HomeMy WebLinkAbout951927.tiffRESOLUTION
RE: APPROVE CORPORATE REPORT OF CHANGES TO TAVERN LIQUOR LICENSE,
WITH EXTENDED HOURS, FOR LUCKY STAR CORPORATION, DBA LUCKY STAR
BAR AND GRILL, AND AUTHORIZE CHAIRMAN TO SIGN
WHEREAS, the Board of County Commissioners of Weld County, Colorado, pursuant to
Colorado statute and the Weld County Home Rule Charter, is vested with the authority of
administering the affairs of Weld County, Colorado, and
WHEREAS, Lucky Star Corporation, dba Lucky Star Bar and Grill, holder of a Tavern Liquor
License, with extended hours, in Weld County, Colorado, has presented the Board with a Corporate
Report of Changes, and
WHEREAS, said corporate change is as follows: Hadi Tehranian replaces Michael Branand
as President, Mahmoud Tehranian replaces Michael Branand as Vice -President, and Fatemeh
Sohrabi replaces Michael Branand as Treasurer, and
WHEREAS, after study and review, the Board deems it advisable to approve said corporate
report of changes.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Corporate Report of Changes submitted by Lucky Star Corporation, dba
Lucky Star Bar and Grill, be, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chairman be, and hereby is, authorized
to sign said report.
The above and foregoing Resolution was, on motion duly made and seconded, adopted by
the following vote on the 13th day of September, A.D., 1995.
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COOR�ADO
APP lAS TO FO
intCA-aftruc
Dale K. Hall, Chairman
ilkt.
Marbara J. Kirkmeyer,
Geoorgeve-Baxter
Constance L. Harbert
(--
`—� ism
W. H. Webster
; 5 7t)TE; /ILL y 3-72-)A1 ) 6 CI
A
LTA
951927
LC0016
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
Name of Applicant(s) (exactly as it appears on state application)
2. Trade Name of Establishment (DBA)
4a city s- far — 6r, 1 /
3. Address of Premises (as it Sppears on the application)
3313 /8� UGe-/— eCa66to4/6
State Sales Tax No Business Phone • ALL ANSWERS MUST BE PRINTED IN BLACK INK OR TYPE-
WRITTEN
• APPLICANT MUST CHECK THWIOPRIATE BOX(ES)
• LOCAL LICENSE FEE $
City
4-u fern
State
County I e et
ZIP Codesa v/O
DO NOT WRITE IN THIS SPACE
2320-750 (999)
SECTION A FEES
If applicant has a Beer and Wine, or Malt, Vinous and
Spirituous Liquor Licens , indicateyour state Liquor
• License Account No. /4 - 9q LiG1 4e. —YOOO
Retail Warehouse Storage Permit $50.00
Li Request to Change, Alter or Modify Premises ....75.00
Li 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.
L1 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 Hotei/Restaurant liquor license and is
registering a new manager, indicate your state Liquor
• License Account No.
Li Manager's Registration $75.00
LIAB
2300 L
2310 f J
1940 ❑
1940 LI
1950 ❑
1950 ❑
1960 ❑
1960 ❑
1970 ❑
1990 ❑
1990 ❑
2010: ❑
2020 - ❑
2030 ❑
2040 ❑
1905 ❑
2110
2300
2310
2121
2121
2122
2122
2123
2123
2170
SECTION D LIQUOR LICENSE FEES
Application Fee for New License $450.00
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 I J city [-] county 326.25
H & R License w/opt Prom ❑ city [] county 326.25
Club License J city ❑ county 135.00
Tavern License El city Li county 326.25
Arts License ❑ city ❑ county 135.00
Racetrack License LI city ❑ county 326.25
Optional Premises License ❑ city ❑ county 326.25
Retail Gaming Tavern Lic LI city ❑county 326.25
❑ BWS Special Event Permit each 25.00
❑ Manager's Registration (hotel & restaurant only) .... 75.00
❑ Extended Hours 170.00
CanC of Ccrp. LCC.1-1.3r�
Ta_v; zo/x-mod PA n>rS
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%io 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
LIABILITY INFORMATION
County
City
industry Type
Liability Date
License Issued Through
(Expiration Date)"
License Account Number
ee paid for 3.2% Beer
Fee paid for Beer, Wine, and Spirituous Liquor
Stall
-750 (999)
City
2180-100 (999)
County
2190-100 (999
State
-750 (999)
City
2180-100 (999)
County
2190-100 (999)
Managers Reg
1970-755 (999)
Cash Fund New Llama*
2300-100
(999)
Cash Fund Vanes, Lien.
