HomeMy WebLinkAbout970226.tiff RESOLUTION
RE: APPROVAL OF RENEWAL REQUEST FOR 3.2% BEER LICENSE ISSUED TO
CONO-SERVICES, INC., DBA CONOCO #06394 - EXPIRES APRIL 5, 1998
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, Cono-Services, Inc., dba Conoco #06394, presented to the Board of
County Commissioners of Weld County, Colorado, an application for the renewal 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, and
WHEREAS, pursuant to Weld County Ordinance No. 6, Section II., C., said applicant
has paid the sum of$57.50 to the County of Weld for the renewal 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:
3851 Highway 119, Longmont, Colorado 80501
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 97-03 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 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 April 5, 1998, 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.
970226
LC0031
Cl�' : $0) Lunocv
RENEW 3.2% BEER LICENSE - CONOCO #06394
PAGE 2
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 22nd day of January, A.D., 1997.
BOARD OF COUNTY COMMISSIONERS
\Ca I WELD COUNTY, COLORADO
ATTE ,1` � � -
Geor e E. Baxter, Chair
Weld ourity Clerk to the Boajd
1 ' Constance L. Harbert,
BY: " �i71 1
Deputy Cler o the Board '
Dale K. Hall
APP AS TO • EXCUSED DATE OF SIGNING (AYE)
Barbara J. Kirkmeye
my Atto nr e b JI
W. H. Webster
970226
LC0031
THIS LICENSE MUST BE POSTED IN PUBLIC VIEW
OR 8402110192) STATE OF COLORADO
DEPARTMENT OF REVENUE
Liquor Enforcement Division
1375 Sherman Street
Denver,Colorado 80261
CONO—SERVICES INC
CONOCO N006394
3851 HWY 119
LONGMONT CO 80501
ALCOHOLIC BEVERAGE LICENSE
Liability Information
Account Number County City Indust. Type Liability Date LICENSE EXPIRES AT MIDNIGHT
21-35816-0067 03 206 5541 C 040690 APR 05, 1998
Type Name and Description of License Fee
2122 3.2 PERCENT BEER RETAIL $ 50.00
LICENSE (OFF PREMISES)
2190 COUNTY 85 PERCENT OAP FEE $ 42.50
TOTAL FEE(S) $ 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.
41
testimony whereof,I have hereunto set my hand.
c....,,cot C. eif 1/4.11an ce
JAN 2 91997
Division Director Executive Dire tor
•
970226
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91702.26
License Number License Type
DR 8400 (10/95) LIQUOR OR 3.2 BEER LICENSE 21 -35816-0067 2122
COLORADO DEPT OF REVENUE
LIQUOR ENFORCEMENT DIVISION RENEWAL APPLICATION Liability Information
1375 SHERMAN ST
DENVER CO 80261 03 206 5541 C 040690
Business Location
11111111 II,IIII„III„Illliilirill,liiil,l,ltil,lllii111 3851 HWY 119
CONOCO N006394 LONGMONT CO
SUSIE BASTIAN Current License Expires
6855 S HAVANA STE610 APR 05 , 1997
ENGLEWOOD CO 80112-3837
PLEASE COPY FOR
YOUR RECORDS
14 This renewal reflects no changes from the last Application for renewal must be filed with your LOCAL
application. Complete page 2 and file now! LICENSING AUTHORITY at least 45 DAYS PRIOR to the
❑ There are changes from the last application. expiration date of your current license.
Complete and attach page 2 (DR 8401) and if a Exception: Wholesaler, manufacturer, importer, and public
corporation, DR 8177 - Corporate Report of transportation system license renewals do not need Local
Changes; or if a Limited Liability Company (DR Licensing Authority approval and must be returned directly to
8405). Ali other changes of ownership require a the Colorado Department of Revenue at least :AO days prior to
transfer of ownership application See your Local the current license expiration date.
