. 9S-09c'D Memo, LiquorCheck May 14, 1998 Page 2. The Board must consider the evidence and make a specific finding of fact as to whether the building in which the liquor is to be sold is located within these distance restrictions. 6. If application is for an optional premises license, pursuant to Section 12-47-413, C.R.S., make sure that the optional premises is for outdoor sports and recreational purposes, pursuant to C.R.S., § 12-47-103 (22)(a). An "outdoor sports and recreational facility" means a facility that charges a fee for the use of such facility. C.R.S., § 12-47-103 (22)(b). CHECKLIST OF PROCEDURES FOR THE BOARD TO TAKE AFTER THE APPLICATION HAS BEEN FILED 1. Establish the boundaries of the neighborhood and schedule a public hearing. The hearing may not be less than 30 days from the date the application is filed. C.R.S., § 12-47- 311(1). 2. Post and publish notice of the hearing not less than 10 days prior to the date of the hearing. C.R.S., § 12-47-311(1). 3. The Board should make known its findings, based on its investigation, in writing to the applicant and other interested parties, not less than 5 days prior to the date of hearing. Section 12-47-312(1), C.R.S. The findings should be based upon what the Board has found in its on -site visit and investigation of character, pursuant to C.R.S., §§ 12-47-312(2)(a), and 12-47-307(1)(a)(II). 4. After the public hearing, the Board must notify the applicant in writing of the decision. The notification must state the reasons for the decision and must be sent to the applicant by certified mail within 30 days after the date of the public hearing. C.R.S., § 12- 47-312(3). 5. Each application for a State retail license shall contain a report of the Board. The report must show the opinion of the Board concerning the reasonable requirements of the neighborhood; the desires of the inhabitants with respect to the issuance of the license applied for; and the character of the new applicant. C.R.S., § 12-47-312(3) and Regulation 47-324 A., C.C.R. Bruce T. Barker Weld County Attorney BTB/db:Memo/B OCC/Ligourcheck pc: Carol Harding HEARING CERTIFICATION DOCKET NO. 98-29 RE: RETAIL LIQUOR STORE LICENSE APPLICATION - DOROTHY ZITEK, DBA HEREFORD PACKAGE LIQUOR A public hearing was conducted on June 1, 1998, at 9:00 a.m., with the following present: Commissioner Constance L. Harbert, Chair Commissioner W. H. Webster, Pro -Tern Commissioner George E. Baxter Commissioner Dale K. Hall Commissioner Barbara J. Kirkmeyer Also present: Acting Clerk to the Board, Esther Gesick County Attorney, Bruce Barker The following business was transacted: I hereby certify that pursuant to a notice dated May 13, 1998, and duly published May 20, 1998, in the Platteville Herald, a public hearing was conducted to consider the application of Dorothy Zitek, dba Hereford Package Liquor, 39520 Weld County Road 136, Hereford, Colorado 80732, for a Retail Liquor Store License. Bruce Barker, County Attorney, made this a matter of record. Mr. Barker stated Commissioner Baxter was designated to inspect the property. Following the inspection, Commissioner Baxter sent a letter dated May 26, 1998, reporting his investigation to Ms. Zitek. Mr. Barker stated Hereford Package Liquor will be located within the same building as Hereford Bar and Grill; however, he explained this is possible because both licenses will be totally separated. Mr. Barker stated Ms. Zitek has complied with all of the application requirements and recommended approval. No public testimony was offered concerning this matter. Commissioner Hall moved to approve the application of Dorothy Zitek, dba Hereford Package Liquor for a Retail Liquor Store License. The motion was seconded by Commissioner Webster, and it carried unanimously. 