2310-100
(999) _
TOTAL
Cosh Fund Now Uwn..
2300-100
(999)
CaM1 Fund Tnml.r
2310-100
(999)
Est 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 1 54:422 t pplicant
Corporate Applicant Name
DR 8177 (03/95)
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:
O Date Stamped Articles of Incorporation if incorporated less than 2 years.
Lj Certificate of Good Standing dated within the last two years if Corporation is at least two old.
Ei 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-I (Individual History Record).
State Liquor License Number
14-29494-0000
Trade Name jLltc / L -t
' /3/1/2--s 60.11
Address of Licensed Premises
33)3) 14194o -id gS La.
Mailing Address if different than above
Po &oct 52 -
ALL APPLICANTS MUST LIST CURRENT OFFICERS AND DIRECTORS. If currently licensed and this is a change of corporate
structure, also identify the Officers/Directors replaced and attach a certificate of good standing, dated within the last two years.
Follow instructions in the shaded area above. Attach separate sheet if necessary.
Name Home Address
President
a -e RS
> MICHAEL BRANAND
Secretary
City
Telephone Number CEO
yo) 35i 6c7o-0
SLa
City / State
LLca�n-2-czo
ZIP Code 0(4416
ZIP Code<<
U ,
gh NJ
DOB Replaces
CURRENT DIRECTORS
Name Home Address _ DOB - Replaces
LIST ALL STOCKHOLDERS AND PERCENTAGE OF STOCK NOW OWNED Is this corporation subject to the reporting
requirements of the Securities and Exchange Act of 1934? (Publicly traded) Yes n No If yes, list only those
stockholders owning 10% (or more) of the issued stock. If no, list all stockholders.
CURRENT STOCKHOLDERS
Lint; Tch r^nLniay.
Fa Grn2-A 4,ohrr..k
nlahtw.a u.- 76{1 ♦etn an.
Registered Agent
Name
Home Address
�a •K -C
le,44_ratc,
Address For Service
DOB I % of Stock Now Owned
) 5
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
Local Licensing Authority For
State Tax Account Number
!Q/—,9 eNti
Title
Date91/ 3/ 93
foregoing changes have been received and examined by the Local
'rig Authority.
REPORT OF LOCAL LICENSING AUT ''v
f
t *DRAM) Zirefd1
w l tiffAIRMAN, WELD COUNTY BOARD
signature."w.. v�, tAil �OF COMMISSIONERS
Attest
/7/J 71. BY: 2( P
-7 ^ �` ; DEPUTY RK I 0 BOARD
NOTE: Local authority, for all changes in Gt orporations, please submit all copies to the Liquor Enforcemf
An acknowledgment will be returned to the local authority.
r
County Town/City
Date
09/13/95
Date
09/13/95
951927
LUc)cI STAR cello_
•
CD
P 387 472 028
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED
NOT FOR INTERNATIONAL MAIL
(See Reverse)
Sent to
COLORADO DEPT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
STATE CAPITOL ANNEX
1375 SHERMAN ST
DENVER CO 80203
Certified Fee
Return Receipt showing
to whom and Date Delivered
Return Receipt showing to whom
Date. and Address of Delivery
AO Postmark or Dale
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951927
R 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 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 Loci<y {�-t� �j ,rn 1 , fin
i..) W(� 6,fin
Date
Social Security Number(s)
2. Your Full Name (last, first, middle),.—
3. Also Known As (maidenlnam1 name/nickname, etc.)
/fff0�1-�/`�y/� /✓ 11 all
4. Mailing Address (if different from residence)
Home Telephone
(3 )1 S 2cti‘
5. Residence Address (street and number, oily, state, ZIP)
12.0 9 -1 CI: w L eto' P L. 4-a)w La- , c0 g col 2
6. Date of Birth /
JZ.
