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Home My WebLink About981491.tiffLicense picked -up on 9/9/�98� by: 42r FINDINGS AND RESOLUTION RE: FINDINGS AND RESOLUTION CONCERNING APPLICATION OF DIXIE KINGSBURY, DBA P & M RECREATION, FOR 3.2% BEER RETAIL LICENSE, AND AUTHORIZE CHAIR TO SIGN - EXPIRES AUGUST 31, 1999 The application of Dixie Kingsbury, dba P & M Recreation, Lots 5 and 6, Block 3, Main Street, Stoneham, Colorado 80754, for a 3.2% Beer Retail License, came on for hearing on the 17th day of August, 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 Dixie Kingsbury, dba P & M Recreation, Lots 5 and 6, Block 3, Main Street, Stoneham, Colorado 80754, for a 3.2% Beer Retail License, for the sale of fermented malt beverages, containing not more than 3.2% of alcohol by weight, for consumption by the drink on the premises only, and/or 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 3.2% Beer Retail License for Dixie Kingsbury, dba P & M Recreation. 981491 LC0010 de: SD,' Ppp 1. NEW 3.2% BEER LICENSE - P & M RECREATION 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 grant License Number 98-09 to said applicant to sell 3.2% fermented malt beverages for consumption by the drink on the premises only, and/or in sealed containers not for consumption at the place where sold, only at retail at said location; and the Board does hereby authorize and direct the issuance of said license by the Chair of the Board of County Commissioners, attested to by the Clerk to the Board of Weld County, Colorado, which license shall be in effect until August 31, 1999, providing that said place where the licensee is authorized to sell 3.2% fermented malt beverages for for consumption by the drink on the premises only, and/or 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. The above and foregoing Resolution was, on motion duly made and seconded, adopted by the following vote on the 17th day of August, A.D., 1998. ATTEST: Weld County Cler, BY APP Deputy Clerk t VED AS TO FORM: County Attorney 0 BOARD OF COUNTY COMMISSIONERS O�I WEt,Q COUNTY, COLO DO Cons nce L. ar rt, Chair /i) W. H. Webs er, ro-T EXCUSED DATE OF SIGNING George E. Baxter EXCUSED Dale K. Hall (AYE) a J ;��A Barbara J. Kirkmeyer 981491 LC0010 THIS LICENSE MUST BE POSTED IN PUBLIC VIEW DR 8402 -G, (10/921 STATE DEPARTMENT ALCOHOLIC OF COLORADO OF REVENUE Liquor Enforcement Division 1 375 Sherman Street Denver, Colorado 80261 KINGSBURY DIXIE JEAN P & M RECREATION LOT 5 & 6 BLOCK 3 MAIN ST STONEHAM CO 80754 BEVERAGE LICENSE Account Number Liability Information LICENSE EXPIRES AT MIDNIGHT County City Indust. Type Liability Date 24-81132-0000 03 206 5900 I 090198 AUG 31, 1999 Type Name and Description of License Fee 2123 2190 3.2 PERCENT BEER RETAIL LICENSE (ON/OFF PREMISES) COUNTY 85 PERCENT OAP FEE $ 50.00 $ 42.50 TOTAL FEEISI This license is issued subject to the laws of the State of Colorado and especially provision of Title 12. Articles 46 or 47, CRS 1973, as amended. nontransferable and shall be conspicuously posted in the place above described. only valid through the expiration date shown above. Questions concerning be addressed to the Department of Revenue, Liquor Enforcement Division, Street, Denver, CO 80261. testimony whereof, I have hereunto set my hand. ,ta C �%L✓Ptic Division Director SEr u /4 m1:J Executive $ 92.50 under the This license is This license is this license should 1375 Sherman ez Dire tor HEARING CERTIFICATION DOCKET NO. 98-46 RE: APPLICATION FOR A 3.2 PERCENT BEER RETAIL LICENSE- DIXIE KINGSBURY, DBA P & M RECREATION A public hearing was conducted on August 17, 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 - EXCUSED 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 July 21, 1998, and duly published July 29, 1998, in the Platteville Herald, a public hearing was conducted to consider the request of Dixie Kingsbury, dba P & M Recreation for a 3.2 Percent Beer Retail License. Bruce Barker, County Attorney, made this a matter of record and stated the neighborhood to be served by this license. He further stated the application is complete, the applicant has paid the required fees, and Commissioner Baxter was nominated to inspect the site. Commissioner Baxter reported that he inspected the site; however, it was closed when he arrived so he could only view the inside of the establishment from the front window. He indicated a letter sent to Ms. Kingsbury, dated August 12, 1998, stating the establishment meets all the necessary requirements. No public testimony was offered concerning this matter. Commissioner Webster moved to approve the request of Dixie Kingsbury, dba P & M Recreation for a 3.2 Percent Beer Retail License. The motion was seconded by Commissioner Kirkmeyer, and it carried unanimously. 