98094O LC0024-B HEARING CERTIFICATION - RETAIL LIQUOR STORE LICENSE APPLICATION - ZITEK PAGE 2 This Certification was approved on the 3rd day of June, 1998. APPROVED: ATTEST: Weld County C BY. Deputy Cler TAPE #98-14 DOCKET #98-29 BOARD OF COUNTY COMMISSIONERS 7COUNTY, COLORADO Constance L. Herbert, Chair W. H. Webster, Pro -Tern f org- . Baxter Dale K. Ha I \-//41,x/744,..„, B rbara J. Kirkmeyer 980940 LC0024-B DR 8404 (06/97) Page 1 COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION 1375 SHERMAN STREET DENVER CO 80261 COLORADO LIQUOR OR 3.2% FERMENTED MALT BEVERAGE RETAIL LICENSE APPLICATION 21 Er -NEW LICENSE 0 TRANSFER OF OWNERSHIP 0 LICENSE RENEWAL • ALL ANSWERS MUST BE PRINTED IN BLACK INK OR TYPEWRITTEN • APPLICANT MUST CHECK THE APPROPRIATE BOX(ES) • LOCAL LICENSE FEE $ DO NOT WRITE IN THIS SPACE • APPUCANT SHOULD OBTAIN A curt ur INC LAiLUNiUU ia4wn .U•.. lai...l New..., ... ___ __. .. -., , r 1. Applicant is applying as a LJ individual ❑ Corporation ❑ Limited Liability Company ❑ Partnership (includes Limited Liability and Husband and Wife Partnerships) ❑ Association or Other 2. Name of Applicant(s) iIf partnership, list partners' names (at least two); if corporation, name of corporation D 2/°1-€/- OP n `I ' 2a.Trade NameOf Establishment (DBA) ._ I/ER6S-clRci PA-cHlk96 &/%OeR State Sales Tax No. Business Telephone '9 Y7C-Sts---;l/� 3. Address of Premises (specify exact Vocation of pre es 3 9S a 0 /'J . C R 13 4 • City (� /tens J- ksIL County r,)E• /d State <_O ZIP Code g0 %3.'L-, 4. Mailing Address (Number and Street) ;"/ it)/ C R, V, 3 Ci or Town H (h'a V F. 2 State co • ZIP Code ,c1 74 4-91 , 5. If the currently have a liquor or beer license, you MUST answer the following questions: premises Present Trade Name of Establishment (DBA) AirFCnxc{ RA(R 4 i Ri II Present State License No. Present Class of License Expiration Date Present Ex P APPLICATION FEES ' LIAB.SECTION D ° LIQUOR LICENSE FEES': SECTION A . ':- 2360 2300 2300 2310 O 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 , 1940 1940 1950 19501 • Retail Liquor Store License (city) $202.50 d Retail Liquor Store License (county) 287.50 ■ Liquor Licensed Drugstore (city) 202.50 ■ Liquor Licensed Drugstore (couky) 287.50 326.25 SECTION,B ;: .- fi: '.4 3.2% BEER LICENSE FEES 1960 IN Beer & Wine License (city) 2121 2121 2122 9122 2123 2123 • Retail 3.2% Beer On Premises - (city) $71.25 O Retail 3.2% Beer On Premises - (county) 92.50 ■ Retail 3.2% Beer Off Premises - (city) 71.25 El Retail 3 2% Beer Off Premises - (county) 92.50 ❑ Retail 3.2% Beer On/Off Premises - (city) 71.25 O Retail 3.2% Beer On/Off Premises - (county) 92.50 1960. 1970 1980 2010 2020 2030 O Beer & Wine License (county) 411.25 ■ H & R License NI city ■ county 475.00 ■ H & R License w/opt Prem O city ❑ county 475.00 ❑ Club License ❑ city ■ county 283.75 O Tavern License ■ city ■ county 475.00 ' • Arts License ■ city O county 283.75 ❑ Racetrack License ■city ❑county 475.00 SECTION.C. ;"` •. - RELATED FEES' ND PERMITS 2040 ■ Optional Premises License O city • county 475.00 2210-100 (999) ❑ Retail Warehouse Storage Permit $75.00 1980-100 (999) ❑ Addition of Optional Premises to existing hotel/restaurant +(,v $50:00 x Total Fee .1905;. .1975' ■ Retail Gaming Tavern Lic ['city ■ county 475.00 O Brew -Pub License 725.00 /:.'., 1970-750 (999) ❑ Manager's Registration (hotel & restaurant only) ...