Place of Birth
7. U.S. Citizen?
Yes U No
If Nat alized, state where
5 to
When
,,.tcl 7y
Name of U.S.11District Court
I ,..,,z_(.
Naturalization Certificate Number
Date of Certificate
AL o C C k I I 1.2 7
If an Alien, Give Alien's Registration Card Number
Permanent Residence Card Number
8. Heights
Weight
Hair Color
Eye Color
o
Sex
/v1
Race
O
9. Do
You Have a current Driver's Licensee If yes, give number, & state
Yes ❑ No
''e
I <4p
)k
Is t
10. Name of
Present Employer
v/4
M. Type of Business or Employment
12. Address of Business Where Employed (street number, city, state, ZIP)
Business Telephone
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 Spouse's Present Employer
20. List the name(s) of all relatives working in or having a financial interest in the liquor industry.
OF RELATIVE
RELATIONSHIP TO YOU
POSITION HELD
NAME OF EMPLOYER
LOCATION OF EMPLOYER
NAME
I
y /
_ /f C
it 7/
1,4 4 wo
c
r' 1'C‘ CA. . /' l'IN ut
.-t�'h
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
Li Yes EANo
9S1927
•
•. DR 840A)t (2/94) Page 2
eferred ence, or 22 vHave you ever iolations, unless they resulted d in suspension or revocation of your drivers lia crime, or received a suspended sentence,cense, oryou twee convicted of ited rliving under the influence of dr any offense in criminal or rugs or alcoholic (Do
beverages.) If yes,
explain in detail.
U Yes No
23. Have you ever received aviolation 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 BI No
24. Military Service (branch)
-f Type of Discharge
From To I Serial Number
25.
List all addresses where you have lived for the past five years. (Attach separate sheet if necessary)
TO
)
CITY, STATE, ZIP
STREET AND NUMBER
(O7n-6u u
26. List all former employers or businesses engaged in within the last five years. (Attach separate sheet if necessary.)
POSITION HELD FROM TO
NAME OF EMPLOYER ADDRESS (STREET, NUMBER, CITY, STATE, ZIP)
27. What is your relationship to the applicant? (sole owner, partner, orporate office director, stockholder, member or manager)
28. If stockholder, number of shares owned beneficially or of record
Percent of Partnership Owned
If Limited Liability Company (percent owned)
29. If partner, state whether ❑ General ❑ Limited
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 $_---
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 Namns onaccountsdin o or this business.) s
an
Amounts Sources - Account Numbers sign on this account
$ Y' r�L 3 ✓r )- eC tofb—
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. —� Date
Title I r ,.
wthorl ure h .- r 1 j _ I f )
Vt d_Jrar11t
951927
TELEPHONE
(303) 455-0725
'Thomas;. Bednase% ELI.
PUBUC 'ACCOUNTANT
ENROLLED TO PRACTICE BEFORE THE
INTERNAL REVENUE SERVICE
5055 TENNYSON STREET
DENVER. CO 80212
Mr. Hadi Tehranian
12097 East Colorado Place
Aurora, CO 80012
To Whom It May Concern:
I have known Hadi Tehranian and Fatemeh Sohrabi and three of
their children since 1985. During that time I have found that
they have been honest in their business dealings and forthright
in their association with me.
I am unaware of anything negitive which would cast a shadow on
their reputation or character. From my dealings with them I do
recommend them highly..
Thomas J. Bednasek, EA, PA
December 4, 1993
951927 1
COLORADO HOMES &LAND,INC.
December 13, 1993
Jody Sitkoski
REALTOR
Colorado Homes and Land, Inc.
19557 E. Mainstreet
Parker, CO 80134
To Whom It May Concern:
I have known the Tehranian and Sohrabi family for 8 years.
I consider them in the highest deference in their business and
personal dealings. I have enjoyed doing business with them
and will continue to do so in the future.
