HomeMy WebLinkAbout950933.tiffRESOLUTION
RE: APPROVE CHANGE OF OWNERSHIP REQUEST FOR 3.2% BEER LICENSE FROM
KEN SPOONER, DBA OUR LITTLE STORE, TO KEN'S MARKET, INC., DBA OUR
LITTLE STORE
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, Ken's Market, Inc., dba Our Little Store, has presented to the Board of County
Commissioners of Weld County, Colorado, an application for a Change of Ownership of a County
Retail License for the sale of fermented malt beverages, containing not more than 3.2% of alcohol
by weight, in sealed containers not for consumption at the place where sold, said license previously
held by Ken Spooner, dba Our Little Store, and
WHEREAS, pursuant to Weld County Ordinance No. 6, Section II., C., said applicant has
paid the required fees to the County of Weld for a Change of Ownership of the existing license, and
WHEREAS, said applicant has exhibited a State License for the sale of 3.2% fermented
malt beverages in sealed containers not for consumption at the place where sold, outside the
corporate limits of any town or city in the County of Weld at the location described as follows:
4821 Yellowstone Drive, Greeley, Colorado 80634
NOW, THEREFORE, BE IT RESOLVED that the Board of County Commissioners of Weld
County, Colorado, having examined said application and the other qualifications of the applicant,
does hereby grant License Number 95-06 to said applicant to sell 3.2% fermented malt beverages
in sealed containers not for consumption at the place where sold, only at retail at said location and
does hereby authorize and direct the issuance of said license by the Chairman 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 April 25, 1996, providing that said place where the licensee is
authorized to sell 3.2% fermented malt beverages in sealed containers not for consumption at the
place where sold, shall be conducted in strict conformity to all of the laws of the State of Colorado
and the rules and regulations relating thereto, heretofore passed by the Board of County
Commissioners of Weld County, Colorado, and any violations thereof shall be cause for revocation
of the license.
950933
d.C: ,5Oj Xen'5MK-1jInc .
LC0021
CHANGE OWNERSHIP OF 3.2% BEER LICENSE - OUR LITTLE STORE
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 6th day of March, A.D., 1995.
AP D AS TO F
7ou Attorneye--
BOARD OF COUNTY COMMISSIONERS
D COUNTY, COLPRADO
Dale K. Hall, Chairman
FXCEJSFfI DATF OF SIf;NINC, (AY9
Barbara . Kirkmeyer, Pr -Tem
eorge Baxter
Constance L. Harbert
Webst-r
950933
LC0021
THIS LICENSE MUST BE POSTED IN PUBLIC VIEW
OR 8602 (10/92)
STATE OF COLORADO
DEPARTMENT OF REVENUE
Liquor Enforcement Division
1375 Sherman Street
Denver, Colorado 80261
KENS MARKET INC
OUR LITTLE STORE
4821 YELLOWSTONE DR
GREELEY CO 80634-9119
ALCOHOLIC BEVERAGE LICEN
Account Number
Liability Information
LICENSE EXPIRES AT MIDNIGHT
!Count City Indust. T
Y Type Liability Date
12-23472-0000
03 206 5813 C 042695
APR 25, 1996
Type
Name and Description of License
Fee
2122
2190
3.2 PERCENT BEER RETAIL
LICENSE (OFF PREMISES)
COUNTY 85 PERCENT OAP FEE
$ 50.00
$ 42.50
TOTAL FEEIS)
$ 92.50
This license is issued subject to the laws of the State of Colorado and especially under the
provision of Title 12, Articles 46 or 47, CRS 1973, as amended. This license is
nontransferable and shall be conspicuously posted in the place above described. This license is
only valid through the expiration date shown above. Questions concerning this license should
be addressed to the Department of Revenue. Liquor Enforcement Division, 1375 Sherman
Street, Denver, CO 80261.
testimony whereof. I have hereunto set my hand.
L
Division Director
MET �l.✓P_
APR 271995
Executive Director
950933
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THIS LICENSE EXPIRES
R 8404 (02/94)
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1375 SHERMAN STREET
DENVER CO 90261
COLORADO LIQUOR OR 3.2 % FERMENTED MALT BEVERAGE
LICENSE APPLICATION
1. Applicant is a
Z Corporation (Attach DR 8177)
❑ Partnership (Attach DR 8441)
la. Name of Applicant(s) If partnership, list partners' names (at least two); if corporation, name of corporation
/E IJ 4' M 1}(tic rL, 110 C..
2. Trade Name o Establishment (DBA)
JJU& ! 1 TTIf- 5rn(t_r
3. Address of Premises (specify exact location of premises
❑ Individual (Attach DR 8404-I)
Limited Liability Company (Attach DR 8405)
State Sales Tax No.
L-74to t-11dI0
Date filed with Local Authority
F.E.I.N.
2.9.r6Li
Social Security No.