$75.00 No Fee ❑ 3.2% Beer On/Off Premises Only Delivery Permit No Fee O Retail Liquor Store Delivery Permit ■ Other DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY LIABILITY -INFORMATION - . County a City lndu T 's = tkeroalsaued Through , '.. `ratfort Dte)'', (Expi r icense Account Number--,, Liability,Date _ •Id,a..a.a Can V////a/////a/a//a/////////��O��/I��/I�� State -750 (999) 2180-100 (999) 2190-100(999) 1970-750 (999) ) Cash Fwd Tm•Ir. U ,+•...-.. 2310-100 (999) 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. IN 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-I). ❑ 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. CORPORA TE APPLICANT Itvr'-iYrMATiOri(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. "principal • D. List of officers, directors and stockholders of parent corporation (designate 1 person as officer"). VI. PARTNERSHIP APPLICANT INFORMATION (If Applicable) IN A. Partnership Agreement (general or limited). Not needed if husband and wife. VII. LIMITED LIABILITY COMPANY APPLICANT INFORMATION (If Applicable) • 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). 490 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 officers, stock- holders or directors if a corporation) or manager under the age of twenty-one years? Yes No • 2- 7. Has 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) 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? If you answered yes to 7a, b or c, explain in detail on a separate sheet. ❑ 0-- ❑ 0- • , � 8a. Has a liquor license application (same license class), that was located within 500 feet of the proposed premises, been denied within 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. the ❑ g--1 • 9. Are the premises to be licensed within 500 feet of any public or private school that meets compulsory education requirements of Colorado law, or the principal campus of any college, university or seminary? ■ Lf I 10. Has a liquor or beer license ever been issued to the applicant (including any of the partners, if a partnership; members or manager limited liability company; or officers, stockholders or directors if a corporation)? If yes, identify the name of the business and list current financial interest in said business including any loans to or from a licensee. if a any • [E]' 11. a. Attach and Does the Applicant, this license will as listed on line 2 of this application, be issued by virtue of ownership, lease [L]. -Lease 0 Other (Explain in of landlord and tenant, and date of have legal possession of the premises for at least 1 year from the date that or other arrangement? Detail) g • • Ownership If leased, list name expiration, EXACTLY as they appear on the lease: Lats�lord ant Expires a diagram what each room d outline rea to be licensed (including dimensi which showLttle bars, brewery, walls, partitions, shall be utilized for in this business. This diagram should be no larger than 8 1/2' X 11'. (Doesn't have entrances, exits 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 dniei-2 i ) . /r l; y 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 grosiproceeds 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 A local ordinance or resolution authorizing optional Number of separate Optional Premises areas requested. with Optional Premises premises has been adopted. Yes No 0 Ifr 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 ■ B- M Club Liquor (a) Is the not for (b) Is the operated (c) How long (Three License applicants answer the following applicant organization operated