HomeMy WebLinkAbout20232233.tiffBEFORE THE STATE LICENSING AUTHORITY
DEPARTMENT OF REVENUE
STATE OF COLORADO
AFFIDAVIT FOR SURRENDER OF STATE LIQUOR LICENSE
IN THE MATTER OF:
LICENSEE: The Fort 21, Ltd.
TRADE NAME: The Fort 21
ADDRESS: 985 East 18th Street
CITY: Greeley STATE: CO ZIP CODE: 80631
TELEPHONE: (970) 352-9910 EMAIL: deeannwolfe519@gmail.com
LICENSE NO: 06-27829-0000 & 2022-20
I, DeeAnn Cosner , an authorized representative of the above -named
Licensee hereby voluntarily surrender the Colorado state liquor license and all related licensing privileges.
Licensee hereby requests the Liquor Enforcement Division ("Division") of the Colorado Department of Revenue,
on behalf of the State Liquor Licensing Authority, to immediately cancel, terminate, and void Licensee's Colorado
state liquor license.
Licensee states that this surrender of Licensee's Colorado state liquor license and licensing privileges is made
voluntarily by the Licensee, and that Licensee is not surrendering the aforesaid liquor license(s) and privileges as
the result of any threat, promise, or coercion by the Division or any of its agents or employees.
Licensee further acknowledges:
• This surrender does not violate any requirements of a Forcible Entry and Detainer (FED) order, or Writ of
Restitution requiring the licensee to dispossess the licensed premises.
• That an application to transfer this liquor license has not been filed with the local licensing authority.
• This is not an attempt to avoid prosecution of a violation of the Colorado Liquor Code and that the Division
may refuse to accept this affidavit of surrender until after any pending administrative action is complete.
• The Licensee's privileges will be canceled, terminated, and voided upon the issuance of an order by the
Director of the Division accepting this voluntary surrender of licenses.
I affirm under penalty of perjury, I am authorized to surrender this license on behalf of the aforementioned
Licensee.
Name
Title d\l`r(03,--r5
Signature act.
Date rl
Is this Affidavit for Surrender part of a Change of Class or New Issue License? 0 Yes 0 No
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2023-2233
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THIS LICWt EXPIRES AUGUST 8 2023
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License Num' 4 2022-20
STATE OF COLORADO
License Fee $175.00
COUNTY OF WELD
E
RE IQUOR LICENSE
BY AU'T'HORITY OF THE BOARD OF COUNTY CON RiISSIONERS
FOR A TAVERN (COUNTY) LIQUOR LICENSE
TO SELL MALT, VINOUS, AND SPIRITUOUS LIQUORS
This is to Certify, that The Fort 21, Ltd., dba The Fort 21, of the State of Colorado, having applied for a License to sell malt,
vinous, and spirituous liquors, and having paid to the County Treasurer the sum of One Hundred and Seventy -Five [00/100]
($175.00) Dollars; therefore, the above applicant is hereby licensed to sell malt, vinous, and spirituous liquors containing more
t Ilan 3.2% Alcohol by weight, by the drink for consumption on the premises only, as a Tavern (County), at the address of
985 East 18th Street, Greeley, Colorado 80631, in the County of Weld, State of Colorado, for a period beginning on the 9th
chi` f August, 2022, and ending on the 8th day of August, 2023, unless this License is revoked sooner as provided by law.
This license is issued subject to the Laws of the State of Colorado and especially under the provisions of Article 3 of Tide 44,
Colorado Revised Statues, as amended.
IN TESTIMONY WHEREOF, the Board of County Commissioners has hereunto subscribed its name by its officers duly
authorized this 26th day of September, 2022, nunc pro tunc August 9, 2022.
• 1'1"TEST: dreitAgaj .XdeAfIfe
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BY
The Board of County Commissioners.
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TO BE POSTED IN A CONS
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It
CE. NON -TRANSFERABLE.
THIS LICENSE MUST BE POSTED IN PUBLIC VIEW
DR 8402 (07/01/2012)
STATE OF COLORADO
DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1707 Cole Blvd, Suite 300
Lakewood, CO 80401
FORT 21 LTD THE
dba FORT 21 THE
985 EAST 18TH STREET
Greeley CO 80631
ALCOHOL BEVERAGE LICENSE
Liquor License Number
06-27829-0000
License Expires at Midnight
August 08, 2023
License Type
TAVERN (COUN'.
Authorized Beverages
MALT, VINOUS AND SPIRITUOUS LIQUOR
This license is issued subject to the laws of the State of Colorado and especially under the
provisions of Title 44, Articles 4, 3, 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. Any questions concerning this license should be addressed to:
Colorado Liquor Enforcement Division, 1707 Cole Blvd, Suite 300 Lakewood, CO 80401.
In testimony whereof, I have hereunto set my hand. 10/21/2022 JM
/71,66/Ld& Ank
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Michelle Stone-Principato, Division Director Mark Ferrandino, Executive Director/CEO
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