981491 , C!; 1416hu,y LC0010 HEARING CERTIFICATION - 3.2 PERCENT BEER RETAIL LICENSE - P & M RECREATION PAGE 2 This Certification was approved on the 19th day of August, 1998. APPROVED: ATTEST: . �'�-' 6�,! / BOARD OF COUNTY COMMISSIONERS W D COUNTY, COLORADO. Weld County BY: Deputy Cle, TAPE #98-22 DOCKET #98-46 Consta c L. rIrrt, hai W. H. Webster, Pro-Tem EXCUSED DATE OF APPROVAL George E. Baxter EXCUSED Dal K. Hall jrba ra J. Kirkmeyer 981491 LC0010 DR 8404 (06/97) Page 1 21 COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION COLORADO LIQUOR 1375 SHERMAN STREET OR 3.2% FERMENTED MALT BEVERAGE DENVER CO 80261 RETAIL LICENSE APPLICATION rn aA {Q,c9 f / lq DO NOT WRITE IN THIS SPACE NEW LICENSE ,'::-.4 TRANSFER OF OWNERSHIP ❑ LICENSE RENEWAL • ALL ANSWERS MUST BE PRINTED IN BLACK INK OR TYPEWRITTEN • APPLICANT MUST CHECK THE APPROPRIATE BOX(ES) • LOCAL LICENSE FEE S • APPLICANT SHOULD OBTAIN A COPY OF THE COLORADO UQUOR AND BEER CODE(Call 303-3214164) 1. Applicant is applying as a tgi Individual ❑ Corporation ❑ Limited Liability Company ❑ Partnership (includes Limited Liability and Husband and Wife Partnerships) ❑ Association or Other 2. fame of Applicant(s) If partnership, list p rtners' names (at least two); if corporation, name of corporation ) Xi e: 1 le,"'')..$ 1. I A. 3_4 I, z.,,- 7 Trade Name of Estatlishment (DBA) 7 tip, I) /1 i 1") T✓ c"....„6_/- toil''7r State Sales Tax No. business Telephone :� { l it �� l � 2 'T � 2Lf7' Address of Premises (specify exact location of premises) -5' 4.hi 4 /k3 44 -in S''f .3 City } rh! c font cm County 1,✓e l 4 State ' 0 .- ZIP Code g' b 7c 0 4. Mailing Addre s (Number and Street) , City r Town State Ccr?5. ZIP ode If the premises currently have a liquor or beer license, you MUST answer the following questions: Present Trade Name ofEstablishment (DBA) .)].I, I`'i �) .i,cJ' x3 011 Present State License No. Present Class of License Present Expiration Date ! .__ SECTION A APPUEATION FEES UAB 1940 1940 1950 1950 1960 1960 1970 1980 2010 2020 2030 2040 1905 1975 SECTION D LIQUOR LICENSE FEES • ❑ ■ • ■ ■ ■ ■ ■ El ❑ ❑ ❑ ■ ❑ ■ Retail Liquor Store License (city) $202.50 Retail Liquor Store License (county) 287.50 Liquor Licensed Drugstore (city) 202.50 Liquor Licensed Drugstore (county) 287.50 Beer & Wine License (city) 326.25 Beer & Wine License (county) 411.25 H & R License • city ■ county 475.00 H & R License w/opt Prem ■ city ■ county 475.00 Club License ❑ city ■ county 283.75 Tavern License ❑ city 9 county 475.00 Arts License • city ■ county 283.75 Racetrack License ❑ city 9 county 475.00 Optional Premises License ■ city ■ county 475.00 Retail Gaming Tavern Lic ■ city ■ county 475.00 Brew -Pub License 725.00 Other 2360 2300 2300 2310 ❑ Late Renewal Application Fee $500.00 ■ Application Fee for New License 650.00 ■ Application Fee -New License Concurrent Review 750.00 'l Application Fee for Transfer of Ownership 650.00 SECTION B 3.2% BEER LICENSE FEES 2121 2121 2122 2122 2123 2123 IN 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 ' SECTION C RELATED FEES Afffl P ERMI7S. 2210-100 (999)D Retail Warehouse Storage Permit $75.00 1980-100 (999) ❑ Addition of Optional Premises to existing hotel/restaurant $75.00 x Total Fee 1970-750 (999) ❑ Manager's Registration (hotel & restaurant only) $75.00 No Fee ■ 3.2% Beer On/Off Premises Only Delivery Permit No Fee ■ Retail Liquor Store Delivery Permit DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY LIABILITY INFORMATION County City Industry Type License Issued Through (Expiration Date) License Account Number Liability Date State -750 (999) City 2180-100 (999) County 2190-100 (999) Managers Reg 1970-750 (999) A. Cash Fund Now Means* 2300-100 (999) Cash Fund Trennfor Llooneo 2310-100 (999) TOTAL A OR 8404 (06197) 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 O ---"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. I1. DIAGRAM OF THE PREMISES a -A. No larger than 8 1/2" X 11". 