solely pecuniary gain? applicant organization a regularly solely for the object of a patriotic has the club been incorporated? years required) and attach: for a national, social, fratemal, 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 • [ ■ I }" 16. Brew -Pub License Applicants answer the following: (a) Has the applicant received or applied for a Federal Brewers Notice? (Copy of notice or application must be attached) • S' 17a. Name of Managdr and Restaurant 1713. Does this manager licensed establishment .!,, y,C'��-'r / (If this is an application for a Hotel number. Date of Birth %& ' Hotel & Restr. Lic. Yes No License, the manager musitaiso submit an Individual History Record (DR 8404-I). act as the manager of, or have a financial interest in, any other liquor in the State of Colorado? If yes, provide name, type of license and account • E' Yes No • ID -- 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 • Q' DR 8404 (06197) Page 4 19. If applicant is a corporation, general partners, managing financial interest in the applicant. and provide fingerprint cards partnership, association or a limited liability company, it is required to list by position all officers and directors, members, all stockholders, partners (including limited partners) and members who have a 10% or greater All persons listed here or by attachment must submit and attach a DR. 8404-I (Individual History Record) 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. ❑ PARTNERSHIP Partnership Agreement (General old) O Cert. of ❑ or Limited) ❑ Husband and Wife partnership (no ❑ LIMITED LIABILITY COMPANY O Articles of Organization ❑ Cert. of Authority (if foreign company) ❑ ASSOCIATION OR OTHER Attach copy of agreements creating association or relationship between the parties Registered (if a foreign written agreement) ❑ Operating Agrmt. corp.) Agent (if applicable) Address for Service 1 declare under penally of perjury in the to the best of my knowledge. I also,acknowledge to comply with the prov sions'af the Colorado thonzed OATH OF APPLICANT second degree that this application and Matti is my responsibility and Liquor or Beer Code which affect alt attachments are true, correct and complete the. responsibility of my agents and employees my license• . ' Signature ) A�t �J/rLb(% Tit, ✓'L�7�Zoivat. Date,,// REPORT AND APPROVAL OF LOCAL LICENSING AUTHORITY (CITY/COUNTY) Date application filed with local authority April 6,, 1998_ 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. June 1, 1998 Each person required to file DR 8404•I: Yes No a. Has been fingerprinted b. Background investigation and NCIC and CCIC check for outstanding warrants conducted C • c. The liquor licensed premises is ready for occupancy and has been inspected by the Local Licensing Authority. C If 'no', the building will be completed and ready for inspection by (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. Local Licensing Authority for Weld County, Colorado Signatu,- I Telephone Number (970) 356-4000 1couNTY TOWN, CITY Signature(. V` n 4S, Title H. Webster, Chair Protem Date 06/01/98 et) 9, Deputy Clerk n, fiori 2], to the Board Date 06/01/98 If premises are located vliiilinVa • .' IS;, - ,ov: approval should ha si ned b th of the board of county co then such approval shoul 9 y e mayor and clerk, If in a county, then by the chairman board. If, by ordinance or otherwise, the local licensing authority is some other official, TO U/Nom IT M4Y CONCERN: Zhave known Dcaothy ZLtek /oa come 35 seance. She has alwaza been an honest, moth/ull and :Law-abtdtng cLLL en. She and hen husband 5ach ,aLaed 4 vent nLce chLldnen Ln the communttc, and Z am auae she has a.Lao played an Lnpontant pole Ln thten gnanndchLlden'a lLvea. Donothh1 2Ltek La a conaLentLoua and pao/eaaofLal pennon, and does excellant job Ln what even she aftempta. SINCERELY Lola mcCLLRRY 4550/ UICR /38 Gnoven Co 80729 7.)) 