HomeMy WebLinkAbout20251804.tiffResolution
Approve Permit Application and Report of Changes Form to Register a Manager,
and Authorize Chair to Sign — 7 -Eleven, Inc., dba 7 -Eleven Store 39510H
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 been presented with a Permit Application and Report of
Changes Form for 7 -Eleven, Inc., dba 7 -Eleven Store 39510H, to register a manager, in
connection with its' Fermented Malt Beverage and Wine Off -Premises (County) License,
for the sale of malt beverages and vinous liquors in sealed containers not for consumption
at the place where sold, located at 3914 State Highway 119, Longmont, Colorado 80504,
and
Whereas, after review, the Board deems it advisable to approve said form.
Now, therefore, be it resolved by the Board of County Commissioners of Weld County,
Colorado, that the Permit Application and Report of Changes Form for 7 -Eleven, Inc.,
dba 7 -Eleven Store 39510H, to register a manager, in connection with its' Fermented Malt
Beverage and Wine Off -Premises (County) License, for the sale of malt beverages and
vinous liquors in sealed containers not for consumption at place where sold, be, and
hereby is, approved.
Be it further resolved by the Board that the Chair be, and hereby is, authorized to sign
said form.
The Board of County Commissioners of Weld County, Colorado, approved the above
and foregoing Resolution, on motion duly made and seconded, by the following vote on
the 25th day of June, A.D., 2025:
[Insert Resolution Attestation Block Post Meeting]
2025-1804
LC0052
Instruction Sheet for Permit Application and Report of Changes
For All Sections, Complete Questions on Page 2
0 Section A
To Register or Change Managers, check the appropriate box in section A and complete question 10
on page 6. Proceed to the Oath of Applicant for signature. Submit to State Licensing
Authority for approval.
❑ Section B
For a Duplicate license, be sure to include the liquor license number in section B on page 1 and
proceed to page 8 for Oath of Applicant signature.
❑ Section C
Check the appropriate box in section C
and proceed below.
For a Retail Warehouse Storage Permit, go to
page 4 complete questions in the section (be
sure to check the appropriate box). Submit the
necessary information and proceed to page 8
for Oath of Applicant signature. Submit to the
State Licensing Authority for approval.
For a Wholesale Branch House Permit, go
to page 4 and complete questions in the
section (be sure to check the appropriate
box). Submit the necessary information and
proceed to page 8 for Oath of Applicant
signature. Submit to the State Licensing
Authority for approval.
To Change Trade Name or Corporation
Name, go to page 4 and complete
questions in the section (be sure to check
the appropriate box). Submit the necessary
information and proceed to page 8 for Oath
of Applicant signature. Retail Liquor License
submit to the Local Liquor Licensing Authority
(City or County). Manufacturer, Wholesaler and
Importer's Liquor Licenses submit to the State
Liquor Licensing Authority.
To modify Premises, or add Sidewalk
Service Area, go to page 7 and complete
all questions. Submit the necessary information
and proceed to page 8 for Oath of Applicant
signature. Retail Liquor License submit to
the Local Liquor Licensing Authority (City
or County). Manufacturer, Wholesaler and
Importer's Liquor Licenses submit to the State
Liquor Licensing Authority.
For Optional Premises go to page 7 and
complete all questions. Submit the necessary
information and proceed to page 8 for
Oath of Applicant signature. Retail Liquor
License submit to the Local Liquor Licensing
Authority (City or County).
To Change Location, go to page 5 and
complete questions in the section. Submit
the necessary information and proceed to
page 8 for Oath of Applicant signature.
Retail Liquor License submit permit application
or report of change to the Local Liquor Licensing
Authority (City or County). Manufacturer,
Wholesaler and Importer's Liquor Licenses
submit to the State Liquor Licensing Authority.
Noncontiguous or Primary Manufacturing
Location Change, go to page 6, and
complete questions in the section. Use this
section to make a current Noncontiguous
Manufacturing Location into a Primary
Manufacturing Location, or a Primary
Manufacturing Location into a Noncontiguous
Manufacturing Location. To be eligible for a
Noncontiguous or Primary Manufacturing
Location Change, you must be a Colorado state
licensed manufacturer pursuant to section 44-3-
402 or 44-3-403, C.R.S.