Business Telephone
3379to2
"4'rt ') ,( '-1 t A f fl l .J 1 I U r. A— I r r `,-,
City
G n
County
(Va.(
t o
State p�
C)Ln
ZIP Code c_3(1
go
cu
4. Mailing Address (Number and Street)
U0.Z( Learn, ,CT,.T Oh
City or Town
CA -
State
w Ca
ZIP Code
RoG34
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. Present Type of License
r()Q 1 1-rn F 4rnat__ 01_--760- 77 -nnN -L.1 -u-t_
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? 0.
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? ❑
(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.
Present Expiration Date
�i o7-qC
8. Has a liquor license for the premises to be licensed been refused within the preceding two years? If "yes," explain in detail.
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.
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 ❑
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)? It 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 la 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.)
D Ownership ' Lease ❑ Other (Explain in Detail)
a. f leased, list name of landlord and tenant, and date of expiration, EXACTLY as they appear on the lease:
❑ 1g
Landlord Tenant
C.—Pr`US I(oo S /✓I AO fir IA -c.
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 scale)
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.
INTEREST
s
Ezpir
/.r31 1 U)
NAME
ADDRESS
,, ❑
K &J 50O4Tho iu
Ln7 So Jacc?MINE t,uaWEJ
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
/ /r. ,1 n_ 1 /
o{o
950933
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
1. Name of Applicant(s) (exactly as it appears on state application)
IC.ctoS MAnYc 1 !SELL _
2. Trade Name of Establishment (DBA)
(?U2 L.(TTLF S I (PF
3. Address of Premises (as it appears on the application)
4321 1/4-1cai ouJ cm 7A._
State Sales Tax No
O 2-- 7on-7 00C
City
State
C e L0
Business Phone
339 9za'L
County
(A) an
ZIP Code
80(331.1
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. *15
❑ Retail Warehouse Storage Permit $50.00
❑ Request to Change, Alter or Modify Premises ....75.00
❑ Addition of Optional Premises to Existing
HoteVRestaurant $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.
❑ Request to Change, Alter or Modify Premises 75.00
Request to Change Corporate or Trade Name 25.00
❑ 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
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 $
LIAB
SECTION D LIQUOR LICENSE FEES
2300
2310
1940
1940
1950
1950
1960
1960
1970
1980
1990
2010
2020
2030
2040
1905
2110
la Application Fee for New License $450.00
jil_Application Fee for Transfer of Ownership 450.00
❑ Retail Liquor Store License (city) 202.50
❑ Retail Liquor Store License (county) 287.50
❑ Liquor Licensed Drugstore (city) 202.50
❑ Liquor Licensed Drugstore (county) 287.50
❑ Beer & Wine License (city) 177.50
❑ Beer & Wine License (county) 262.50
❑ H & R License ❑city ❑ county 326.25
❑ H & R License w/opt Prem ❑ city ❑ county 326.25
❑ Club License ❑ city ❑ county 135.00
❑ Tavern License ❑ city ❑ county 326.25
❑ Arts License ❑ city ❑ county 135.00
❑ Racetrack License ❑ city ❑ county 326.25
❑ Optional Premises License ❑ city ❑ county 326.25
❑ Retail Gaming Tavern Lic ❑ city ❑county 326.25
❑ BWS Special Event Permit each 25.00
❑ Manager's Registration (hotel & restaurant only) .... 75.00
❑ Extended Hours 170.00
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
❑ Retail 3.2% Beer On/Off Premises - (county) 92.50
❑ 3.2% Beer Special Event Permit each 10.00
DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY
UABILITY 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
slats
-750 (999)
city
2180x100 (999)
2190-100 (999)
State
-750 (999)
2180.100(999)
County
2190-100 (999)
Managers Reg
1970-755 (999)
CY hFund aw Lic n
2300-100
(999) r.-
Cue Fund Tomato' Limon
2310-100
TOTAL
Cue Fund Now Limns
2300-100
(999)
Ore Fund Tnnrw.
-2310-100
(999)
Ext Hours City
2180-100
(999)
Ext Hours county
2190-100
(999)
White Copy - Department of Revenue Canary Copy Liquor Enforcement Division Pink Copy - Local Authority Goldenrod Copy - Applicant
950933
DR 8177 (02/94)
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1375 SHERMAN STREET ROOM 600
DENVER CO 80261
(303) 866-3741
CORPORATE APPLICANT
INFORMATION AND
CORPORATE REPORT OF CHANGES
Liquor and 3.2 Beer License
Submit to Local Authority (Local Authority will submit to State)
DO NOT USE THIS FORM TO REFLECT A CHANGE IN PARTNERSHIP. IF THERE IS A CHANGE IN PARTNERSHIP, USE THE
DR 8404 AND FILE A CHANGE OF OWNERSHIP WITH YOUR LOCAL LICENSING AUTHORITY.
Attach the following documents to this applicant information:
`Z Certificate of Incorporation if incorporated more than 2 years g Corporate minutes reflecting election of the
Certificate of Good Standing dated within the last two years current officers, directors and stockholders.