9 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). O D. Kitchen - identified if Hotel and Restaurant. Ill. PROOF OF PROPERTY POSSESSION P, A. Deed in name of the Applicant ONLY (or) ❑ B. Lease in the name of the Applicant ONLY. ❑ C. Lease Assignment in the name of the Applicant (ONLY) with proper consent from the Landlord and acceptance by the Applicant. 0 D. Other Agreement if not deed or lease. IV. BACKGROUND INFORMATION AND FINANCIAL DOCUMENTS Q' A. Individual History Record(s) (Form DR 8404-I). Q' B. Fingerprints taken and submitted to local authority. (State authority for master file applicants.) • C. Purchase agreement, stock transfer agreement, and or authorization to transfer license. ■ D. List of all notes and loans. V. CORPORATE APPLICANT INFORMATION (If Applicable) • A. Certificate of Incorporation (and/or) • B. Certificate of Good Standing if incorporated more than 2 years ago. • C. Certificate of Authorization if foreign corporation. • D. List of officers, directors and stockholders of parent corporation (designate 1 person as "principal officer"). VI. PARTNERSHIP APPLICANT INFORMATION (If Applicable) • A. Partnership Agreement (general or limited). Not needed if husband and wife. VII. LIMITED LIABILITY COMPANY APPLICANT INFORMATION (If Applicable) ❑ 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 0 A. $75.00 fee. • B. Individual History Record (DR 8404-1). q gq/ DR 8404 (08/97) 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, • DK( 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? El(b) had an alcoholic beverage license suspended or revoked? O (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. 8a. Has a liquor license application (same license class), that was located within 500 feet of the proposed premises, been denied within the preceding two years? If "yes," explain in detail. ❑ 8b. Has a 3.2 beer license for the premises to be licensed been denied within the preceding one year? If "yes," explain in detail. ❑ Z 9. Are the premises to be licensed within 500 feet of any public or private school that meets compulsory education requirements of ❑ IX Colorado law, or the principal campus of any college, university or seminary? 10. Has a liquor or beer license ever been issued to the applicant (including any of the partners, if a partnership; members or manager 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 ■ 54 11. a. Attach and Does the Applicant, as listed on line 2 of this application, th license will be issued by virtue of ownership, lease in of have legal possession of the premises for at least 1 year from the date that or other arrangement? Detail) MiOwnership • Lease ■ Other (Explain If leased, list name of landlord and tenant, and date expiration, EXACTLY as they appear on the lease: [Landlord Tenant Expires a diagram and outline the area to be licensed (including dimensions) which shows the bars, brewery, walls, partitions, entrances, exits what each room shall be utilized for in this business. This diagram should be no larger than 8 1/2" X 11". (Doesn't have to be to scale) 12. Who, besides the owners listed in this application (including persons, firms, partnerships, corporations, limited liability companies), will loan or give money, inventory, furniture or equipment to or for use in this business; or who will receive money from this business. Attach a separate sheet if necessary. NAME DATE OF BIRTH FEIN OR SSN INTEREST 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 A local ordinance or resolution authorizing optional Number of separate Optional Premises areas requested. with Optional Premises premises has been adopted. Yes No ■ 21 14. Liquor Licensed Drug Store applicants, answer the following: (a) Does the applicant for a Liquor Licensed Drug Store have a license issued by the Colorado Board of Yes No Pharmacy? COPY MUST BE ATTACHED. ❑ 14 15. Club Liquor License applicants answer the following (a) Is the applicant organization operated solely not for pecuniary gain? (b) Is the applicant organization a regularly operated solely for the object of a patriotic (c) How long has the club been incorporated? (Three years required) and attach: for a national, social, fraternal, patriotic, political or athletic purpose chartered branch, lodge or chapter of a national organization which or fraternal organization or society, but not for pecuniary gain? (d) How long has applicant occupied the premises to be licensed as a club? (Three years required) and is ■ O • ■ 16. Brew -Pub License Applicants answer the following: (a) Has the applicant received or applied for a Federal Brewers Notice? (Copy