Campus Liquor Complex Designation, go to
page 8 and complete questions in the section.
Submit the necessary information and proceed
to page 8 for Oath of Applicant signature.
To add another Related Facility to an existing
Resort or Campus Liquor Complex, go to
page 8 and complete questions in the section.
DR 8442 (12/11/24) Page 1 of 8
RECEIVED
DR 8442 (12/11/24)
COLORADO DEPARTMENT OF REVENUE
Liquor Enforcement Division
PO BOX 17087
Denver CO 80217-0087
(303)205-2300
JUN 0 2 2025
Permit Application and Report of Changes WELD UNT
C0MMISSIC00NERYS
All Answers Must Be Printed in Black Ink or Typewritten
Applicant is a 0 Corporation O Individual 0 Partnership 0 Limited Liability Company
License Number
04-01356
Name of Licensee
7 -ELEVEN, INC.
Trade Name of Establishment (DBA)
I7 -ELEVEN STORE 39510H
Address of Premises (specify exact location of premises)
13914 State Highway 119
City
ILONGMONT
Business Email Address
I (WELD
County
ELECTRONICRENEWALS@7-11.COM
State ZIP Code
k�
80504
Business Phone Number
1303-774-7668
Select the Appropriate Section Below and Reference the Instructions on Page 1.
Section A — Manager
❑ Manager's Registration (Hotel & Restaurant) $30.00
❑ Manager's Registration (Tavern) $30.00
❑ Manager's Registration (Lodging Facility) $30.00
❑ Manager's Registration (Entertainment Facility) $30.00
❑X Change of Manager (Other Licenses pursuant to section 44-3-301(8), C.R.S.) No Fee
Please note that Manager's Registration for Hotel & Restaurant, Lodging Facility, Entertainment
Facility, and Tavern licenses requires a local fee with submission to the local licensing authority as
well. Please reach out to local licensing authorities directly regarding local processing and fees.
Section B — Duplicate License
❑ Duplicate License $50.00
Page 2 of 8
Section C
❑ Retail Warehouse Storage Permit (each) $100.00
❑ Wholesale Branch House Permit (each) $100.00
❑ Change Corporation or Trade Name Permit (each) $50.00
❑ Change Location Permit (each) $150.00
❑ Noncontiguous or Primary Manufacturing Location Change $150.00
❑ Change, Alter or Modify Premises $150.00 x
❑ Addition of Optional Premises to
Existing Hotel/Restaurant $100.00 x
❑ Addition of Related Facility to an Existing
Resort or Campus Liquor Complex $160.00 x
I I
Total Fee:
Total Fee:
Total Fee:
❑ Campus Liquor Complex Designation No Fee
❑ Sidewalk Service Area $75.00
Do Not Write in This Space — For Department of Revenue Use Only
Date License Issued License Account Number
Period
The State may convert your check to a one time electronic banking transaction. Your bank account may be debited as early as
the same day received by the State. If converted, your check will not be retumed. If your check is rejected due to insufficient or
uncollected funds, the Department of Revenue may collect the payment amount directly from your bank account electronically.
Total Amount Due $
00
DR 8442 (.11/24)
Page 3 of 8
Storage Permit
Retail Warehouse Storage Permit or a Wholesalers Branch House Permit
❑ Retail Warehouse Permit for:
❑ On —Premises Licensee (Taverns, Restaurants etc.)
❑ Off —Premises Licensee (Liquor stores)
❑ Wholesalers Branch House Permit
Address of Storage Premises
City
County
Attach a deed/lease or rental agreement for the storage premises.
Attach a detailed diagram of the storage premises.
Change Trade Name or Corporate Name
ZIP Code
❑ Change of Trade Name/DBA only
❑ Corporate Name Change (Attach the following supporting documents)
1. Certificate of Amendment filed with the Secretary of State, or
2. Statement of Change filed with the Secretary of State, and
3. Minutes of Corporate meeting, Limited Liability Members meeting, Partnership agreement.
Old Trade Name
New Trade Name
Old Corporate Name
New Corporate Name
DR 8442 (12/11/24)
Page 4 of 8
Change of Location
Note to Retail Licensees: An application to change location has a local application fee of $750
payable to your local licensing authority. You may only change location within the same jurisdiction as
the original license that was issued. Pursuant to 44-3-311(1) C.R.S. Your application must be on file
with the local authority thirty (30) days before a public hearing can be held.