❑ Certificate of Authority if a foreign corporation
NOTE: All Officers and Directors of the Applicant/Licensee must fill out a DR 8404-I (Individual History Record). All
stockholders with a 10% (or more) ownership interest in the Applicant must also fill out a DR 8404-1 (Individual History
Record).
Corporate Applicant Name
IL tc MA(Keri I P(.
State Tax Acct. Number
0.1----7o0-71- 0000
State Liquor
0 2-"7bo7Z.-6Cb1
Telephone
33'?
License Number
Number
9 Z
Trade Name
O0a- 11TrLT ST62
Address of Licensed Premises
4 43 Qi Lt euu ca(,) crr,„c prt___
City
C ti. t�
State
Co
ZIP Code
S O h 3 L(
CHANGE OF CORPORATE STRUCTURE You MUST attach a certificate of Good Corporate standing; and a Copy of
Minutes. All Officers and Directors of the Applicant/Licensee must fill out a DR 8404-I (Individual History Record). All stockholders
with a 10% (or more) ownership interest in the Applicant must also fill out a DR 8404-I (lndiv'dual History Record)
CURRENT CORPORATE OFFICERS Name
Home Address
DOB
Replaces
President
Vice -President
Treasurer
Secretary
NEW STOCKHOLDERS/TRANSFER OF CAPITAL STOCK
Is this corporation subject to the reporting requirements of the Securities and
No If yes, list only those stockholders owning 10% (or more) of the issued
Exchange Act of 1934? (Publicly traded) Yes
stock ff no, list all stockholders.
CURRENT STOCKHOLDERS/TRANSFERS OF CAPITAL STOCK Name
Home Address
DOB
''/. of Stock Now Owned
CURRENT DIRECTORS Name
Home Address
DOB
Replaces
Registered Agent
Address For Service -
OATH OF APPLICANT
I declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete to the best
t of my knowledge.
F.
Authorized fignature
V L /A-11--
Title
i9 /1-1::_ 1 l C) -r‘, --k
Date
3 t i / 1
T
The foregoing changes have been received and examined by the Local
REPORT OF LOCAL LICENSING AUTHORITY Licensing Authority.
Local Licensing Authority For
Weld County, Colorado a County ❑ Town/City
i n tore
TitteChairman, Weld County Board
of Commissioner
(
Date
03/06/95
Attest! �'ly,v By:74
Date
03/06/95
��
eputy-15; o Boa�rd
NOTE: Local authority, for all changes in Corporations, please submit all copies to the Liquor Enforcement Division.
One copy will be returned to the applicant and one to the local authority upon acknowledgment.950933
OR 8404-I (07/92)
:OLORADO DEPARTMENT OF REVENUE
IOUOR ENFORCEMENT DIVISION
•,375 SHERMAN STREET
DENVER CO 80261
INDIVIDUAL HISTORY RECORD
To be completed by each Individual applicant, each general and over 5% limited partner of a partnership, each officer, director, and
over 5% stockholder of public corporation, over 5% limited liability company members/persons and managers
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 and reputation of the
applicant.
1. Name of Business
p(/a. L.I-rrLr Srort.E
Date
2-I -9C
Soda] Security Number
2. Your Full Name (last, first, middle)
S Po o t\-1'\,- (Cr N t✓ erW Q0 C Wl.
3. Also Known As (maiden name/nickname, etc.)
—
4. Mailing Address (if different from residence)
I 11nk3N Mtt_LIICE"' a Soso
Home Telephone
cc -37-X431
5. Residence Address (street and number, city, state, zip)
) d2 So ,J 03 ee .u± tt M\LL1Ice r' (2) s-cy3
16.
Is your residence gowned rented
If rented, from whom?
7. Date of Birth
5l1 --
of Birth
Lex i,,c-re ,� N4Q R
8. U.S. Citizen? �
tc -7.�� es ❑ No
If Naturalized, state where
When
Name of U.S. District Court
Naturalization Certificate Number
Date of Certificate
Ban Alen, Give Allen's Registration Card Number
Permanent Residence Card Number
9. Heigh
S///'d
Weight
/Pi
Hair Color
C32J
Eye Color
k -\-CL-
Sex
/\''\
Race
CA CD ,
10. Do You Have a Colorado Drivers License? If yes, give number
Yes ❑ No SRS -
What Is your relationah p to the applicant? (sole owner, partner, corporate officer, director, stockholder, member or manager)
Ca) 7Leo F o#(ci-c`
12. If stockholder, number of shares owned beneficially or of record
Percent of outstanding stock owned
13.