of notice or application must be attached) 0 ■ 17a. 17b. Name of Manager (If this is an application for a Hotel number. Date of Birth Hotel & Rese Lic. Yes No and Restaurant License, the manager must also submit an Individual History Record (DR 8404-I). Does this manager act as the manager of, or have a financial interest in, any other liquor licensed establishment in the State of Colorado? If yes, provide name, type of license and account • ❑ Yes No ■ ■ 18. Tax Distraint Information. Does the applicant or any other person listed on this application and including its partners, officers, Yes No directors, stockholders, members (LLC) or managing members (LLC) and any other persons with a 10% or greater financial interest ❑ rdi in the applicant currently have an outstanding tax distraint issued to them by the Colorado Department of Revenue? �l If yes, provide an explanation and include copies of any payment agreements. 66N9/ DR 8404 (08/97) Page 4 19. If applicant is a corporation, partnership, association or a limited liability company, it is required to list by position all officers and directors, general partners, managing members, all stockholders, partners (including limited partners) and members who have a 10% or greater financial interest in the applicant. All persons listed here or by attachment must submit and attach a DR 8404-I (Individual History Record) and provide fingerprint cards to their local licensing authority. NAME HOME ADDRESS, CITY & STATE DATE OF BIRTH POSITION % OWNED Additional Documents to be submitted by type of entity ❑ CORPORATION ❑ Cert. of Incorp. ❑ Cert. of Good Standing (if more than 2 yrs. old) ❑ Cert. of Auth. (if a foreign corp.) ❑ PARTNERSHIP ❑ Partnership Agreement (General or Limited) ❑ Husband and Wife partnership (no written agreement) ❑ LIMITED LIABILITY COMPANY ❑ Articles of Organization ❑ Cert. of Authority (if foreign company) ❑ Operating Agrmt. ❑ ASSOCIATION OR OTHER Attach copy of agreements creating association or relationship between the parties Registered Agent (it applicable) Address for Service OATH OF APPLICA[ I declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete to the best of my knowledge. 1 also acknowledge that it Is my responsibility and the responsibility of my agents and employees to comply with the provisions of the Colorado Liquor or Beer Code which affect my license. Authorized Signature 1 . Q . 1-(L4Virettrla Title irLLir- Date IW REPORT AND APPROVAL OF LOCAL LICENSING AUTHORITY (CITY/COUNTY) Date application filed with local authority July 15 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. August 17, 1998 Each person required to file DR 8404-I: Yes a. Has been fingerprinted b. Background investigation and NCIC and CCIC check for outstanding warrants conducted c. The liquor licensed premises is ready for occupancy and has been inspected by the Local Licensing Authority, If "no", the building will be completed and ready for inspection by No x❑ © ■ (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. olorado Telephone Number (970)356-4000 TOWN, CITY ® COUNTY Signature / 1 .� i f>; i " \. tE� L, . ; •t�:�' itie Protem, Weld County Board of / Commissioners Date 08/17/98 _1 _;., . Signature (attestTitle Deputy Clerk to the Board Date 08/17/98 If premises are located within a town or city, the above approval should be signed by the mayor and clerk, 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. 957/4/9 DR 8404-1 (2/94) Page 2 22. Have you ever been convicted of a crime, or received a suspended sentence, deferred sentence, or forfeited bail for any offense in criminal or military court? (Do not include traffic violations, unless they resulted in suspension or revocation of your driver's license, or you were convicted of driving under the influence of drugs or alcoholic beverages.) if yes, explain in detail. CI Yes X 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 ' No 24. Military Service (branch) 71 ©h�i From To Serial Number I 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 31'2 2? 7r4 Age._ 5/7e,e/4„, c., ,o75.po75. 1 4 1 4 co (ltn r 5 5f0)9 -4 -he -m_ A O et07 iffg 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 • j`�jc Ai L= PLrseerAl- S S �'1�•.'i/l� a /,'r�,, ��L -r-fir 5-i- !i $-/i/1' L.;14/15 r .t.��r,.-tr I y z—' $ 3 Avg f-•1 fiJ iii O,.,..1-0‘.....• 0 ...-,....