Sincerely,
Jody Sitkoski
REALTOR
19557 E. Mainstreet • Suite 109 • Parker • Colorado • 80134-7374 • (303) 841-6744
951927 '
Smile 'wr
Family Denlisty
Dr. Joyce Cuff
3005 S. Peoria Suite B
Aurora, Colorado
80014
To Whom It May Concern, 12/10/93
I am pleased to give a reference for Mr Hadi Tehranian I -have known
Mr. Hadi Tehranian and his family since 1988. In my dealings with him. I have
found him to be honest, capable and trustworthy. In my opinion he is a very
upstanding member of the community. I would gladly stand behind him in any
decision that he might make, business or otherwise
Sincerely,
17r,✓ ( // L ln' l
Joyce A. Duff D D.S
or
351927
DR 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 -
LU:i:A7STz2 C 196 �''(hy'II
Date
Social
2. Your Full Name (last, first, middle)
s._ 1
3. Also Known As (maiden name/nickname, etc.)
4. Mailing Address (if different from residence)
Home Telephone }) 1 552111
l V
5. Residence Address (street and number, city, state, ZIP)
);.:42 9 �7 a .- ; . . ; .7 r c C . 0._,I 2-
6. Date of Birth
Place of Birth
i A.
7. U.S. Citizen?
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 /
55
Weight
Ira
Hair Color
el-c..-�
.
Eye Color
G
Sex
F
Race
,/y,;./e.
9. Do You Have a current
Driver'
P Yes No
10. Name of Present Employer
AliA
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
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 Spouse's Present Employer
2D.` 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
N r1`, J.
x'/111/ iR L V•
f l t L.,, i 1k irk
21. Do you now, or have you
Licensee? If yes, answer
❑ Yes cx
ever held a State of Colorado Liquor or Beer License, or loaned money, furniture, fixtures, equipment or inventory, to any Colorado Liquor or Beer
in detail
No
CONTINUED ON REVERSE SIDE
DR 8404-I (2194) 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.
LI Yes 1 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 X 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 r
�' L rs o jJ.
41.&
7-a , r_ � c, o1 r"
-IC �
4 {� ;r ;.4
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
N/4
27. What is relationship to the applicant? (sole owner, partner,{corporate office director, stockholder, member or manager)
your
28. If stockholder, number of shares owned beneficially or of record
stock owned 0:2_,5 outstanding
of oug
(t 7
PercenD
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)
3
Amount $
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.)
Names on accounts or person who can
sign on this account
Amounts
Sources - Account Numbers
Ll —
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
go et
f 71 ,7 d
E kit
Title
Date
951927
1
DR 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 ,�
L��k�m -7--
T �A�� zi �,Y;II
Date
Social Security Number(s)
2. Your Full Name (last, first, middle)
72MMIAM 1bk6)144l8FA
All }{MOOD
3. Also Known As (maiden name/nickname, etc.)
moe-
4. Mailing Address (it different from residence)
Home Telephone
5. Residence Address (street and number, city, state ZIP)
12097 a co/o• ()L. A //liena- , Li -0 : koc
Z.
6. Dale of Birth K/ 6 `
Birth �
R AA '7.
/ V
U.S. Citizen? N Yes
No
It Naturalized, state where ^�
"�
When
Tu 14_1- Eci
Name of U.S. Di�rict Court
i 0-162, de
P12--7--3 -} 5 1' b —nVem—,, C Ci
Naturalization Certificate Number
O/233333
Certificate
3L.)- F 9
If an Alien, Give Alien's Registration Card Number
Permanent Residence Card Number
8. Height
51II
Weight
I 5 C
Hair Color
t5Lh
Eye Color
}-Iz L,
Sex
/t/(,
Race
0JAzz.
9. Do You Have a current Driver's License? It yes, ive number, 8 statQ
®Yes ❑No R'N-
of Present Employer
/11/4.
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
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 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
% /
. �
/ {5
G ) cc /
I
el
-"
,
° .5% alb-
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 No �/ J• l I l/ )/(4-7 CI UEEli a
951327
CONTINUED ON REVERSE SIDE
n 6404-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
violation; unless they result¢d 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. 1.
fI Yes Q 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 Q No
24. Military Service (branch)
From
To
Serial Number
Type of Discharge
NfA
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
Aurora co 80012
—1249-7—g, Colo. P1,
zs. 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
T
TO
gaes.
2651 S. Barter Rd.
Mqr.
1jf,99944/94
� i$'1
�,--,canvvzcEa� .
