HomeMy WebLinkAbout20151388.tiffRESOLUTION
RE: APPROVE SPECIAL EVENTS PERMIT AND AUTHORIZE CHAIR TO SIGN -
UKRAINE ORPHAN OUTREACH
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, Ukraine Orphan Outreach presented to the Board of County Commissioners
of Weld County, Colorado, an application for a Special Events Permit for the sale of malt, vinous
and spirituous liquors for consumption by the drink on the premises only, and 3.2% fermented
malt beverages for consumption by the drink on the premises only, and
WHEREAS, said applicant has paid the sum of ONE HUNDRED DOLLARS ($100.00) to
Weld County, Colorado, pursuant to the laws providing therefore in payment for a County Retail
Permit for the sale of malt, vinous and spirituous liquors for consumption by the drink on the
premises only, for an event scheduled for one day only on May 30, 2015, at 5:00 p.m., until
9:00 p.m., outside the corporate limits of any town or city in the County of Weld at the location
described as follows:
18519 County Road 5, Berthoud, Colorado, 80513,
being more fully described as Lot B of Recorded
Exemption, RE -2682, being part of the NE1/4 of
Section 32, Township 4 North, Range 68 West of the
6th P.M., Weld County, Colorado
WHEREAS, said applicant has also paid the sum of TWENTY-FIVE DOLLARS ($25.00)
to the Colorado Department of Revenue and has exhibited a State Special Events Permit for the
sale of malt, vinous and spirituous liquors for consumption by the drink on the premises only.
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 Special Events Permit Number 2015-10 to said applicant to sell malt,
vinous and spirituous liquors for consumption by the drink on the premises only, only at retail at
said location; and the Board does hereby authorize and direct the issuance of said permit by the
Chair of the Board of County Commissioners, attested to by the Clerk to the Board of Weld
County, Colorado, which permit shall be effective from 5:00 p.m., until 9:00 p.m., on May 30,
2015, providing that said place where the permitee is authorized to sell malt, vinous and spirituous
liquors for consumption by the drink on the premises only, 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 permit.
CC, 5/a''
2015-1388
LC0022
SPECIAL EVENTS PERMIT - UKRAINE ORPHAN OUTREACH
PAGE 2
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said application and license.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 18th day of May, A.D., 2015.
ATTEST.W Gc j ;64,
Weld County Clerk to the Board
54,o
Date of signature:
BOARD OF COUNTY COMMISSIONERS
W
LD COUNTY, COLORADO
ar
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�bara Kirkmeyer, Chair
raCkeldu.
Mike Freeman, Pro -Tern
Cozad
Ly&-< rnie2W%-vt.re
Steve Moreno
2015-1388
LC0022
DR 8428 (08/01/2012)
COLORADO DEPARTMENT OF REVENUE
1881 PIERCE STREET, SUITE 108
LAKEWOOD, CO 80214
STATE OF COLORADO
DEPARTMENT OF REVENUE
VALID ONLY FOR THE ORGANIZATION AT THIS LOCATION
UKRAINE ORPHAN OUTREACHKELLY SCHWALBERT
18519 WCR 5
BERTHOUD CO 80513
Permit Number: 4801379
Event Manager: KELLY SCHWALBERT
SPECIAL EVENTS PERMIT
MALT, VINOUS AND SPIRITOUS LIQUOR
VALID ONLY FOR THE FOLLOWING PERIODS
EVENT 1:
05/30/2015 5 PM -9 PM
EVENT 2:
EVENT 3:
EVENT 4:
EVENT 5:
This permit is issued subject to the laws of the State of Colorado and especially under the provisions of
Title 12, Articles 46 or 47, CRS 1973, as amended. This permit is nontransferable and shall be
conspicuously posted in the place above described. This permit is only valid during the event date(s)
shown above.
In testimony whereof, I have hereunto set my hand. 5/26/2015 SJC
Division Director Executive Director
THIS LICENSE EXPIRES MAY 30, 2015 AT 9:01 P.M.
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COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1375 SHERMAN STREET
DENVER CO 80261
(303)205.2300
IN ORDER TO QUA_IFY FOR A SPECIAL EVENTS PERMIT, YOU MUST BE NONPROFIT
AND NE OF THE FOLLOWING (See back for details.)