2)c_ CiL,97Axd To Whom It May Concern: Subject: Reference for Dorothy Zitek Dorothy has been a respected member of the community for several years. During that time she has always had a reputation of helping others in their time of need. She is reliable and hardworking. We have never heard anyone with a bad thing to say about her. We have become a lot better acquainted with her during the past couple of years since her son opened the Hereford Bar and Grill in Hereford, Colorado. She has always been a pleasant person to talk with. She is courteous yet firm with her handling of customers in a proper manner. We believe she would operate a package liquor operation with the utmost dependablilty. At functions that they have had at the Hereford Bar and Grill, we have seen her take care that no youth in attendence is allowed to come in contact with the prohibited alcohol. She is a very observant person. We would like to see her considered for the license to sell package liquor in Hereford, CO. If you have any questions or concerns that we would be helpful with, feel free to contact us. Sincerely Your Gary and Norma Smith 66401 WCR Hereford, CO 80732 970-895-2411 9 /O ° To Whom it may concern I have known Dorothy Zitek since 1952. She has always been a honest and hard working person. If something needed to be done she pitches in and gets it done. Dorothy and her husband owned a business in Hereford at one time, and I worked for them. You couldn't ask for better people to work for. Dorothy and her family are well respected in the community, because the are good neighbors and good friends to everyone. Eileen Woolington Postmaster Hereford, Co. ema L _ C2.,1n,s /fir -z`% _ _L,._- -. 7 cc--,, Iy 0, ...7.il. { _...,a©G)_. SG ., T2 ri- Jr. _ea 5 0, _l c - _.47C10 Y _. !i << f-_ 74 ce glir!d-S 3 yh'.ee 4✓ cr2_ 1 3 ‘ _TrOv v5 9-__yh-t`I--?s 3t, 41 /2< 9Sv'M3 DR 8404-1(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 ilfA''',:c1Rd PA c/'Ac : Li; ud, Date — b /99 e? Social Security Number(s) ,, 2. Your Full Name (last, first, middle) DoRo-fh K MICE, Zi°74-F.. 0 Also nown As (maiden name/nickname, etc.) ,DG ,e" 4. Mailing Address (if different from residence) Home Telephone 5. Residence Address (street and number, city, state, ZIP) a .G. X. 7_3 (Ro''(R, c,\ . SPv�.29-76ad ,s'q..7si 6. Date of Birth " Place of Birth .U..r_r ,2 6,'S .4/£,b.. 7. U.S. Citizen? I'�I Yes ❑ No If Naturalized, stale 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 ,.5' a Weight /il, Hair Color ,RR Eye Color L?/JE; Sex /r.-.: Race Wil i°k. 9. Do You Have a current Driver's License? If yes, give number, & state li-es I I 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 14. Marital Status -r-c e J 15. Name of Spouse (include maiden name if applicable) /4 SA --).,7 L s ,d-, 2.1°H/4 ..y,; 16. Spouse's Date of Birth Spouse's Place of Birth F: ti's: IR/rlcS-S I-1 (So , 17. Spouse's residence address. if different than yours (street and number, city, state, 7IP) . 18. Spouse's Present Employer I Occupation 17/.S,4b/c"c I 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 /1';11BO"1/ I.;I/ , i.34.) .3 -...s , ccJ e . . sJ idr- 6 c . %,°h * ✓/ o PRa.' iiCkid• MA R K ti Z °1 X _So C-6 ./ n, (S c !it ,1-4.