If partner, state whether ❑ General ❑ Limited
Percent of Partnership Owned
If Limited Liability Company, percent owned
14. Name of Present Employer
ILEA.; S. MAacc, (N)(
15. Type of Business or Employment
(,206 c7 5%(2.,'
16. Address of Business Where Employed (street number, city, state, zip)
R03 Brie tan s Mc..,LJVVC,) CI, RoC6(1
Business Telephone
CE? 7— c/2zl
17. Present Position
Pru ioEn
18. Marital Status
19. Name of Spouse (include maiden name if applicable
CnNSTAmcf 2 S II0 LT Z
20. Spouse's Date of Birth
Spouse's Place of Birth .
oiv\AN/a 1 NtQ(L-
21. Spouse's residence address, if different than yours (street and number, city, state, zip)
22. Spouse's Present Employer
, EN 1 Th. A2Yk7--
Occupation
12 AD( u'/ -E /t_-
23. Address of Spouse's Present Employer
Q 0 n!+-o,,l0 Sr Mtt_ciltCi ..../
24.
List the name(s) of all relatives working in the liquor industry.
Name of Relative
to You
Position Held
Name of Employer
Location of Employer
tt
1DAVin 5-H ..—
{f�� /�//Re��lationship
13g 41NECL.��IN (Ark)
jx-tiuc /
$Qocnrsrn
((((��
0E&Alert
CONTINUED ON REVERSE SIDE
25. Do you now, or have
you ever held a direct or indirect interest in a State of Colorado Liquor or Beer License? If yes, answer in detail
0Yes ❑ No P(I-�S I(JFfv , KCEtj ty a,v-gr_ 14—ISc,G5
Mt sg(v,,.cz 1•4Ac 11PpaalY't) UN0th,62-7cnl2-oot. NE\S J)st- Ir%(0aP(12ann,L 26. Do you now, or have
you ever had a direct or indirect interest in a liquor or beer license, or been employed in a liquor or beer related business outside the Stale of Colorado? If
yes, describe in detail.
❑ YesNo
27. Have you ever been convicted of a crime, fined, imprisoned, placed on probation, received a suspended sentence or forfeited bail for any offense in criminal or military court? (Do
not include traffic violations, unless they resulted in suspension or revocation of your driver's license, or you were convicted of driving under the influence of alcoholic beverages.)
If yes, explain in detail.
❑ Yes.No
28. Have
you ever received a violation notice, suspension or revocation for a liquor law violation, or been denied a liquor or beer license any where in the U.S.? If yes, explain in detail.
❑ Yes ig_No
29. Have you ever held a gambling or gaming license or owned a Federal Gambling Stamp? If yes, explain in detail below,
❑ Yes CZ -No
State/Federal
State/Federal
Year
City
State
30 Military Service
Year
City
State
4a--
f"f2'v`-7
31. tY
From
.7—c.7
To
lo -67 I
Serial Number
S23 —L{- 999
( / !U
Type of Discharge
WC)
List all addresses where you have lived for the past five years. (Attach separate sheet if necessary)
A764i
Street and Number
City, State, Zip
107 Sa , l ai P(1 I yF
M ILC.I lee -A Sos
From
I -7ci
To
?ac
32.
List all former employers or business engaged in within the last five years. (Attach separate sheet if necessary.)
Name of Employer
Address (street, number, city, state, zip)
Position Held
4EA)/ MA2i«
'103 en-oRo )
?AV \oewy.
From
I78
To
foxi,
33.
List the names of persons who can vouch for your good character and fitness in connection with this app 'cation.
Name of Reference
Address (street, number, city, state, zip)
Number
CcyoE f3e-(6(c
113 So -l-fpkr di/A{4afrat,,LJ
of Years Known
11
RANo JAce(3Can)
M,tL(K-C.,-1 POUcc CH El
q
e,c , oe BGJArt,gnm
g[0 9n-oAD cr kiLLl)c1r,/
(7
OATH OF APPLICANT: / declare under penalty of perjury in the second degree that I have read the foregoing application
ments thereto, and that all information therein is true, correct, and complete to the best of my knowledge.
Signature
and all attach-
& (Title
94 ' / nc--'tir
f=
Date
q%4471 '2
DR 8404-I (07/92)
COLORADO DEPARTMENT OF REVENUE
JQUOR ENFORCEMENT DIVISION
1375 SHERMAN STREET
DENVER CO 80261
INDIVIDUAL HISTORY RECORD
To be completed by each Individual applicant, each general and over 5% limited partner of a partnership, each officer, director, and
over 5% stockholder of public corporation, over 5% limited liability company members/persons and managers.
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 and reputation of the
applicant.
•1. Name of Business
Keu's h7r}->Z14 , rev C.
2. Your Full Name (last, first, middle)
SPo0NER , CoNsr*Ncc
4. Mailing Address (if different from residence)
P0. (3oY 3147
S. Residence Address (street and number, city, state, zip)
R4 5
Date
Social Security Number
3. Also Known As (maiden name/nickname, etc.)
CoNNIE �f1/ULTZ
Home Telephone
1107 S. JOSE PtI NE h/LLIkeAJ 6.94-012 co sloc�f3
I
6. f rented, from whom?