kaK SOCIAL ` j ATHLETIC PHILANTHROPIC INSTITUTION
ri FRATERNAL CHARTERED BRANCH. LODGE OR CHAPTER 7 POLIf ICAL CANDIDATE
U PATRIOTIC 1__, OF A NATIONAL ORGANIZATION OR SOCIETY MUNICIPALITY OWNING ARTS
1...! POLITICAL ❑ RELIGIOUS INSTITUTION FACILITIES
LIAB TYPE OF SPECIAL EVENT APPLICANT IS APPLYING FOR:
2110K MALT, VINOUS AND SPIRITUOUS LIQUOR $25.00 PER DAY
217C❑ FERMENTED MALT BEVERAGE (3.2 Beer) $10 00 PER DAY
DO NOT WRITE IN THIS SPACE
LIQUOR PERMIT NUMBER
1. NAME OF APPLICANT ORGANIZATION OR POLITI L CANDIDATE
(okra A' r -e. O h ay, i.L readh
State Sales Tax Number (Required)
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2. MAILING ADDRESS OF ORGANIZATION OR POLITICAL CANDIDATE • 3. ADDRESS OF PLACE TO HAVE SPECIAL EVENT
(include street. city/town and ZIP) (include street city/town and ZIP)
{ g is �i;:�. I 5 1 '-s5ig Loc.
%crfy'c 'L --r CO''' -5't3 —6e_ rtli6v0 (. Cf13
NAME I DATE OF BIRTH HOME ADDRESS (Street. City, State. ZIP) PHONE NUMBER
4. PRES.'SEC'Y OF ORG. or POLITICAL CANDIDATE
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6. HAS AP (CANT ORGANIZATION OR POLITICAL CANDIDATE BEEN 7. IS PREMISES NOW LICENSED UNDER STATE LIQUOR OR BEER CODE?
ISSUED A SPECIAL. EVENT PERMIT THIS CALENDAR YEAR?
NO : : YES HOW MANY DAYS? O YES TO WHOM?
8. DOES THE APPLICANT HAVE POSSESSION OR WRITTEN PERMISSION FOR THE USE OF THE PREMISES TO BE LICENSED Yes • No
LIST BELOW THE EXACT DATE(S) FOR WHICH APPLICATION IS BEING MADE FOR PERMIT
Date O5j 0513(1 1)5
Hours From 5:Ct 19.m.
To eViVQ m.
Date Date Date 1 Date
Hours From .m. Hours From .m. Hours From .m. I Hours From m.
To m. To .m. To m. : To m.
t
I declare under penalty of
that all info oration therein
perjury
is true,
OATH OF APPLICANT
in the second degree that I have read the foregoing application and all attachments thereto, and
correct, and complete to the best of my knowledge.
SIGNATUR
iTITLF 1DATE
1
REPORT AND APPROVAL OF LOCAL LICENSING AUTHORITY (CITY OR COUNTY)
Th foregoing application has been examined and the premises, business conducted and character of the applicant is satisfactory,
and we do report that such permit, if granted, will comply with the provisions of Title 12, Article 48, C.R.S., as amended.
THEREFORE, THIS APPLICATION IS APPROVED.
LOCAL L ICENSING AUTHORITY (CITY
Weld County
SIGNATUR f !:'
4, :iiL i i./r�k`
OR COUNTY)
E=. CITY ° TELEPHONE NUMBER
!X COUNTY 970-336-7204
etTHir, Board of Weld
(Commissioners
OF CITY/COUNTY CLERK
-(......,
County DATE
` MAY 1 8 2015
DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY
LIABILITY INFORMATION
License Account Number
Liability Date
State
TOTAL
-750 (999)
APPLICATION FOR A SPECIAL
EVENTS PERMIT
Department Use Only
(instructions on Reverse Size)
2015-1388
SPECIAL EVENT PERMIT QUESTIONNAIRE AND AFFIDAVIT
1. What type of an event is planned (e.g., annual, quarterly, benefit, etc.)?
a/'1lefe P-l� 1 f
2. Explain in detail the nature of your organization, its function, and who or what benefits from
its operations (attach separate sheet if necessary).
f�C,^� fora tmt
3. Who or what organization will be the recipient of funds derived from this event?
01 raiiPe ( grin°_, a/c/
4. How many attendees are expected at this event?
1
5. Describe the premises at which this event will take place. /.--)1/- ( VC.Pi 12)rore..il
etar A I(1 bC�L r ✓L�/ / /
6. What type of security will be provided at this event?
5 fc
7. How many security personnel will be on hand?
8. How will security personnel be identified?
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9. If this event is being held outdoors, how will the exterior boundaries of the premises be
marked (e.g., roped, fenced, etc.)?
Iw( I nsr cte rthr �Yl
10. What type of entertainment will be provided, if any, for this event?
Live band
11. What method will be used in checking identification for proper age of attendees (e.g., at the
door, at the bar, etc.) and how will underage patrons be identified so as not to be served
alcoholic beverages (e.g., stamp or mark on the hand, etc.)
er dev co7 curPa l.r,t,l i c kecL I ru✓urc
M:\CT B\CTB FO RM S\FOS PECIALE V ENT.D OC s peci a (Event
12. How will the conduct and level of intoxication ��� of �p attendees be monitored and by whom?
l� S (1-14T— . Y bar 'P Ld ei . 4,L1-1 01(.0
13. Have volunteers or members of your organization been trained in the sale/service of
alcoholic beverages: If yes, what training have they received and by whom?