-R6.,,x ,, x 4 ,,;',v ,i sf R ; f 1 11,eC' 7e.. d,, CC • 21. Do Licensee? ■ 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 If yes, answer in detail Yes frNo CONTINUED ON REVERSE SIDE 22. Have violations, explain ■ 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 unless they resulted in suspension or revocation of your driver's license, or you ware convicted of driving under the influence of drugs or alcoholic beverages.) If yes, in detail. Yes l 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 II'No 24. Military Service (branch) �v From f To I 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 e /!' s h., %1 9 od ' / -.- '".- /.‘,..? 457;, AZt_67 _67 . cc1, • ,9 -z A 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 2�.._ A -/e .3.4c7€ co cz 0A rs !yy2 199-3-.. 4,IeL ,' _ d'o 9,?9 ,tym,t:c 27. What is your relationship to the applicant? (sole owner, partner, corporate officer, director, stockholder, member or manager) r) u) A/t- l2_ 4,.,Ir 28. If stockholder, number of shares owned beneficially or of record 12 F Percent of outstanding stock owned ,1/n 29. If partner, state whether ❑ General ❑ Limited 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) ii Li � -Zr t / d ( l -1 a 01 -,., 4..,c..k a. L�J ; / / ire- a 444/1 i / j?C.9 c/ y p; 2 .,,eac / ..ve s$ . + Amount $ / �'t�l"c� :ik; 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.) -r- Amounts Sources Account Numbers Names on accounts or person who can sign on this account $ o ._.. .022 3f i e-=f�nJe3 L, eK $ 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 1 Title C's ,..1 y - Date ( — 6 -/P27 yo I ,9h 6 ("I •s (7 2 r L. G ✓ 1' 401. � 13..14.4..:- 4;1., / /1/10 iL u 1-'.(r` le !+4.:,. i' 9 9qc R 100 (05,97) 1375 Sherman Street Denver CO 80261-0013 3 RECEIVED 741 THIS FORM WILL MEWED FOR UNEMPLOYMENT ItANCE (UI) LIABILITY • If trade name registration with the Department of Revenue is required, the information marked with a diamond will become public record. U DQ BUSINESS REGISTRATION 19 PLEA ESS FIRMLY AND PRINT CLEARLY 1. REASON FOR FILING THIS APPLICATION EU Original Application ❑ Change of Ownership Do you have a Dept of Revenue Account Number? ❑ yes p no IF YES, Account a Do you want this number assigned to new location? ❑ yes p no •2. INDICATE TYPE OF ORGANIZATION to Individual ❑ Limited Liability limited ❑ General Partnership PaMership (W2) ❑ limited Partnership Corporation ❑ United Liability Company (LLC) OO S' Corporation ❑ limited Liability Partnership (LLP) ❑ Association 0 cc ac 0 a Z Z 0 N Z cc cc Estate Government Joint Venture Trust Non-profit 501 (C)(3) (Please enclose copy of the IRS letter of exemption.) Other Non -Profit Other ,MAY 0 5 1998 Colo. Dept. of Revenue DO NOT WRITE IN THIS SPACE REVENU REE GtSTRATIONACCOUNr NUM;ER - Taxpayer Name (owner, partners or corporate name) (last, first, middle) i-f-eK noectIY /� • 2a. Trade Name/Doing Business As Of applicabl Li • f/&tr`ern Pc 3a. Street Address of Principal Place of Business in`Cpl • : 37520 . w cI2 w,i3 6! 3b. County ' • Lie 1-0 4a. In Care Of (do) �o did/A4, z/e1 liege1049 6. First Day of Payroll (MO/DAY/YR) Psy%tiE• �e, s 1 If business is within limits of a dty,, what cttyo 2b. Federal Employer Identification Number (FEIN) • Telephone. . 