Is your residence X owned ❑ rented
7. Date of Birth
If Naturalized, state where
Place of Birth
oM AHI9 NEBRRoki9
When
8. U.S. Citizen?
Yes ❑ No
Name of U.S. District Court
Naturalization Certificate Number
I9. Height
LS-1S/r
Date of Certificate
If an Mien, Glve Mien's Registration Card Number
Permanent Residence Card Number
Weight
)53 -
Hair Color
REn
Eye Color
riLU?,
Sex
FEN#LE
Race
10. Do You Have a Colorado Drivers License? If yes, give number
RIYes ❑ No
11. What is your relationship to the applicant? (sole owner, partner, corporate officer, director, stockholder, member or manager)
CoRPo12/4-1- O�iceYL — Ti /9-SLIJ2EIC
12. If stockholder, number of shares owned beneficially or of record
Percent of outstanding stock owned
13.
If partner, state whether ❑ General ❑ Limited
14. Name of Present Em foyer
X& iil'c /1/41 /4-ICey tNc •
16. Address of Business Where Employed (street number, city, state, zip)
BZ 963 o, -n • Mlr�l/�s� (6(014400 -aSY3
17. Present Position
Mnunc Ell
18. Marital Status
PIA-RRR1ED
20. Spouse's Date of Birth
21. Spouse's residence address, if different than yours (street and number, city, state, zip)
Percent of Partnership Owned
If Limited Liability Company, percent owned
15. Type of Business or Employment
Gi2UCEI `i S7U KE
19. Name of Spouse (include maiden name if applicable
KEW)eTH
Spouse's Place of Birth
LeV) iu6 ra&
,z SrootER
Business Telephone
W7- /
22. Spouse's Present Employer
llest, Ma t-KF 1' , zu c r
23. Address of Spouse's Present Employer
903 8/L0130 sl-/ MILLlk r.) CocoLti-Y7 goSY3
24.
Occupation
h2ES. — / ti4} YE/C
List the name(s) of all relatives working in the liquor industry. ass
Name of Relative
jauicol Silk lit
Relationship to You
by-o+-14e>r
Position Held
PeliJevf
}yi/kVt
Name of Employer
botdweuserc
Location of Employer
De no ex
CONTINUED ON REVERSE SIDE
9
3as
25. Do you now, or have you ever held a direct or indirect interest in a State of Colorado Liquor or Beer License? If yes, answer in detail
gi Yes ❑ No KeAJ y Rctte16e,--ittJC -ire e /93utKV? 3 2 % C.i cejtsc /4 -ire v7
t
MR Scr sfl 1.tot nPu,irro UN) 04-tW07-7oc-7t-000 IJ.i is Jc:J-r' Ihcttn P(42A)n, C.
28. Do you now, or have you ever had adirect or indirect interest in a liquor or beer license, or been employed in a liquor or beer related business outside the State of Colorado? If
yes, describe in detail.
❑ Yes 3c No
27. Have you ever been convicted of a crime, fined, imprisoned, placed on probation, received a suspended sentence or forfeited bail for any offense in criminal or military court? (Do
not include traffic violations, unless they resulted in suspension or revocation of your driver's license, or you were convicted of driving under the influence of alcoholic beverages.)
If yes, explain in detail.
IT Yes XfNo
28. Have you ever received a violation notice, suspension or revocation for a liquor law violation, or been denied a liquor or beer license any where in the U.S.? If yes, explain in detail.
ir
❑ Yes gNo
29. Have you ever held a gambling or gaming license or owned a Federal Gambling Stamp? If yes, explain in detail below.
❑ Yes f No
State/Federal
Year
City
State
State/Federal
Year
City
State
30 Military Service (branch)
From
To
Serial Number
Type of Discharge
31.
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
107 5.0d5e4he if e
N9: II; kfN Co 'os-V3
1179
1995-
j
32.
List all former employers or business 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
eE/01 s Sutpe12ETTg
9d 3 /38040 si. M/LLile yetc,1/3
(J6ui:a/rape-
7t
Y4
ilt=N (5 No ye -et rN C
(I /
7rcksuvcr,4 ny,
/ 1
%5
33.
List the names of persons who can vouch for your good character and fitness in connection with this app ication.
Name of Reference
Address (street, number, city, state, zip).
Number of Years Known
—)Pte.g-`C J i I )GiLE
aUW S. ,jo; epIi' -c I1;IIJKit(Cd 16SV3
%O ycays
yeas
13yegvs
and all attach-
M a v y tU. Y v o4clt
10 3 5• 7-asef12i ro e ii/7
ea f l 6/76V0i%0
305 5. 4/A7eeN (r )r
OATH OF APPLICANT: / declare under penalty of perjury in the second degree that I have read the foregoing application
ments thereto, and that all information therein is true, correct, and complete to the best of my knowledge.