-e,./ /-/; I_ 27. What is your relation hip to the applicant? (sole owner, partner, corporate officer, director, stockholder, member or manager) 5 a Ji 10 14_,,11-4-r- 28. If stockholder, number of shares owned beneficially or of record Percent of outstanding stock owned 29. If partner, state whether III 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) Amount $ 70 /" 00 31. Identify the sources of all funds you will invest in this business as listed in 30 above. List all bank names, account numbers and the amount derived from such source. Also identify all persons authorized to sign on, or who are part owners of said account. (Attach copies of all your notes or loans used in or for this business.) Amounts Sources - Account Numbers Names on accounts or person who can si on this account g7c ,...O 12,44---.,"% J $ 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 /5 Afi44 _L2 X. .1.ekti:1 Title frt4111-ZA Date if 7 R 8404-I (02/94) COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION 1375 SHERMAN STREET DENVER CO 80261 INDIVIDUAL HISTORY RECORD To be completed by each individual applicant, all general partners of a partnership, all limited partners owning 10% (or more) of a partnership; all officers and directors of a corporation, all stockholders of a corporation owning 10% (or more) of the stock of such corporation; all limited liability company MANAGING members, or other limited liability company members with a 10% (or more) ownership interest in such company and all managers of a Hotel and Restaurant license. NOTICE: This individual history record provides basic information which is necessary for the licensing authorities investigation. ALL questions must be answered in their entirety. EVERY answer you give will be checked for its truthfulness. A deliberate falsehood will jeopardize the application as such falsehood within itself constitutes evidence regarding the character of the applicant. 1 Name of Business em Pand Date Social Security Number(s) 2. Your Ful Name (last, first, mid I l hn b& r%r , fe1 ��Q-7 Id. Als Known s (maiden y_name/nickname, etc.) i,�/ h, �-e, 4. Mailin dress (if difte nt from residence) I,,, O- p Dsl 72 Home Telephone C97o)13.E 24'1 5. Residence A dress (street and number, city, slat?, ZIP) Li/ je be,.. P`Ey. _f 07✓ --r/ 7 tri. bate of Birth• tP ce of Birth c 7. U.S. Citizen? l'. Yes ❑ No If Naturalized, sta*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 513" Weight i 1 'plot Hair Color rbWf Eye Color / j & Se Race . iih/ `L 9. Do You Have a current Driver's License? If yes, give number, & state 1g) Yes n No i9 10. Name of Present Employe 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 lotdldou'&cd 1 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 21. Do you now, or have you Licensee? If yes, answer ❑ Yes Si 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 ;oft, 111111e. COLORADO August 12, 1998 Dixie Kingsbury dba P & M Recreation Lots 5 and 6, Block 3 Main Street Stoneham, CO 80754 Dear Ms. Kingsbury: BOARD OF COUNTY COMMISSIONERS PHONE (970) 356-4000, EXT.4200 FAX: (970) 352-0242 P.O. BOX 758 GREELEY, COLORADO 80632 On Monday, August 3, 1998, I travelled to the proposed licensed premises known as P & M Recreation, located at Lots 5 and 6, Block 3, Main Street, Stoneham, Colorado. While there I made an on -site inspection regarding the Liquor License Application. The application is for a 3.2 Percent Beer License. It will be heard by the Board of County Commissioners as the liquor licensing authority for Weld County on Monday, August 17, 1998, at 9:00 a.m. My inspection revealed the following: 1. 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 are no other liquor licensed or 3.2% beer licensed premises within the neighborhood. 4. 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 Monday, August 3, 1998. 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 WELL COUNTY, COLORADO 'George E. Baxter cc: Bruce Barker, County Attorney LC0010 PERSONAL REPRESENTATIVE'S DEED (Testate Estate) THIS DEED is made by GALEN BEAUEREAD WHITE as Personal Representative of the Estate of Myrtle Gladys Jordan aka Myrtle G. Jordan, deceased, Grantor, to DIXIE JEAN KINGSBURY, Grantee, whose legal address is P. O. Box 43, Stoneham, CO 80754 of the County of Weld, and State of Colorado. WHEREAS, the Last Will and Testament of the above -named decedent was made and executed in the lifetime of the decedent, and is dated January 19, 1998 which Will was duly admitted to informal probate on March 24, 1998 by the District Court