27. What is your relationship to the applicant? (sole owner, partner, corporate officer, director, stockholder, member or manager)
28. If stockholder, number of shares owned beneficially or of record , ,
L'
Percent of outstanding stock owned
5�
29. If partner, state whether dieneral IN 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)
Amount $_,„2/.1 (
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
$ (
f., ?:•• �, /re -t Bror7'--f
T".-ir t/R A a, ,a J 1)O6
$
$
$
Oath of Applicant
1 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 .i
Title
Date
COLORADO HOMES &LAND,INC.
CDt
December 13, 1993
Jody Sitkoski
REALTOR
Colorado Homes and Land, Inc.
19557 E. Mainstreet
Parker, CO 80134
To Whom It May Concern:
I have known the Tehranian and Sohrabi family for 8 years.
I consider them in the highest deference in their business and
personal dealings. I have enjoyed doing business with them
and will continue to do so in the future.
Sincerely,
Jody Sitkoski
REALTOR
19557 E. Mainstreet • Suite 109 • Parker • Colorado • 80134-7374 • (303) 841-6744
951927
TELEPHONE
(303) 455-0725
'Thomas 9. Bednasek ER
PUSUC,ACCOUNTANT
ENROLLED TO PRACTICE BEFORE THE
INTERNAL REVENUE SERVICE
5055 TENNYSON STREET
DENVER, CO 80212
Mr. Hadi Tehranian
12097 East Colorado Place
Aurora, CO 80012
To Whom It May Concern:
I have known Hadi Tehranian and Fatemeh Sohrabi and three of
their children since 1985. During that time I have found that
they have been honest in their business dealings and forthright
in their association with me.
I am unaware of anything negitive which would cast a shadow on
their reputation or character. From my dealings with them I do
recommend them highly..
Thomas J. Bednasek, EA, PA
December 4, 1993
951.92'7
ASmile
remi/y Dentistry
Or. Joyce Duff
3005 S. Peoria Suite B
Aurora, Colorado
80014
To Whom It May Concern, 01/18/94
I am pleased to give a reference for Mr. Massoud Tehranian. I have known
Mr. Tehranian and his family since 1988. In my dealings with him, I have
found him to be honest, capable and trustworthy. In my.opinion he is a very
upstanding member of the community. I would gladly stand behind his in any
decision that he might make, business or otherwise.
Sincerely,
PS
Joyce A. Duff D D
951.927
BUSINESS LEASE
this lease, dated September 1, 1995
is between Hadi Tehranian,
Mahmoud Tehranian, Fatemeh Sohrabi as Landlord,
and The Lucky Star Corporation as Tenant.
In consideration of the payment of the rent and the performance of the covenants and agreements by the Tenant set forth herein,
the Landlord does hereby lease to the Tenant the following described premises situate in
County, in the State of Coloradoi the address of which is
Weld
33131 Highway 85, Lucerne, CO
Property Address
Legal Description
Said premises, with all the appurtenances, are leased to the Tenant from the date of
until the date of Seot 1, 2005
Sept 1, 1995
at and for a rental for the full term of $
payable in monthly installments of 5000.00
60,000.00
in advance. on the 1 s t day of each calendar month during the term of this lease, payable at
33131 Highway 85, Lucerne, CO without notice.
Address
THE TENAN'h. IN CONSIDERATION OF THE LEASING OFTHE PREMISES AGREES AS FOLLOWS:
to pay the rent for the premises above -described-
'. to keep the improvements upon the premises, including sewer connections, plumbing, wiring and glass in good repair, all at Tenant's
expense. and at the expiration of this lease to surrender the premises in as good a condition as when the Tenant entered the premises. loss by fire,
inevitable accident. and ordinary wear excepted. To keep all sidewalks on and around the premises free and clear of ice and snow, and to keep the
entire exterior premises free from all litter, dirt, debris and obstructions: to keep the premises in a clean and sanitary condition as required by the
ordinances of the errs and county in which the property is situate.
3 TO sublet no part of the premises, and not to assign the lease or any interest therein without the written consent of the Landlord, which
consent shall not he unreasonably withheld.