0 ;: , (970) g95- ?10 4b. Mailing Address' Reiff from above (include unit 19 Po. Sox Bank Address Location (fist address) rl 7. Whet products and/or services do you Pmvi ? compllete section `H") -a../Owner/Partner/Corp Offcer,JJ° Bb. Address (residence r P 0. BpiC street • 5-7x51 welt ._. "9a Owneq,P,artner/Carr Officer a rD w J 6 rn 9b. Address (residence or P,O: Box, • It you aequired the businesssin wto(e'' 10a. PdorTaxpayer Name, V - 1. ❑ If Seasonal, mark each business month. ❑ JAN ❑ FEB ❑ MAR 2a. FILING FREQUENCY: If sales tax collect O $15.00/month or less - Annually ❑ er $300/month - Quarterly $200/month or more - Monthly Wholesale only - Annually 3. Indicate which applies to you: ❑ Wholesaler ❑ Charitable II/Retail-Sales O Multiple Event El Retailers -Use .50 ❑ JULY O OCT ❑ AUG ❑ NOV ❑ SEPT ❑ DEC 2b. FII of Sales (MO/DAYNR) ❑ Single Event - Period Covered (MO/DAY/YR) Event Location ✓ 1. FILING FREQUENCY: If wage withholding amount is $1 - $6.999/year - Quartedy ❑ Make Chet payable to p $7,0 - - onthly Must file by Electronic Funds Transfer Corn. Deft of Reverse TOTAL THE REVERSE SIDE OF THIS PAGE MUST BE COMPLETED, AND BOTHWHITE PAGES RETURNED. I declare under penalty of perjury in the second degree that the statements made n this application are true and complete to the best of my knowledge. Date PERIOD COVERED FROM: TO: MO/YR MO/YR Telephone (77o) 675— a2/0 Bank,Account Number ,tw ,Payroll Records Telephone Yesi Do you rent out items for 30 days or less? er 0IT_ rw~r (0280- Trade Name 750) Registration (999) $ /d- (0020- State Sales Tax 810) Deposit (355) (0080- Sales Tax 750) License (999) (1000- wage 750) Withholding (999 $ /6,,o0 $ 0.00 SI(JlffjUnE Iner orporate& er ClUI ED �l) Sic IA Sig ❑ N OFFICE USE ONtJP/ Account T _ OD vv SC 2. OILIGAS U Withholding Title • /de -Ai Org LC LD TR-1 Date Tech Sig (continue on reverse sloe of this page.) 6/809 5/O 1D3:4:17118°251611°13 375Shemran5treet COLORADO BUSINESS REGISTRATION 19 DemerCO tf4251-0Ott! PLEASE PRESS FIRMLY AND PRINT CLEARLY DO NOT WRITE IN THIS SPACE =IIIIIIIIIIIIIIIIMMMIIIIIIIMM REVENUE 9EGISTRATION ACCOUNT NUMBER �% 7 4 2 7 ! �c .;74;,-, v' ' '.,, 7v!:. '� W : , y, .:1-:,.,..:1,:—::::, 7.-1.:,1g 1. REASON FOR FILING THIS APPLICATION , +:l 4E: L.AiliLi! i Original Application ❑ Charge of Ownership ,.i<i`Lv,`1y4[ i'd`'.' :'4 i:i&Lk•;eL'i (t_) • If trade name registration with the Department of ' t you have a Dept of Revenue Account Number? yes no rIF, YES, Account # Revenue is required, the information marked with a diamond will become public record. Do you want this number assigned to new location? ❑ yes Et no ♦2. INDICATE TYPE OF ORGANIZATION • - O Estate D Other Non -Profit 1g Individual ❑ limitedUebiltyLatiited :: ❑ Government ❑ General Pannershirty., G ...--__,.Partnership (LLLP)• ' '•• ❑ Joint Venture O Other t ❑ Limited Partnership O Corporation Trust ❑ Limited Liability Company (LLC) ❑ 'S' Corporation Non-profit 501 (C)(3) ❑ Limited !,ability Partnership (LLP) ❑ Association (Please enclose copy of the IRS letter of exemption) IZATION INFORMATION • 1. Taxpayer ame (owner, partners or corporate name) (last, first,: middle) f)'''f� /�= ��yJ �. e } j x?arc .q£ j � .. .. 2a. Trade Name/Doing Business As (if applicable) a • //€rig* ,21 -RS - . A - X4 f & - ) v 2b Federal Employer Identification Number {FEIN) 3a. Street Address of Principal Place of Business in Col rado ••335.8 604',b City • 4s` State ZIP 3b. County ♦ „Ljn It business is within limits of a.city,.whatcity? , Telephone el�' ' kCfQ) ?s.,.2 216, ,4a In Care Of (clo) - p pti6+1.1 -ek - 4b,;Mailin ddress fi different fro above) (include unit ♦ 6 #) City State ZIP 5. Bank Name (if available)" :: Bank Address Bank Account Number 6: First Day of Payroll' (MOIDAY/YR) . ,`_ Payroll RecOrdSLocation (list address y:., '�,S.' '• _ • i, i ' Payroll Records Telephone ( , ) ' i : Wholt producrss an or seciiim 11, )ll ,.': rd.: i.