Licensing Authority immediately. FAILURE TO FILE THIS RENEWAL AT LEAST 45
D Delivery Permit requested? Retail Liquor Store, DAYS PRIOR TO THE EXPIRATION DATE OF.YOUR
Drug Store or 3.2% Beer - Combination On/Off LICENSE MAY RESULT IN YOUR LICENSE NOT
Premises Licenses ONLY. Check the box if you BEING RH�WED.
want the permit to be issued
•
•
... ....,-
.; ;OAT1•I'OF'/#PPLtGANT; 9 >,: 2::
I declare under p alty of perjury in the second degree that this application and all attachments are true,correct,and complete to the
best
Authorized
myknowle ge `y/'�� `J
Authorized Signature Date Business Phone
7
Title of Signer(if rpora ion) EE.,SS waxer S esT x Numbe -
<'. REPORT AND APPROVAL OOF LICENSING AUTHORITY 7s!t "'
The foregoing application has been examined and the premises,business conducted and character of the appli t are sf c ,
and we do hereby report that such license,if granted,will comply with the provisions of Title 12,Articles 46 47, �'I
THEREFORE THIS APPLICATION IS APPROVED. JBi » `;?U 4V
Local Licensing Authority f or - Date (` -
/ Weld County, Colorado ❑ Town/City ® Coup ,
Signs C Title Chair, Weld County Attest
` A /�.L„��% Board of Commissioners By• p , dvput3
[co NOT TACH DO NOT DETACH OT DETACH
DR 8400 (08/95) LIQUOR OR 3.2 BEER LICENSE r/ 1
COLORADO DEPT OF REVENUE
1375 SHERMAN ST _ RENEWAL APPLICATION
DENVER CO 80261
Business Name LICENSE NUMBER(Use for all reference) RENEWED LICENSE EXPIRES AFTER
CONOCO N006394 21 -35816-0067 04-05-98
TYPE OF LICENSE ISSUED CASH FUND STATE FEE
3 . 2 PERCENT BEER RETAIL COUNTY 85% OAP
LICENSE ( OFF PREMISES) 2330- 100 (999) 2122-750(999) 2190- 100(999 )
$ 25 . 00 $ 25 . 00 $ 42 . 50
TOTAL AMOUNT DUE $ 92 . 50
Make check payable to:Colorado Department of Revenue L CUe 3/
970226
DR 8401 (07/94)
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1375 SHERMAN STREET ATTACHMENT TO LIQUOR OR
DENVER CO 80261
(303)866-3741 3.2 BEER LICENSE RENEWAL APPLICATION
This page must be completed and attached to your signed renewal application form.
Failure to include this page with the application may result in your license not being renewed.
Trade Name of Establi ent State License Number
el) O ‘03 % - Bi / :35//&-OOlo7
1./Oppeerrating Manager /� Home� Addressr9 / ) /7 Q '/Date of Birth
/ 273R/d/!/ R rr-,c�ShN �//3 J1Jj ,si Sit ,f tD SlyK. l D O sceY
2. Do you have legal possession of the premises for which this application for license is made? Yes No
Are the premises owned or rented: OCL.At_S • If rented,expiration date of lease: ❑
3, Has there been any change in financial interest(new notes,loans,owners,etc.)since the last annual application?If yes,explain in Yes No
detail and attach a listing of all liquor businesses in which these new lenders or owners,(other than licensed financial institutions)are I X
materially interested. _ 1
4. Since the date of filing of the last annual application,has the applicant,or any of Its agents,owners,managers,principals,or lenders Yes No
(other than licensed financial institutions),been convicted of a crime?If yes,attach a detailed explanation. ❑
5. Since the date of filing of the last annual application,has the applicant,or any of its agents,owners,managers,principals,or lenders
(other than licensed financial institutions),been denied an alcoholic beverage license,had an alcoholic beverage license suspended or Yes No
revoked,or had interest in any entity that had an alcoholic beverage license denied,suspended or revoked?If yes,attach a detailed I n
explanation.
Cm_
( n e L .--,n Quo
6. Does the applicant,or any of its agents,owners,managers,princ als,or lenders(other than licensed financial institutions),have a Yes No
direct or indirect interest in any other Colorado liqu license(include loans to or from any� licensee,or interest in a loan to any R❑
licensee)?If yes,attach a detailed explanation. �el4 1 0 lsn „(' 0 h G
v v--
7. Sole owners or husband-wife partnerships answer this question.Si rice the date of filing of the last annual license application:
Has ownership changed in whole or in part,from a sole owner to any other person,partnership,corporation,or limited liability Yes No
company other than the licensee listed on your state liquor license?If yes,this license must be transferred to the new owner and ri
may not be renewed.Contact your Local Authority immediately.