4. to use the premises only. as Restaurant and Lounge with Music & darmanto uethe premises for
no purposes prohibited by the laws of the United States or the State of Colorado, or of the ordinances of the city or town in which said premises
are located, and for no improper or questionable purposes whatsoever. and to neither permit nor suffer any disorderly conduct, noise or nuisance
having a tendency to annoy or disturb any persons occupying adjacent premises.
5. to neither hold nor attempt to hold the Landlord liable for any injury or damage, either proximate or remote, occurring through or
caused by the repairs, alterations, injury or accident on or to the premises, or adjacent premises, or other parts of the above premises not herein
demised, or by reason of the negligence or default of the owners or occupants thereof or any other person, nor to hold the Landlord liable for any
injury or damage occasioned by defective electric wiring, or the breakage or stoppage of plumbing or sewerage upon said premises or upon
adjacent premises, whether breakage or stoppage results from freezing or otherwise; to neither permit nor suffer said premises, or the walls or
floors thereof to be endangered by overloading, nor said premises to be used for any purpose which would render the insurance thereon void or
the insurance risk more hazardous. nor make any alterations in or changes in, upon, or about said premises without first obtaining the written
consent of the Landlord therefor, but to permit the Landlord to place a "For Rent" sign upon the leased premises at any time after sixty (60) days
before the end of this tease.
To allow the Landlord 10 enter upon the premises at any reasonable hour.
IT IS EXPRESSLY UNDERSTOOD AND AGREED BETWEEN LANDLORD AND TENANT AS FOLLOWS:
7. All charges for water and water rents are to be paid by ❑ Landlord 12 Tenant. All charges for heating and lighting are to be paid by
Landlord x Tenant. Janitorial services are to be paid by _. Landlord It -Tenant.
8. No assent, express or implied. to any breach of any one or more of the agreements hereof shall be deemed or taken to be a waiver of any
succeeding or other breach.
9. If. after the expiration of this lease, the Tenant shall remain in possession of the premises and continue to pay rent without a written
agreement as to such possession, then such tenancy shall be regarded as a month -to -month tenancy, at a monthly rental, payable in advance,
eq ulcalent to the last month's rent paid under this lease, and subject to all the terms and conditions of this lease.
10. lithe premises are left vacant and any part of the rent reserved hereunder is not paid, then the Landlord may, without being obligated to
do so. and without terminating this lease, retake possession of the said premises and rent the same for such rent, and upon such conditions as the
Landlord may think hest. making such changes and repairs as may be required, giving credit for the amount of rent so received less all expenses of
such dtanges and repairs, and the Tenant shall be liable for the balance of the rent herein reserved until the expiration of the term of this lease.
I I. The Landlord acknowledges receipt of a deposit in the amount of $ — 0 — to be held by the Landlord for the faithful
perlitrmance of all of the terms. conditions and convenants of this lease. The Landlord may apply the deposit to cure any default under the terms
of this lease and shall account to the Tenant for the balance. The Tenant may not apply the deposit hereunder to the payment of the rent reserved
hereunder or the performance of other obligations.
12. At the Landlord's option. it shall he deemed a breach of this lease if the Tenant defaults (a) in the payment of the rent or any other
monetary obligation herein; or (h) in the performance of any other term or condition of this lease. The Landlord may elect to cure such default and
any expenses of curing may be added to the rent and shall become immediately due and payable.
In the event that the Landlord elects to declare a breach of this lease, the Landlord shall have the right to give the Tenant three (3) days
written notice requiring payment of the rent or compliance with other terms or provisions of the lease, or delivery of the possession of the
premises. In the event any default remains uncorrected alter three (3) days written notice, the Landlord, at Landlord's option, may declare the
term ended, repossess the premises, expel the Tenant and those claiming through or under the Tenant and remove the effects of the Tenant, all
without being deemed guilty in trespass or of a forcible entry and detainer and without prejudice to any other remedies to which the Landlord
may he entitled. If at any time this lease is terminated under this paragraph, the Tenant agrees to peacefully surrender the premises to the
Landlord immediately upon termination, and if the Tenant remains in possession of the premises, the Tenant shall be deemed guilty of unlawful
detention of the premises. The Landlord shall be entitled to recover from the Tenant all damages by reason of the Tenant's default, including but
not limited to the cost to recover and repossess the premises, the expenses of reletting, necessary renovation and alteration expenses, commissions
and the rent for the balance of the term of this lease.