Date filed with Local Authority
Address of current premises.
Address
Date of Hearing
City
County
ZIP Code
Address of proposed New Premises
(Attach copy of the deed or lease that establishes possession of the premises by the licensee)
Address
City
New mailing address if applicable.
Address
County
ZIP Code
City
County
State ZIP Code
Attach detailed diagram of the premises showing where the alcohol beverages will be stored,
served, possessed or consumed. Include kitchen area(s) for hotel and restaurants.
DR 8442 (.11/24)
Page 5 of 8
Noncontiguous or Primary Manufacturing Location Change
Select the option that applies to your situation:
O Make a current Primary Manufacturing Location (Location 1) into a Noncontiguous Location
(Location 2); or
O Make a current Noncontiguous Manufacturing Location (Location 1) into a Primary
Manufacturing Location (Location 2).
Address of Location 1:
Address
City
Address of Location 2:
Address
County
ZIP Code
City
County
I I _
Change of Manager
ZIP Code
Change of Manager or to Register the Manager of a Tavern, Hotel and Restaurant, Lodging Facility
and Entertainment Facility liquor license or licenses pursuant to section 44-3-301(8), C.R.S.
Change of Manager
Former Manager's Name
[JEANNE WOLF
New Manager's Name
RACHAEL SHELINBARGER
Date of Employment
05/01/2022
Has manager ever managed a liquor licensed establishment? O Yes 0 No
Does manager have a financial interest in any other liquor
licensed establishment? 0 Yes Q No
If yes, give name and location of establishment
3914 STATE HWY 119 LONGMONT CO 80504
DR 8442 (.11/24)
Page 6 of 8
Modify Premises or Addition of Optional Premises, Related Facility, or Sidewalk Service Area
Note: Licensees may not modify or add to their licensed premises until approved by state and
local authorities.
(a) Describe change proposed
(b) If the modification is temporary, when will the proposed change:
Start (month/day/year) End (month/day/year)
Note: The total state fee for temporary modification is $300.00
(c) Will the proposed change result in the licensed premises now being located
within 500 feet of any public or private school that meets compulsory
education requirements of Colorado law, or the principal campus of any
college, university or seminary? O Yes 0 No
(If yes, explain in detail and describe any exemptions that apply)
(d) Is the proposed change in compliance with local building and zoning laws? 0 Yes 0 No
(e) If this modification is for an additional Hotel and Restaurant Optional Premises
has the local authority authorized by resolution or ordinance the issuance of
optional premises? 0 Yes 0 No
(f) Attach a diagram of the current licensed premises and a diagram of the proposed changes for the
licensed premises.
(g) Attach any existing lease that is revised due to the modification.
(h) For the addition of a Sidewalk Service Area per Regulation 47-302(A)(4), 1 C.C.R. 203-2,
include documentation received from the local governing body authorizing use of the sidewalk.
Documentation may include but is not limited to a statement of use, permit, easement, or other
legal permissions.
DR 8442 (12/11/24)
Page 7 of 8
Campus Liquor Complex Designation
An institution of higher education or a person who contracts with the institution to provide food services
wish to designate my existing:
Liquor License Type
Liquor License Number
1 I _
to a Campus Liquor Complex Q Yes Q No
Additional Related Facility
To add a Related Facility to an existing Resort or Campus Liquor Complex, include the name of the
Related Facility and include the address and an outlined drawing of the Related Facility Premises.
Address of Related Facility
Address
City
State ZIP Code
Outlined diagram provided Q Yes Q No
Oath of Applicant
I declare under penalty of perjury in the second degree that I have read the foregoing application and all
attachments thereto, and that all information therein is true, correct, and complete to the best of my knowledge.
Print Name
KARLA APARICIO
Electronic signature is not accepted,
hvsical signature is re
uired.
Title
SR. LICENSING COORDINATOR
Date
MM/DD/YY
Report and Approval of Local Licensing Authority (City / County)
The foregoing application has been examined and the premises, business conducted and character of
the applicant is satisfactory, and we do report that such per ... • ranted, will comply with the applicable
provisions of Title 44, Articles 4 and 3, C.R.S., as ame c�'�' �'•�►-, This Application is Approved.