8. Partnership applicants must answer this question.Since the date of filing of the last annual license application: Yes No
(a) Are there,or have there been any general partners added to,or deleted from the partnership?If yes,this license must be ❑
transferred to the new partnership and may not be renewed.Contact your Local Authority immediately.
(b) Are there,or have there been any limited partners with a 10%or more interest,added or deleted from the partnership?If yes,this n
license must be transferred to the new partnership and may not be renewed.Contact your Local Authority immediately.
9. Corporate applicants must answer this question.Since the date of filing of the last annual license application: Yes No
(a) Are there,or have there been any officers or directors added to,gr deleted from the corporation?It yes,complete and attach
DR 8177 and submit to your Local Authority immediately.
(b) Are there,or have there been any stockholders with 10%or more of the is uedgt=ock,a e to,or elete rom the corporation?
If yes,complete and attach DR 8177 and submit to your Local Authority immediately. // / ❑
(c) Date of tiling last annual corporate report with the Colorado Secretary of State: / P1�j 9 Q9 _
10. Limited Liability Company applicants must answer this question.Since the date of filing of the last annual license application: Yes No
(a) ,Are there,or have there been any managing members added to,or deleted from the company? If yes,complete and attach
DR 8405 and submit to your Local Authority immediately.
(b) Are there,or have there been any members with 10%or more membership interest,added to,or deleted from the company?
If yes,complete and attach DR 8405 and submit to your Local Authority immediately.
(c) Date of filing last annual LLCO report with the Colorado Secretary of State:
11. Bed and Breakfast applicants must answer this question and certify compliance with 12-47-118.5 C.R.S.,to the state licensing
authority by initialing the following listed questions:
That it has no more than 20 sleeping rooms,and
That it provides at least 1 meal per day at no charge other than for overnight lodging,and
That it does not sell alcoholic beverages by the drink or in sealed containers,and
That it shall not serve alcoholic beverages for more than 4 hours in any one day,as follows:
MONDAY HOURS TUESDAY HOURS WEDNESDAY HOURS THURSDAY HOURS FRIDAY HOURS SATURDAY HOURS SUNDAY HOURS
From: limp. From: m. From: ' - m. From: �/ (G m. From:I i/ m. From: ),/ m. From: ry m.
To: 017" m. To:a T m. To: Y" m. To: O' m. To: It/
m. To: `f m. To:d` m.
S70^"r
UI UJ JU U. IUIut ra m UI,L, DILL u bona IJ 04J4ULI 1UU, UUJ
Cono-Services Inc.
Violations which have resulted in suspensions of the license
12-84 Jefferson County Ten day suspension for sale to a minor.
3-90 Arvada Five day suspension for sale to a minor; four of which are held in abeyance for 12 months.
9-90 Thornton Two locations,ten days suspension each;five to be held in abeyance for one year,a fine in lieu
of suspension of three days,and two days actual suspension.
3-91 Dept.of Rev. Store#06326 in Denver received a one day suspension for failure to conspicuously display the
liquor license,a fine was paid in lieu of suspension.
6-91 Longmont Store#06356. Received a 10 day suspension for sale to a minor. Paid a fine in lieu of suspension:
7-91 Broomfield Store#06370 Received a 7 day suspension for sale to a minor, 4 days to be held in abeyance
for one year and a fine was paid for the other three days.
12-92 Denver Store 06421, received 10 day suspension for sale to a minor,held in abeyance.
1-93 Denver Store#06333. Received 10 day suspension for sale to a minor 8-92,held in abeyance. 1-93,Fine
paid for 10 day suspension,20 days to be held in abeyance,for sale to a minor.
2-93 Broomfield Store#06412. Received 7 day suspension for sale to a minor. Four days held in abeyance,fine
paid in lieu of remaining three days suspension.
7-93 State Store #06430 (Westminster). Received a 3 day suspension for improper posting of a minor
warning sign. Fine paid and two days held in abeyance for one year.
8-93 Denver Stores#6351, 6418, and 6335. Received 10 days suspension at each location for sale to a minor.
7 days were held in abeyance for a period of one year and a fine was paid in lieu of remaining
three days suspension.
10-93 Broomfield Store#06412. Received 21 day suspension for sale to a minor. Ten days held in abeyance,a fine
was paid in lieu of suspension of four days and seven days suspension were served.