in and for the County of Weld State of Colorado, Probate No. 98 PR 93. Division I WHEREAS, Grantor was duly appointed Personal Representative of said Estate on March 24, 1998 and is now qualified and acting in said capacity. NOW THEREFORE, pursuant to the powers conferred upon Grantor by the Colorado Probate Code, Grantor does hereby sell, convey, assign, transfer and set over unto said Grantee as the person entitled to distribution of the property in the above captioned Will, the following described real property situate in the County of Weld, State of Colorado: West 90 feet and East 50 feet of Lots 19 to 21, Block 3, Stoneham, Weld County, Colorado, and Lots 5 and 6, Block 3, Town of New Stoneham, Weld County, Colorado With all appurtenances, subject to covenants, easements and restrictions of record, and subject to general property taxes for the year 1998, due and payable in 1999, and thereafter; existing roads, public highways, established easements and rights of way; oil, gas and mineral reservations, conveyances and leases of record; restrictions and liabilities by reason of inclusion in any special assessment district; and zoning, subdivision and use restrictions of patent, if any. As used herein, die singular includes the plural and the plural the singular. Executed / At 19 9f State of Colorado) )s, County of R. 2 // Personal Representative of the Estate of Myrtle Gladys Jordan aka Myrtle G. Jordan, Deceased. The foregoing instrument was acknowledged before me this day of May 1998, by Galen Beaufread White as Personal Representative of the Estate of Myrtle Gladys Jordan aka Myrtle G. Jordan, Deceased. t ,..• • My conwnissioo expires: Wihiess my hand and official seal. r -i / ACC ./Z�-6 -e- Qiantyriit fl ta'iht '.M Name and Address of Person Creating Newly Created L gal Description (138-35-106.), C.R.S.} 111111111111111111 111111 11111 III 1111111 III 11111 IIII IIII 2812936 05/14/1998 03:44P Weld County CO 1 of 1 R 6.00 D 0.00 JA Suki Tsukamoto .937 V9/ -u Weld County Commissioners Clerk To The Board P. 0. Box 758 Greeley, Co 80632 William E Pedersen Rt 2 Box 59 Merino Co. 80741 Dear Sirs: This is a reference letter regarding the ability of Dixie Jean Kingsbury. She is realible in the work she does and friendly to all the people. She is very responable for the work she does. Dixie has been very honest and truthful in every thing she does. Dixie has keep my checking account up to date and the bookkeeping on my farm up to date. Dixie has also help work on the farm too. I have a farming corporation, which I own. Lis\ y6 -7-77-e" July 10, 1998 to: Weld County Commissioners This is a reference letter regarding Dixie Kingsbury. Dixie is a hrrdworking, honest individual who is helpful to many others. She is friendly and a caring person to all she comes in contact with. Her family has been a center point of the community for many years. I feel she is trustworthy and reliable which is very important in. a small community such as Stoneham. 91i1/ji July 10, 1998 To: Weld County Commissioners Dixie Kingsbury is an asset to the Stoneham community. She is an active member of one of our local churches and is helpful to others in town, The business, The P and Y, which she now owns has been a vital meeting place for rural famers and ranchers over a period of many years. Dixie is an honest and hardworking person who needs this business reopened for her well being. Z',/ ‘4'7)? iroe, j fa/ fj f 4/ APr 13 1j,z/' Ova. Affidavit of Publication STATE OF COLORADO County of Weld SS. I A. Winkler Riesel of said County of Adams being duly sworn, say that I am publisher of PLATTEVILLE HERALD that the same is a weekly newspaper of general clambake was printed and published in the town of FORT LUPTON in said county and state that the notice of advertisement, of which the annexed is a true copy has been published in said weekly newspaper for ONE consecutive weeks: that the notice was published in the regular and entire issue of every number of said newspaper during the period and time of publication of said notice and in the newspaper proper and not in a supplement thereof: that the first publication of said notice was contained in the issue of said newspaper bearing the date of JULY 29. A.D. 1998 and the last publication thereof, in the issue of said newspaper, bearing date, the 29th day of JULY 1998 that the said PLATTEVILLE HERALD has been published continuously and uninterruptedly during the period of at least fifty-two consecutive weeks next prior to the first issue thereof containing said notice or advertisement above referred to: and that said newspaper was at the time of each of the publications of said notice duly qualified for that purpose within the meaning of an act entitled. "An Act Concerning Legal Notices, Advertisements and Publications and the Fees of Printers and Publishers thereof, and to Repeal all Acts and Parts of Acts in Conflict with the Provisions of this Act" approved April 7, 1921, and all amendments thereof, and particularly as amended by an act approved, March 30, 1923, and an act approved May 13, 1931. i4!