No. 1044. Rey. 2-91. BUSINESS LEASE
Bradford Publishing. 1743 Warms St_ Dcnar. CO 80202 - O011292-2500 - 1 2-9 2
cepvri25392 i
3 In the event the premises shall become untenantable on account of damage by fire, flood or act of God, this lease may be thereupon
terminated and the rent apportioned to the date of the occurrence of such damage.
14. In the event of any dispute arising under the terms of this lease, or in the event of non-payment of any sums arising under this lease
and in the event the matter is turned over to an attorney, the party prevailing in such dispute shall be entitled, in addition to other damages or
costs, to receive reasonable attorneys' fees from the other party.
5. In the event any payment required hereunder is not made within (10) days after the payment is due, a late charge in the amount of
five percent (5%) of the payment will be paid by the Tenant.
16. In the event of a condemnation or other taking by any governmental agency, all proceeds shall be paid to the Landlord hereunder, the
Tenant waiving all right to any such payments.
I7. This lease is made with the express understanding and agreement that in the event the Tenant becomes insolvent, the Landlord may
declare this lease ended, and all rights of the Tenant hereunder shall terminate and cease.
18 The Landlord and the Tenant further agree
Lessee shall have the option to extend this Lease for an
additional five year term, under provisions identical to the
foregoing, by giving notice of such renewal intent at
least 30 days before expiration.
SHOULD ANY PROVISION of this lease violate any federal, state or local law or ordinance, that provision shall be deemed amended to
so comply with such law or ordinance, and shall be construed in a manner so as to comply.
This lease shall be binding on the parties. their personal representatives, successors and assigns.
When used herein, the singular shall include the plural, and the use of any gender shall apply to both genders.
Attest'.
Attest
GUARANTEE
For value received I hereby guarantee the payment of the rent and the performance of the convenants and agreements by the Tenant in
the within lease covenanted and agreed, in manner and form as in said lease provided.
Dated.
ASSIGNMENT AND ACCEPTANCE
Lot saluc received assignor,
hereby assigns all right, title and interest in and to the within lease unto
assignee, the heirs, successors and assigns of the assignee, with the express understanding and agreement that the said assignor shall be and
remain liable for the full payment of the rent reserved and the performance of all the covenants and agreements made in said lease by the
Tenant therein named, and will pay said rent and fully perform said covenants and agreements in case said assignee shall fail so to do; and in
consideration of this assignment, the said assignee hereby assumes and agrees to make all the payments and perform all the covenants and
agreements contained in said lease, by the Tenant therein agreed to be made and performed.
Dated f/
I
) (E, iL/4 o' -s' 06 Ai
CONSENT OF ASSIGNMENT
Consent to the assignment of the within lease to
is hereby given, on the express condition. however, that the assignor shall remain liable for the prompt payment of the rent and performance of
the covenants on the part of the Tenant as herein mentioned, and that no further assignment of said lease or sub -letting of the premises or any
part thereof shall be made without further written assent first had thereto,
LANDLORD'S ASSIGNMENT
In consideration of One Dollar, in hand paid, I hereby transfer, assign and set over to
and assign my interest in the within lease, and the rent therein reserved,
Dated:
951227
cst4:.
Wi�Yc
COLOA9O0
Colorado Department of Revenue
Liquor Enforcement Division
Attention: Sabrina
1375 Sherman Street, Room 600
Denver, CO 80261
Dear Sabrina:
OFFICE OF COUNTY ATTORNEY
PHONE (970) 356-4000 EXT.4391
FAX (970) 352-0242
P.O. BOX 1948
GREELEY, CO 80632
December 8, 1995
RE: Change of Corporate Ownership of Lucky
Star Corporation
As you may recall, the Lucky Star Corporation submitted to Weld County a Corporate Report of
Changes in September, 1995, showing the change of corporate officers and directors. One of the
requirements for the report was that the Lucky Star Corporation provide to your office a
Certificate of Good Standing.
Enclosed is a document entitled "Corporations Master File Screen" which Mr. Tehranian
Mahmoud received from the Secretary of States Office in September, 1995, showing that the
corporation status is "good" He has asked me to transmit this document to you for your review
and to see if the requirements for the Certificate of Good Standing are satisfied by virture of your
receiving this document.