4-94 Boulder Cnty #06377,Received 5 day suspension for sale to a minor. Two days held in abeyance and three days
served. 5-94, second violation, 14 day suspension.
+C
11-94 Broomfield Store #06412. Received 31 day suspension,24 to bekserved and 7 held in abeyance.
7-95 Lakewood #06378 Licensed surrendered and store closed.No penalty imposed.
7-95 Greenwood Vil #06426 Sale to minor. Penalty 60 days. 30 days held in abeyance,30 days to be served.
8-95 Denver #06326 in Denver,Sale to minor. Penalty 30 days. 24 days in abeyance for 1 year,5 days served
by paying fine and 1 day closure.
9-95 Denver #06405 in Denver,Sale to minor.Penalty 30 days,24 days In abeyance for 1 year.5 days served
by paying fine and 1 day closure.
7 l Qn"D
JUL 3 ' 96 14:09 3037773823 PAGE.002
UI-Ui-sb UC: IdYM YKUM DILL, DILL a t,.tnn IU 0,1 4UC1 YUUdi UUi
5-96 Boulder #6410 in Boulder; Sale to minor. Penalty 3 days suspension,2 days held in abeyance for I year.
I day suspension.
5-96 Broomfield #6412 in Broomfield; Employment of Individual of Not Good Moral Character.Employee was
suspended and demoted.
6-96 Boulder #06302 in Boulder;Sale to minor. Case Pending.
July 3, 1996
•
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si
4�R
JUL 3 ' 96 14:09 3037773823 PAGE .003 _
9rlQnn a
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EXhibit "A"
STORE # ADDRESS CITY ST ZIP
06302 601 S BROADWAY BOULDER CO 80303
06310 11090 N COLORADO BLVD THORNTON co 80233
06312 15351 E ILIFF AVE AURORA CO 80013
06314 4495 PEORIA ST DENVER CO 80239
06315 9175 HARLAN ST WESTMINSTER CO 80030
06317 11515 N HWY 83 PARKER CO 80134
06318 8170 W 80TH AVE ARVADA CO 80005
06319 19001 E QUINCY AVE AURORA CO 80015
06320 16810 E QUINCY AVE AURORA CO 80015
06324 8073 S BROADWAY LITTLETON CO 80122
06325 5810 OMAHA BLVD COLORADO SPRINGS CO 80915 i,
06326 3434 W ALAMEDA DENVER CO 80219
06327 10210 E ARAPAHOE" ENGLEWOOD CO 80112 n i 1.
06328 4085 BEVERLY COLORADO SPRINGS CO 80917 ,`, ; s
06329 275 S FEDERAL DENVER CO 80219 ""
06330 1705 W UINTAH COLORADO SPRINGS CO 80904
06331 4310 FOUNTAIN BLVD COLORADO SPRINGS CO 80909
06333 502 SHERIDAN ST DENVER CO 80219
06334 3210 YOUNGFIELD WHEATRIDGE CO 80033
06335 1501 COLORADO BLVD DENVER CO 80220
06336 14501 E COLFAX AVE AURORA CO 80011
06340 290 S HAVANA AURORA CO 80012
06342 4315 N ACADEMY COLORADO SPRINGS CO 80918
06344 1100 S HAVANA AURORA CO 80012
06350 7199 FEDERAL BLVD WESTMINSTER CO 80030
06352 PO BOX 560 ERIE CO 80516
06354 3809 MULBERRY FT GOWNS CO 80521
06355 12354 WELD COUNTY RD BRIGHTON CO 80601
06356 1801 HOVER RD LONGMONT CO 80501
06357 1260 14TH ST SW LOVELAND CO 80537
06358 5009 N GARFIELD LOVELAND CO = 80537
06360 4981 E 64TH AVE COMMERCE CITY CO 80022
06364 7444 W CHATFIELD LITTLETON CO 80123
06365 5600 S SIMMS UNIT A LITTLETON � CO 80123
06368 1095 FIRST ST BERTHOUD ' CO 80513
06369 3375 28TH ST BOULDER '"" CO 80301
06373 802 S PUBLIC RD LAFAYETTE CO 80026
06375 15590 W 44TH AVE GOLDEN CO 80403
06377 PO BOX 132 NIWOT CO 80544
06381 PO BOX 1134 LA PORTE CO 80535
06382 PO BOX 1071 LA PORTE CO 80535