/K 1-1.6P-0 Subscribed and sworn to before me this of JULY A.D. 1998 • 221h day Notary Publ P.O.BOX 125 FT. LUPTON, CO 80621 My Commission Expires December 27, 2001 al MO. 98-46 Puauanttettellquorlaws of the date of Coloiodo.r`P and Mllecteotprllafs5.ane 6, Main Shier Stoneham, Colorado, 80754, has reguet?er{ the licensing- odklait ak Wbldr 0elahty. Cortodd ]o gaapt oi?etoi 3.2sPerdentSeet license for consumpliRfail ythettfrnkon.. the premises onN and/or in soee•.eogtaiaers net' for ca 6.e. 'fere, ewheie ear n ors;... .. Ceosd`s ";Ealoracle ,has deelorred that the nelgelsdhoodte be served wit b•galollows tots 5 ens6; =Block.3, Main. Street, Stoneham Colorado east, . 'Wind... County, Colgredo The heating; on said license wit be heldin Molest door knsnibty morn. Weld, County Centenniel,Certte,. 975 IS, Greetwv, Caber ,¢0,4efeatt 17.. he Retitrona end esineyrbe wid Ia.tI(sk es offtheClerg_to rd of County Caftwey fISIOt.loadtedk7me Wefa Ctiunty; Centennial Caltliebt15 l0theireet`it*d Floras, 0(eelgy,.Col rado,. BQAN0 OB COUNTY COMMISSIONERS fCgtiNl•Y, COEOffACO DA16®r.-Jtnf313'199•<' '.... Published In the Platteville Heroledull'29:1998. 9S0z/q/ DOCKET NUMBER: DATE SET: HEARING DATE: TIME: NAME AND ADDRESS: RE:. PUBLISH DATE: FILE NO.: 98-45 July 20; .1998 August 10, 1998- 9:00 a.m. Beebe Draw Law Enforcement Authority District Board To .consider the 1998 Master M4niarki,dum of Intergovernmental Agreement for Conduct of Coordinated Elebtioy!s with the Weld Cunty Clerk and Recorder July 29, 1998, in the Platteville Herald SD0001 DOCKET NUMBER: DATE SET: HEARING DATE: TIME: NAME AND ADDRESS: RE: PUBLISH DATE: FILE NO.: 98-46 July 21, 1998 August 17, 1998 9:00 a.m. Dixie Jean Kingsbury P and M Recreation Lots 5 and 6, Block 3, Main Street Stoneham, Colorado 80754 Application for a Retail 3.2 Percent Beer License July 29, 1998, in the Platteville Herald LC0010 Play macro "Docket" instead of copying. Play macro = Alt + F10; place insertion point on line above this instruction.) 12 98/N 1 K:\CTB\98DOCKET osp_ek ,c TLa utclaw oit WIDc. COLORADO 1tinoLu7; (.5, ?9Aa? TO: Weld County Board of County Commissioners FROM: Bruce T. Barker, Weld County Attorney DATE: May 14, 1998 RE: Checklist and Procedures for Beer Licenses The following are checklists to follow in the course of consideration of beer license applications. These checklists have been updated to reflect the current Beer Code provisions. Let me know if you have any questions. CHECKLIST FOR ON -SITE INSPECTIONS OF PREMISES FOR APPLICATIONS PURSUANT TO THE COLORADO BEER CODE 1. Establish that the applicant's premises are separate and distinct from any liquor licensed premise, i.e. liquor stores, taverns, etc. 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 3.2% beer on, off, and on/off license establishments within neighborhood, in order to determine the necessity of the proposed license. C.R.S., § 12-47- 301(2)(a). 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. The findings should be based upon what the Board has found in its on -site visit and investigation of character. Although this step is not required, it should be done out of fairness to the applicant. , require this step to be completed in the case of liquor applications. See C.R.S., § 12-47-312(1). U. S. G. P.O. 1989-239-555 PS Form 3800, June 1985 P 387 472 113 RECEIPT FOR CERTIFIED MAIL NO INSURANCE COVERAGE PROVIDED NOT FOR INTERNATIONAL MAIL (See Reverse) _O-4rO _ Sent to -ZNAG Street and No. - (n O O P.O.. State and - xi m O Postage O z m D _ - N 03 1 m D sic) E Special Delivery — m _ Certified Fee Restricted Delive Return Receipt s to whom and Da Return Receipt si Date. and Addres TOTAL Postage e Postmark or pate nncuid. 