Sp re
'�7c.it -
Wu ie7�(/J �i/�, "
Title
�j � p � � � �� //
�J jtyWt✓.'L /gym i7l{�I'C K-
Date
;--,;-&---If
DATE: March 3,1995
TO: ROSEMARY LOPER, RECORDS
FROM: OFFICE OF WELD COUNTY CLERK TO THE BOARD
SUBJECT: LIQUOR LICENSE CHECKS
Please run a records check on the following establishment. This information will be used by the
Board of County Commissioners in considering renewal of liquor license.
PLEASE RESPOND NO LATER THAN TODAY, MARCH 3, 1995 - ASAP, PLEASE.
(This is a Change of Ownership application on Monday, March 6, 1995, agenda; therefore, we
need this info ASAP today for Board's packets this afternoon.)
Thank you.
ESTABLISHMENT: Ken Spooner, dba Our Little Store
4821 Yellowstone Drive
Greeley, Colorado 80634
INCLUSIVE DATES: March 1994, through March 1995
BY: Shelly K. Miller, Deputy
Call 3564000, ext. 4226 WHEN COMPLETED, OR IF QUESTIONS.
No violations on record.
BY: C l ate_ )
VIOLATIONS: (PLEASE LIST ) (JJ
BY:
k:\shells\ligcheck
950933
Ken's Market, Inc.
Ken & Connie Spooner/Owners
901 Broad St. P.O. Box 314, Milliken, Colo., 80543
4821 Yellowstone Dr. Greeley, Colo. 80634
Feb28,1995
303 587-4221
303 339-9202
Our Little Store shall be sub -leased from Ken Spooner to Kens Market, Inc. as of Oct
31,1994.
All terms and conditions are binding with the original lease from C -Plus.
Ken Spooner
President, Kens Market, Inc.
950933
C PLUS INC.
(303) 892-7171
February 15, 1995
Ken Spooner
Our Little Store
4821 Yellowstone Drive
Greeley, Co. 80634
Dear Ken:
1055 AURARIA PKWY., #100
DENVER, COLORADO 80204
In response to your request to sub -lease Our Little Store to Ken Spooner, Inc., C -plus Inc. does
hereby approve of that action.
I must remind you that, as lesser, all terms and conditions of the lease remain your responsibility
and our relationship as a lessor and lessee remains intact. Further, the sub -lesser must agree to be
bound by all terms and conditions of the lease.
Thank t ou
Gary Wetz arge
Operation Man ger
950933
OR 8177 (02/94)
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1375 SHERMAN/STIFT ROOM 600
DENVER CO80261S �,f''t CORPORATE REPORT OF CHANGES
d
(303) 866-3741
CORPORATE APPLICANT
INFORMATION AND
4,4Liquor and 3.2 Beer License
R 2/995 Submit to Local Authority (Local Authority will submit to State)
DO NOT USE THIS FORM TO REFLECT A CHANGE IN PARTNERSHIP. IF THERE IS A CHANGE IN PARTNERSHIP, USE THE
DR 8404 AND FILE A CHANGE OF OWNERSHIP WITH YOUR LOCAL LICENSING AUTHORITY.
Attach
...V
❑
❑
the following documents to this applicant information:
Certificate of Incorporation if incorporated more than 2 years IX Corporate minutes reflecting election of the
Certificate of Good Standing dated within the last two years current officers, directors and stockholders.
Certificate of Authority if a foreign corporation
NOTE: All Officers and Directors of the Applicant/Licensee must fill out a DR 8404-1 (Individual History Record). All
stockholders with a 10% (or more) ownership interest in the Applicant must also fill out a DR 8404-I (Individual History
Record).
Corporate Applicant Name
L: 1J `S A'kAN1Cer t P r
State Tax Acct. Number
State Liquor License Number
6 .7----7.7----76O6O71..,- 6 6 b rik
t
Trade Name
/ 2 - 3 T72
O 2c
Telephone Number
337 9 2d z.
Address of Licensed Premises
ti e3 2.( �r ECi 0(,)cT-) ,., c pc
City
C fa=ll -g` y
State
Co,8
ZIP Code
O (3 t,
t
CHANGE OF CORPORATE STRUCTURE You MUST attach a certificate of Good Corporate standing; and a Copy of
Minutes. All Officers and Directors of the Applicant/Licensee must fill out a DR 8404-I (Individual History Record), All stockholders
with a 10% (or more) ownership interest in the Applicant must also fill out a DR 8404-I (Individual History Record)
CURRENT CORPORATE OFFICERS Name
Home Address
DOB
Replaces
President jCtn.) S 96(.1,.z,..._. .._.
1O7 5, JoJcPu/A,E
Slrr/
STOCKHOLDERS/TRANSFER OF
Exchange Act of 1934? (Publicly traded)
stock. If no, list all stockholders.