061A3 2803 W 10TH ST GREELEY CO 80631
06391 2880 S CIRCLE DR COLORADO SPRINGS CO 80906
06394 3851 HIGHWAY 119 LONGMONT CO 80501
06395 6740 N ACADEMY COLORADO SPRINGS CO 80918
06396 680 E 84TH AVE THORNTON CO 80219
27O2 5
EXhibit "A"
STORE # ADDRESS CITY ST ZIP
06400 534 STATE HWY 105 MONUMENT CO 80132
06402 400 E 104TH THORNTON CO 80229
06404 3103 S SHERIDAN BLVD DENVER CO 80226
06405 1696 S COLORADO BLVD DENVER CO 80292
06406 1090 S HAVANA AURORA CO 80012
06407 303 S COLORADO BLVD DENVER CO 80222
06408 2110 S FEDERAL DENVER CO 80219
06409 14401 E 6TH AVE AURORA CO 80011 •
06410 3000 28TH ST BOULDER CO 80301
06411 600 S BROADWAY BOULDER CO 80303
06412 525 US HWY 287 BROOMFIELD CO 80020
06414 330 S ACADEMY COLORADO SPRINGS CO 80910
06415 507 GARDEN OF THE GODS COLORADO SPRINGS CO 80909
06416 515 N MURRAY RD COLORADO SPRINGS CO 80915
06418 3495 S MONACO PKWY DENVER CO 80222
06419 500 W 120TH AVE NORTHGLENN CO 80234
06421 2100 S MONACO PKWY DENVER CO 80272
06422 785 COLORADO BLVD DENVER CO 80206
06423 4785 FEDERAL BLVD DENVER CO 80211
06424 8900 E HAMPDEN DENVER CO 80231
06425 7295 BELLEVIEW ENGLEWOOD CO 80111
06426 5096 S YOSEMITE GREENWOOD VLG CO 80111
06427 3440 S WADSWORTH LAKEWOOD . CO 80227
06429 160 W 104TH NORTHGLENN CO 80234
06430 7995 N FEDERAL BLVD WESTMINSTER CO 80033
06431 4750 KIPLING WHEATRIDGE CO 80034
06433 5500 E ARAPAHOE RD BOULDER CO 80303
06434 1003 N ACADEMY COLORADO SPRINGS CO 80909
06436 3700 N FREEWAY PUEBLO CO 81008
06437 9201 HURON THORNTON CO 80021
06438 6393 WARD RD ARVADA CO 80004
06439 3790 WADSWORTH BLVD WHEATRIDGE,, CO 80033
06441 9405 S UNIVERSITY HIGHLANDS RANCH CO 80126
06442 520 S MCCA$LIN BLVD LOUISVILLE CO 80027
06443 3512 LOCHWOOD FT COLLINS CO 80525
06444 2250 MOUNTAIN VIEW LONGMONT CO 81501
06446 16920 E LINCOLN WY PARKER CO 80134
06447 191 MCCASLIN BLVD SUPERIOR CO 80027
06448 7695 W. LONG DR. LITTLETON CO 80123
06449 2790 N POWERS BLVD COLORADO SPRINGS CO 80021
06450 9883 W. CHATFIELD LITTLETON, CO 80123
06452 691 E. 120TH AVE THORNTON CO 80233
06459 5190 WEST 113TH AVE WESTMINSTER CO 80030
EFFECTIVE 11/26/96
97C.7,a
) C„�l;'TY
LIQUOR/BEER RENEWAL REVIEW FORM
56
Date: January 13, 1997 CLE^'`'
TO: Deputy Profitt
FROM: Kim Fliethman
SUBJECT: Liquor License Check
In accordance with the new procedure for Liquor and/or beer license checks, please review all
records on the following establishment for any associated reports during the last year and return
your report to the Weld County Clerk to the Board's Office within two weeks. Your report
will be used by the Board of County Commissioners in considering renewal of the liquor and/or
beer license.
PLEASE RESPOND NO LATER THAN: JANUARY 27, 1997
ESTABLISHMENT: CONOCO #06394
DBA CONOCO
3851 HIGHWAY 119
LONGMONT, CO 80501
Current license expires: APRIL 5, 1997
******************************************************************************
x/ No concerns PCP
Deputy's Initials
The Sheriffs Office had a concern and the deputy has mutually
worked with the licensee to correct the concern.