5(A Is your BrIllffi ADDRESS completed on the reverse aids? Ill sr ▪ w m-_z0Crxi i XIr-} ib as 112;44- .... E. =(lzino, g4" °ill! a o $ qj I{o�_ if 0 - m g m Z v -a t W i<O gi 1 o z g a z m ri z I . 6 s 3 Ire �.I m a C III m oO�Oc i o l 3U J 3 m8ppz a 1 -.3 B la;3 s 9..i 4 wraeld ogsewo m_ s $?� 3: El % -> m Tank you for using Return Receipt Sekice. 1-0 C Memo, Beer Checklist May 14, 1998 Page 2 4. After the public hearing, the Board should notify the applicant in writing of the decision. The notification should state the reasons for the decision and should be sent to the applicant by certified mail within 30 days after the date of the public hearing. See 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 in the neighborhood and the desires of the inhabitants with respect to the issuance of the license applied for. C.R.S., § 12-47-312(3) and Regulation 47-324 A., C.C .R. ✓/ Bruce T. Barker Weld County Attorney BTB/db: MemoBOCC/Brcheck pc: Carol Harding NOTICE DOCKET NO. 98-46 Pursuant to the liquor laws of the state of Colorado, P and M Recreation, Lots 5 and 6, Main Street, Stoneham, Colorado 80754, has requested the licensing officials of Weld County, Colorado, to grant a Retail 3.2 Percent Beer license for consumption by the drink on the premises only and/or in sealed containers not for consumption at place where sold The Board of County Commissioners of Weld County, Colorado, has declared that the neighborhood to be served will be as follows: Lots 5 and 6, Block 3, Main Street, Stoneham, Colorado 80754, Weld County, Colorado The hearing on said license will be held in the first floor assembly room, Weld County Centennial Center, 915 10th Street, Greeley, Colorado, on August 17, 1998, at 9:00 a.m. All persons wishing to testify regarding said Retail 3.2 Percent Beer License are encouraged to attend said hearing. Petitions and remonstrances may be filed in the office of the Clerk to the Board of County Commissioners, located in the Weld County Centennial Center, 915 10th Street, Third Floor, Greeley, Colorado. BOARD OF COUNTY COMMISSIONERS WELD COUNTY, COLORADO DATED: July 21, 1998 PUBLISHED: July 29, 1998, in the Platteville Herald 9P/9/ OEPA*IMENT OF REVENUE 137S SI4ERMAN ST OENVoP Co me, Must collect taxes for STATE COLORADO SALES TAX LICENSE USE ACCOUNT NUMBER for all references LIABILITY INFORMATION ISSUE DATE LICENSE VALID DECEMBER 3 1 <,..,, I .P. I ,A 15 a.i. me.,. <.. +.e, 24-81132-0000 03128 5900 I 040198 JUN 25 98 1999 THIS LICENSE MUST BE POSTED AT THE FOLLOWING LOCATION: KINGSBURY DIXIE JEAN P & M RECREATION P 0 BOX 72 STONEHAM CO 80754 LOT 5. & 6 BLOCK 3 MA ST0NEHAM CO' THIS LICENSE IS NOT TRANSFERABLE ExecutiveDire Department of Revenue A DETACH HERE IMPORTANT NOTICE from the Colorado Department of Revenue Please VERIFY that all information on your new sales tax license is correct If your mailing address is incorrect or if you discontinue making sales from this location, notify the Department of Revenue by calling (303) 232-2416 or by writing to: Registration Control Colorado Department of Revenue 1375 Sherman Street, Room 86 Denver CO 80261-0013 Preprinted reporting forms with your Colorado Account Number and other information will be mailed within six weeks to the address shown on your license. You may experience costly delays if materials are returned by the Postal Service to the Department of Revenue because they could not be delivered. Tax reporting and payment of fees and taxes due are your responsibility, whether or not you receive your returns before the filing deadline. In order to avoid late penalties and interest, when you mail your return with your remittance, the envelope must be POSTMARKED on or before the due date. Multiple Event License holders must file only for those months during which they attended an event This license is to be used only for purchasing items tax free for resale. If no tax is remitted on this account for twelve consecutive months, the account will be closed, except for wholesale accounts. If you have any other questions, please contact the Taxpayer Service Division, (303) 232-2416. NEW BUSINESS ASSISTANCE SERVICE CENTER 1625 Broadway. Suite 805 Denver CO 80202 COLORADO SPRINGS REGIONAL SERVICE CENTER 3650 Austin Bluffs Parkway, Suite 188 Colorado Springs CO 80918 FORT COLLINS REGIONAL SERVICE CENTER 300 E. Foothills Parkway Fort Collins CO 80525 GRAND JUNCTION SERVICE CENTER 222 S. Sixth Street, Room 208 Grand Junction CO 81501 PUEBLO SERVICE CENTER 310 E. Abriendo Avenue, Suite A4 Pueblo CO 81004 -1,F/v9/ Hello