Please call me at (970) 356-4000, extension 4390, to let me know if this document is sufficient.
s truly,
' Br e T. Barker`s
eld County Attorne
BTB/db:Sabrina
Enclosure
pc: Clerk to the Board
CORPORATIONS MASTER FILE SCREEN
CORP TYPE:
CORP NAME:
ADD1:
ADD2:
CITY:
AGENT NAME:
ADD1:
ADD2:
CITY:
CORPORATE
1995
1993
1991
CORP
LAST
NAME
H -History
DP
LUCKY STAR CORPORATION
33131 HWY 85
LUCERNE
TEHRANIAN MAHMOUD
33131 HWY 85
PO BOX 52
LUCERNE
REPORT INFO
05/09/95
06/30/93
02/12/92
SUSPEND DATE:
RORA DATE: 09/20/95
RESV EXPIRES:
951117895
931069847
921013937
S -Stock 0 -Officer D -Director
STATUS: GOOD
STATE:CO ZIP:80646
STATE:CO ZIP:80646
FILING DATE: 01/13/1989
INDUSTRY (SIC) CODE: 9899
TERM: PER
STATE OF INCORPORATION: CO
PURGE DATE:
AGENT RESIGN DATE:
AGENT RESIGN LTR DATE:
OFF COUNT: 2 DIR COUNT: 2
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9600 8N1
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cot
*)
STATE Oft = L,0RAD0
7E�j�
DEPARTMENT OF
STATE
CERTIFICATE
2, VICTORIA BUCKLEY, Secretary of State of the State of
Colorado hereby certify that
According to the records of this office
LUCKY STAR CORPORATION
(COLORADO CORPORATION)
file # 891002600 was filed in this office on JANUARY 13, 1989,
and has complied with the applicable provisions of the
laws of the State of Colorado and on this date is in good
standing and authorized and competent to transact business
or to conduct its affairs within this state.
Dated: DECEMBER 6, 1995
ic_e%:9
SECRETARY OF STATE
TIME! 14:31:01 DATE: 12/12/95 INVOICE NUMBER: 95A021698
For proper credit, please reference the invoice number (95A021698) of your
statement in order for the Department to credit the proper account.
If no reference is made, your check will be returned
and your bill will remain outstanding.
Make Check Payable to COLORADO SECRETARY OF STATE
Return your payment to Cashiers Office
Colorado Department of State
1560 Broadway, Suite 200
Denver, Colorado 80202 303-894-2200 Ext. 306
V15
--i nfl
SHELLY K MILLER --I n c,:t7
MAIL WELD COUNTY GOVERNMENT f;� r co
INVOICE l: c
TO 915 10TH ST s
GREELEY CO 80631 :`j O :i<
i.7 . h
O
'ft
RE: LUCKY STAR CORPORATION
30D) Expedite GS
30H) Fax Fee Copies
DESC: G\S EXPEDITE
FAX# 970-352-0242
MAIL/PICKUP: /f%
PHONE # 970-356-4000
INVOICE NUMBER: 95A021698
DOCUMENTS 1 AMOUNT
DOCUMENTS 1 AMOUNT
DATE ORDERED: 12/12/95
DATE COMPLETED: 12/12/95
DUE DATE 01/11/96
SENT TO COLLECT:
$10.00
$5.00
AMT CHG: $15.00
AMT PAID:
BAL DUE: $15.00
**************************************************************************
* PAYMENT TERMS: 30 DAYS NET
* THIS IS YOUR INVOICE NO OTHER NOTICES WILL BE SENT. AFTER 60 DAYS ALL *
* ACCOUNTS WILL BE TURNED OVER TO THE STATE'S CENTRAL COLLECTION AGENCY.
**************************************************************************
TO HELP US SERVE YOU MORE EFFICIENTLY, PLEASE USE OUR HANDY 900# FAX SERVICES:
900-555-1515 FOR NAME AVAILABILITY: 900-555-1616 TO ORDER FORMS
YOU WILL BE BILLED DIRECTLY THROUGH YOUR PHONE BILL.
tr rc/' Cy/2, *90R95
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