CAPITAL
STOCK
Yes X1
Is this corporation subject to the reporting requirements of the Securities and
No If yes, list only those stockholders owning 10% (or more) of the issued
CURRENT STOCKHOLDERS:TRANSFERS OF CAPITAL STOCK Name
Home Address
DOB
% of Stock tikv Owned
ILGQ S(J-OO1.krr..-
fa ,jt),1 42 r.-Cli,(
5616
=
_1_O"7
1JrPK
0) So
4b
CURRENT DIRECTORS Name
Home Address
DOB
0 Replaces
Registered Agent
Address For Service
OATH OF APPLICANT
I declare under penalty of perjury in the second degree that this
of my knowledge.
—rTitia
application and all attachments are true, correct, and complete to the best
Authorized I ature
I
tk ive-tlti� i
C2 lid ; 117.G n, l
Date
� 1 I 9 S
�
REPORT OF LOCAL LICENSING AUTHORITY The
Licensing
foregoing changes have been received and examined by the Local
Authority.
Local Licensing Authority For
Weld Coun
y, Colorado f county U Town/City
i nure
TitleChairman, Weld County Board
Date
of Commissioners
03/06/95
Attest
I �•; .� r By:
v'/
Date
tril�/ " /v• ler
03/06/95
eputy o Boar
NOTE: Local authority, for all changes in Corporations, please submit all copies to the Liquor Enforcement Division.
One copy will be returned to the applicant and one to the local authority upon acknowledgment.95t}933
DR 8404 (2/94) Page 2
14. Liquor Licensed Drug Store applicants, answer the following: Yes
(a) Does the applicant for a Liquor Licensed Drug Store have a license issued by the Colorado Board of
Pharmacy? COPY MUST BE ATTACHED. ❑
No
■
15. Club Liquor License applicants answer the following and attach DR 8177:
(a) Is the applicant organization operated solely for a national, social, fraternal, patriotic, political or athletic purpose and
not for pecuniary gain?
(b) Is the applicant organization a regularly chartered branch, lodge or chapter of a national organization which is
operated solely for the object of a patriotic or fraternal organization or society, but not for pecuniary gain?
(c) How long has the club been incorporated? (d) How long has applicant occupied the premises
(Three years required) 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 direct
or indirect financial interest in a wholesaler, retailer, manufacturer or importer already licensed by the State of Colorado to sell
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.
•
•
•
•
•
•
17. Nonresident Manufacturer (3.2% beer or malt liquor) or Importer (3.2% beer, malt, vinous or spirituous liquor) applicants, answer
the following:
(a) To what Colorado licensed wholesaler do you intend to ship your merchandise?
(b) Does or did any owner, partner, shareholder, director, officer, member or manager have any direct or indirect financial
interest in a wholesaler, retailer, manufacturer or importer already licensed by the State of Colorado to sell 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 in detail.
(d) Are you the primary source of supply in the U.S.? It "no," explain.
(e) Are all your products registered in Colorado? It "no," attach DR 8440 and register said products.
■
•
❑
■
■
■
•
❑
18. Name of Manager (If this is an application for a Hotel and Restaurant License, the manager must also submit a Manager Registration Form
Date of Birth
-
(Dri 8367) and Individual is o DR 8404-I).
(Qti Sf-w_ Nish' Harm
w
OATH OF APPLICANT
I d tare under penalty of perjury in the second degree that this application and all attachments are true, correct, and
co lete to the best of my knowledge.
Author' d Signature
Title
Preslder%}-
Dale
REPORT AND APPROVAL OF LOCAL LICENSING AUTHORITY
(Manufacturers, nonresident manufacturers, importers, wholesalers, limited wineries, arid public transportationlIcensees • s.
disregard the section below.) .-)f,
Is this application for a: ❑ New License ❑ Transfer of Ownership n Other (specify)
Each person required to file DR 8404-I: Yes No
Has been fingerprinted • •
Background. NCIC and CCIC checked ❑
The liquor licensed premises is ready for occupancy and has been inspected by the Local Licensing Authority. ❑ II
It "no,' the building will be completed and ready for inspection by
(dater
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 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 COUNT , C LORADO
•
ICE
TOWN, CITY
COUNTY
s
AL K. HALL
Title CHAIRMAN, WELD COUNTY BOARD
OF COMMISSIONERS
Date
4/18/95
Signatur a est)
j/�
Tills WELD COUNTY y¢,�LERK TO E
BOARD BY: (7,11/7/ �/7/ /DEPOT".
Date
4/18/95
If pr E s f ca , the above approval should be signed by the mayor an lerk, if in a county, then by the chairman of the
board of county commissioners and the clerk to the board. If, by ordinance or otherwise, the local licensing authority is some other official, then such
approval should be given by such official.
950933
£E60S6
n -a- b h
A
Dale K. Hall, Chairman
CLERK TO THE BOARD
WE�Dc.