(.i-PP et .. _ : lo:, f • 1 Do you rent out items for 30 days or less? 0 Yes ❑ No ORGAN 8a. Owner/Partner/Corp. �Officer!• r S• r ` , ' i i • '� .'', • Do.4. kilaf,,ZLYEX Title ♦ .: >¢' rAI t1 Social Security y # '8b. Federal Employer Identification Nuniber(FEIN) Address (residence. Box, street, city, state,.ZIP.) =r • �) 9.2, r :.c 3 Telephone (5,710) k g .-: n 9a. Owner/Partner/Corp. Officer '.; ♦ ; Title ; : ♦ t Social Security # _ Feder ) niployer Identification Number (rEIN) 9b. Address (residence or P.O. Box, street city state, ZIP) • ., 'telephone l t ( It youacqutred the business In whole or in part, complete the following: =, , : "•. 10a. Prior.TaxpayerName Date of Acquisition Prior Taxpayer UI Tax Account Number i lob Address ` ' e 1 City t State' ZIP SALES TAX t ❑ If Seasonal, mark O JAN C APR ❑ JULY ❑ OCT ❑ FEB L MAY ❑ AUG ❑ NOV each business month. ❑ MAR :::'" ❑•-Jtitt,,:, ❑ SEPT LiDEC PERIOD COVERED FROM: MO/YR TO: MO/YR FEES 2a. FILING FREQUENCY: It sales tax collected is: [2b. First: Day of Sales (MO/DAY/YR) ❑ $15.00/month or less Annually I (0280- Trade Name 750) Registration (999) $ ❑ Under $300/month - Quarterly O $300/month or more - Monthly I O Wholesale only Annually @ State Sales Tax 810) {355} $ •Deposit I Pep* 3. Indicate which applies to you: r , ngle Event - Period Covered s... ❑- S,06 ❑ Wholesaler O Charitable Sales Tax .; 750) License .. (999) $ / 4 AY/YR) Retail -Sales O Multiple Event ❑ Retailers -Use Event Location (1000- Wage : : ti. 750) Withofcling :- : 0.00 .(699 WITHHOLDING 1. FILING FREQUENCY: If wage wiffrt iiiii)4* . - ' ❑ $1 $6,999 ear Quarter! Y5� ,,'r:'k',, /y y,' Q $50,•000+/year Weekly` r #d ];4≥... [ , Must file b ❑ $7,000 - $49,999/year - Monthly ;y EIectronic,.Funds Transfetc :.... :.: r i�•` ':;tr check mot: �b0 •• - �rii: TT PAGES ' ddF?F+1Es:. L TOTAILI $ -.i4� e! 1 7.'...:7 AND ECTt . of :1 declare under penalty of penury in the second degree that the statements made in this applfcatlon are true and complete to the best of my knowledge. -.;;•:•,,:• a; .I,' i ^u: s t? Title Date OFFICE USE ON Account T e� Sic Org LC LD QD SC IA _.. Sig ❑ N TR-1 Date Tech Sig (continue on reverse side of this page ) *** TRANSMISSION REPORT *** PRINT TIME 06/19 '98 12:42 ID:WELD CTY GOVT FAX:9703520242 TIMER=-:- MAILBOX= --- FILE START MODE No. TIME 250 06/19 12:41 TX ERROR PAGE= i LOCATION 1022213032052341 To: liquor Enforcement Fax #: (303) 205-2341 Re: Hereford Package Liquor Date: June 19, 1998 Pages: I , including this cover sheet. 2CA2SAA00826 US A STORE TX TOTAL CODE PAGE PAGE TIME 1 1 00'24" OK The applicant. or representative is driving to the Division this afternoon. Please release the I iquor license for Hereford Package liquor at the pick up window. You have been very helpful and we appreciate all of your efforts. If you have any questions, give me a call. Kim CLERIC TO THE BOARD PHONE (970) 356-4000, EXt.4227 FAX: (970) 352-0242 P.O. BOX 758 GREELEY, COLORADO 80632 FAX 9�9(io twig idlonotl wined Bum io{ no6 gusyl PS Form 3800, June 1985 P 387 472 806 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (SP.P RPVPLPPI DOROTHY M ZITEK HEREFORD PACKAGE LIQUOR 39520 WCR 136 HEREFORD CO 80732 Ilttlrllr,J,,JEtlltttl,III.utl 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 $ Postmark or Date s is!! a I i I[ 4� S m st;.€ 2 21 ssm P -a a 2f e q $fig a aig R S 2 .� a edicm! EE id U alas Us o m O OgO .� ?teaI mmy�v 81 m.n 4 4°OON: cC Loma SSJaEu ap uo pasalduroo SS]HOUY Nunlmob sl 102595-9]-B-0179 Domestic Return Receipt Hello