P � . � ,,.It;i�.� Pp PP
Local Licensing Authority (City or County)
Weld County, Colorado
Electronic si•nature is not accepted, •h sical signature
Report of State Licensi • ority
Perry L. Buck,
I 106/02/25
Date filed with Local Authority
I
Date (MM/DD/YY)
(06/25/25 I
The foregoing has been examined and complies with the filing requirements of Title 44, Article 3,
C.R.S., as amended.
Electronic signature is not accepted, physical signature is required. Title
Date (MM/DD/YY)
I I
DR 8442 (12/11/24)
Clerk to the Board's Office
Phone: (970) 400-4225
1150 O Street
P.O. Box 758
Greeley, Colorado 80632
www.weld.gov
June 16, 2025
ATTN DAYNA EPLEY
7 ELEVEN INC
DBA 7 ELEVEN STORE 39510H
PO BOX 139044
DALLAS TX 75313
Re: Application for Renewal of Fermented Malt Beverage and Wine Off -Premises
(County) License — 7 -Eleven, Inc.. dba 7 -Eleven Store 39510H
Dear Licensee:
This is to advise you that the Weld County Board of Commissioners will hear your request
for renewal of a liquor license and to register a manager at the property described as:
3914 State Highway 119, Longmont, Colorado 80504. The meeting is scheduled for
Wednesday, June 25. 2025, at 9:00 a.m., in the Chambers of the Board of County
Commissioners of Weld County, Colorado, Weld County Administration Building, 1150 O
Street, Assembly Room. Greeley, Colorado 80631. While this is a public meeting and you
are welcome to attend, your attendance is not mandatory at this time. The meeting will
be live -streamed at www.weld.gov.
If you have questions or need additional information, please do not hesitate to contact me
at (970) 400-4227 or Iflesner(cr�weld.gov.
Respectfully..
L -
Lid 2 tk,
Leah Flesner
Deputy Clerk to the Board
Enclosures: Receipt
cc: Weld County Attorney's Office
Page 1 of 1
Leah Flesner
From:
Sent:
To:
Cc:
Subject:
Attachments:
Good morning,
Leah Flesner
Monday, June 16, 2025 10:17 AM
electronicrenewals@7-11.com
Chloe White
Notice of Hearing - 7 -Eleven, Inc. dba 7 -Eleven Store 39510H
Notice of Hearing - 7 -Eleven Inc., dba 7 -Eleven Store 39510H.pdf
This is to advise you that the Weld County Board of Commissioners will hear your request for renewal of a liquor
license and to register a manager at the property described as: 3914 State Highway 119, Longmont,
Colorado 80504. The meeting is scheduled for Wednesday, June 25, 2025, at 9:00 a.m. While this is a public
meeting and you are welcome to attend, your attendance is not mandatory at this time. Please see the attached
letter for further information (hard -copies to follow).
Sincere regards,
13M
Leah Flesrwer
Deputy Clerk to the Board
Desk: 970-400-4227
P.O. Box 758, 1150 O St.. Greeley, CO 80632
011000
Join Our Team
IMPORTANT: This electronic transmission and any attached documents or other writings are intended
only for the person or entity to which it is addressed and may contain information that is privileged,
confidential or otherwise protected from disclosure. If you have received this communication in error,
please immediately notify sender by return e-mail and destroy the communication. Any disclosure,
copying, distribution or the taking of any action concerning the contents of this communication or any
attachments by anyone other than the named recipient is strictly prohibited.
Weld County Clerk to the Board's Office
Certificate of Mailing Form
First Name Last Name Company Address 1 City State Postal Email
Code
DAYNA EPLEY 7 ELEVEN PO BOX DALLAS TX 75313 electronicrenewals@7-
INC DBA 7 139044 11.com
ELEVEN
STORE
39510H
I hereby certify that 1 have sent a letter in accordance with the notification requirements of Weld County in the United States
Mail, postage prepaid First Class Mail by letter as addressed on the attached list this 16th day of June, 2025.
Leah Flesner
Deputy Clerk to the Board
Page 1 of 1
Hello