COLORADO
PLEASE POST NEAR EXISTING LICENSE
April 18, 1995
TO WHOM IT MAY CONCERN:
P.O. BOX 758
GREELEY, COLORADO 80832
(303) 358-4000 EXT. 4225
On the 6th day of March, 1995, the Board of County Commissioners of Weld County,
Colorado, did approve the Change of Ownership request of Ken's Market, Inc., dba Our
Little Store, for a 3.2% Beer License, being held by Ken Spooner, dba Our Little Store, and
expiring on April 7, 1995. The required documents for the Change of Ownership have
been submitted to the State Department of Revenue for its approval. Until notification has
been received from the State advising whether this Change of Ownership request has been
approved or disapproved, the Board hereby authorizes the continued sale of 3.2% at this
establishment which is located at 4821 Yellowstone Drive, Greeley, Colorado 80634, under
a Temporary Permit which has been approved by the Board. This Temporary Permit allows
Ken's Market, Inc., dba Our Little Store, to conduct business and sell 3.2% beer in sealed
containers not for consumption at place where sold, at retail at said location in accordance
with the license previously held by Ken Spooner, dba Our Little Store, subject to all other
rules and regulations set forth by the Board of County Commissioners of Weld County,
Colorado, for a period of 120 days, or until such time as the application for Change of
Ownership is approved by the State of Colorado, whichever shall occur first.
If there are any questions concerning this matter, please feel free to contact the Weld
County Clerk to the Board's Office at 356-4000, Extension 4225, between the hours of
8:00 a.m. and 5:00 p.m., Monday through Friday.
Sincerely,
BOARD OF COUNTY COMMISSIONERS
ELD COUNTY, COLORAD
DKH/ Imd
950933
STATE OF COLORADO
LIQUOR ENFORCEMENT DIVISION
Department of Revenue
1375 Sherman Street, Room 600
Denver, Colorado 80261
Phone (303) 866-3741
FAX (303) 866-4541
March 30, 1995
County Clerk
Weld County
P.O. Box 758
Greeley, CO 80632
r
C ECi1,
TO TI r- :.
Roy Romer
Governor
Renny Fagan
Executive Director
David C. Reitz
Division Director
Re: Our Little Store, application for 3.2% Beer license
Dear Clerk:
The following items must be submitted or completed for issuance of the 3.2% Beer license.
4)
Page 2 of the license application (DR 8404) was not included. You
submitted page two of form DR 8404-I (Individual History Record). I am
returning that because we have the completed Individual History record for
Mr. Ken Spooner on the goldenrod form.
"72) I am returning form DR 8401 which is an attachment to a license renewal.
We understand this to be a transfer of ownership, so this form is not
applicable.
73) Form DR 8177 regarding corporate information is not complete. I have
returned it for the applicant's completion.
74) A diagram of the proposed licensed premises must be submitted on 81/2"
x 11" paper designating the area to be licensed.
The applicant may not use the old state sales tax license #02-70072. They
must contact the Taxpayer Service Division at (303) 534-1208 and have
a sales tax liability opened under account #12-23472. This will be their
new liquor license number when the license is issued.
(5),;'
DR 8481 (06/94)
950933
Weld County Clerk
March 30, 1995
Page 2
Should you have any questions, you may reach me at (303) 866-3741.
Sincerely,
Laura K. Smith
Investigator
cc: Ken Spooner
U.S. G. P.O. 1989-234-555
PS Form 3800, June 1985
P 387 473 690
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950933
1266
KEN'S MARKET, INC.
THE
DER OF
903 BROAD ST. PH. 303-587-4221
P.A. BOX 314
MILLIKEN, CO 80543
Flue
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NO INSURANCE COVERAGE PROVIDED
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Return Receipt showir,
to whom and Date Deily
Return Receipt showing to
Date, and Address of Delivery
TOTAL Postage and Fees
Postmark or Date
S _ -s -7s
SENDER:
• Complete items 1 and/or 2 for additional services.
• Complete items 3, and. 4a & b.
• Print your name and address on the reverse of this form so
that we can return this card to you.
• Attach this form to the front of the mailpiece, or on the
back if space does not permit.
• Write "Return Receipt Requested" on the mailpiece next to
the article number.
I also wish to receive the
following services (for an extra
feel:
1. O Addressee's Address
2. ❑ Restricted Delivery
Consult postmaster for fee.
3. Article Addressed to
KEN'S MARKET, INC.
DBA OUR LITTLE STORE
4821 YELLOWSTONE DRIVE
GREELEY, CO 80634
4a. Article Number
P38-7 97/ 69e
4b. Service Type
❑ Registered ❑
Certified
❑ Express Mail
Insured
COD
Return Receipt for
Merchandise
7. Date of Delivery
MAY -6 1995
8. Addressee's A
and fee is paid)
5. Signature (Addressee)
6. S. nature (Agent)
ss (Only if requested
PS or m 11, October 1990 *us. GPO: LMm-treat
LC0 .2/ eenthHA" .
DOMESTIC RETURN RECEIPT
950933
Hello