(Complete Attached Worksheet)
•
Unresolved concerns exist requiring a Probable Cause Hearing
scheduled by the Board of County Commissioners.
(Complete Attached Worksheet)
******************************************************************************
Please notify at Extension of the date and time of the
Board of Commissioner's renewal hearing.
970?,^5
Liquor/Beer License Worksheet
The following concerns are noted:
The Licensee and the Sheriff's Office have collectively agreed to implement the following to
correct concerns noted above: (A time line and corrective action should be listed for each
concern)
Establishment Owner, Please Print Date
Establishment Signature Deputy's Signature
Use another sheet of paper or attach separate proposal to this packet if needed.
Attach copies of all reports associated with this establishment for the last year.
Both the Deputy and the Owner of the establishment will be required to attend the Liquor
Hearing to testify to the above agreement.
27o7^2
/*Gat; MEMORANDUM
useTO: Shelly K. Miller, Deputy Clerk to the Board January 14, 1997
COLORADO From: Julie Chester, Zoning Compliance Officer 4IV
SUBJECT: Liquor License#LC0031 41r4
Review of the following liquor license renewal by the Department of Planning Services shows
the following:
Conoco#06394
DBA Conoco #LC0031
3851 Highway 119
Longmont, CO 80501
Zone District: C-3
The use is allowed through the zone district and a Site Plan Review (SPR -0007).
There are no violations occurring at this time.
SERVICE,TEAMWORK,INTEGRITY,QUALITY
97O2 c
• (conoco)
•
Susie Bastian Conoco Inc.
Analytical Support 6855 S.Havana,Suite 650
Rockies Regional Business Unit. . . , - Englewood,CO 80112
(303)649-4019
Fax:(303)649-4020 •
01/9/97
WELD COUNTY
PO BOX 758
GREELEY, CO 80632-0758
Dear WELD COUNTY:
Enclosed you will find the applications for the BEER licenses for 06394 payment in the
amount of$71.25/53.75 for the licensing fees.
Please return the 1997 License to my attention at 6855 S. Havana, Suite 650,
Englewood, CO 80112, If you have any questions regarding the information submitted, please
contact me at 303-649-4019.
Sincerely,
'C
Susie Bastian
t
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P 387 472 386 m a
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NO INSURANCE COVERAGE PROVIDED m E co b m O I U O ¢
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(conoco)
No.04020387 a3;;°
CONOCO INC
PONCA CITY, OK 74602
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Vendor Code: 008765R11 Company: 001 - CONOCO INC eck No.: 04020387
5 Voucher Invoice Invoice 1099 Gross ADJ Adjustment Discount Net
H Reference Date Number CD ' Amount CD Amount Amount Amount
VENDOR NAME: COLORADO DEPARTMENT OF REVENUE
IN CASE OF QUESTIONS ABOUT THE FOLLOWING INVOICES, PLEASE CALL (303) 649-4121 .00 AO 92.50
S 0139094DC003D010 19970103 01/3/9792.5 92.50
N N N INQUIRIES ON ABOVE INVOICES SHOULD BE DIRECTED TO PHONE NO. LISTED ABOVE 592.50
TOTAL NET AMOUNT
P 387 472 100
RECEIPT FOR CERTIFIED MAIL
NO INSURANCE COVERAGE PROVIDED 18150 wish to receive the
NOT FOR INTERNATIONAL MAIL e 1 and/or 2 for additional services. followingsoservices(for an
(See Reverse) a 3,4a,and 4b.
e and address on the reverse of this form so that we can return this extra fee):
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Sam to n to the front of the mail lace,or on the back ifspace does not ef p' 1. ❑ Addressee's Address
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stColorado Dept. Of Revenue ieceipt Requesfed'on the meil>ece below he snide number. 2. ❑ RestdCted Delivery N
_Liquor Enforcement Div. ceiptwllshowtowhomtheartic a eliveredaindthedate Et
Consult postmaster for fee.a P 1375 Sherman Street t`{ 4a.Article umber 8
Denver, CO 80261 redo D _ Lie ),�/7 V?a /� e
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to whom and Date Delivered By: (Print Name) m
and fee is paid) f
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d Date,and Address of Delivery : (Addressee or Agent)
j TOTAL Postage and Fees S
8 Postmark or Date 11, December 1994� �{ Domestic Return Receipt
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