14. What types of alternate beverages and food/snacks will be available?
anVLQ).'lt 7 l C -C CI) +
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15. Has a State Sales Tax Number been initiated by you or a member of your organization? If
so, write that number in the space provided.
16. Explain how this event will be marketed describing what kinds of advertising material will be
distributed and the targeted recipients of such material.
oft) -e (t.6n(J✓ L
I hereby certify, under penalty of perjury, that the information provided to the Board of County
Commissioners of Weld County contained in this affidavit is true and accurate to the best of my
knowledge.
STATE OF COLORADO
) ss
COUNTY OF WELD
CI`/ ,ki115
Date
RAFAELA ALICIA MARTINEZ
NOTARY" PUBLIC
STATE OF COLORADO
NOTARY ID 20144002878
MY COMMISSION EXPIRES JANUARY 22.2018
Subscribed and sworn to before me this
Witness my hand and official seal.
N
3D day of I Jti ?
ommission expires
Public
20)5
M:\CTB\CTBFORMS\FOSPECIALEV ENT.D0CspecialEvent
APPLICATION INFORMATION AND CHECKLIST
THE FOLLOWING SUPPORTING DOCUMENTS MUST BE ATTACHED TO THIS APPLICATION FOR A PERMIT TO BE ISSUED:
Appropriate fee.
Diagram of the area to be licensed (not larger that 8 1/2" X 11" reflecting bars, walls, partitions, ingress, egress and dimensions.
Note: If the event is to be held outside, please submit evidence of intended control, i.e., fencing, ropes, barriers, etc.
Copy of deed, lease, or written permission of owner for use of the premises.
Certificate of good corporate standing (NONPROFIT) issued by Secretary of State within last two years; or
If not incorporated, a NONPROFIT charter; or
If a political Candidate, attach copies of reports and statements that were filed with the Secretary of State.
N.
APPLICATION MUST FIRST BE SUBMITTED TO THE LOCAL LICENSING AUTHORITY (CITY OR COUNTY) AT LEAST THIRTY (30) DAYS
PRIOR TO THE EVENT.
THE PREMISES TO BE LICENSED MUST BE POSTED AT LEAST TEN (10) DAYS BEFORE A HEARING CAN BE HELD. (12-48-106 C.R.S.)
AN APPROVED APPLICATION MUST BE RECEIVEDBYTHE LIQUOR ENFORCEMENT DIVISION ATLEASTTEN(10)DA YSPRIORTOTHEEVENT.
CHECK PAYABLE TO THE COLORADO DEPARTMENT OF REVENUE
(12-48-102 C.R.S.)
A Special Event Permit issued under this article may be issued to an organization, whether or not presently licensed under
Articles 46 and 47 of this title, which has been incorporated under the laws of this state for the purpose of a social, fraternal,
patriotic, political or athletic nature, and not for pecuniary gain or which is a regularly chartered branch, lodge or chapter
of a national organization or society organized for such purposes and being non profit in nature, or which is a regularly
established religious or philanthropic institution, and to any political candidate who has filed the necessary reports and
statements with the Secretary of State pursuant to Article 45 of Title 1, C.R.S. A Special Event permit may be issued to
any municipality owning arts facilities at which productions or performances of an artistic or cultural nature are presented
for use at such facilities.
If an event is cancelled, the application fees and the day(s) are forfeited.
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Weld County Health Department
1555 N. 17th Ave
Greeley, CO. 80631
April 30, 2015
RE: Ukraine Orphan Outreach Barn Dance
To Whom It May Concern:
We give permission to Ukraine Orphan Outreach for the use of our residence, land
and barn for their upcoming event.
The details of the event are below:
Ukraine Orphan Outreach Barn Dance
Date: May 30, 2015
Location: 18519 WCR 5 Berthoud, CO. 80513
County: Weld
Time: 5:00 pm - 9:00 pm
Phone: (970) 535-4399
Email: kstoesz@aol.com
Please let us know if you have any questions.
Thank you,
Clarke Stoesz
v9- (s-
Kris Stoesz
OFFICE OF THE SECRETARY OF STATE
OF THE STATE OF COLORADO
CERTIFICATE
I, Wayne W. Williams, as the Secretary of State of the State of Colorado, hereby certify that, according to
the records of this office,
Ukraine Orphan Outreach
is a Nonprofit Corporation formed or registered on 08/17/2007 under the law of Colorado, has complied
with all applicable requirements of this office, and is in good standing with this office. This entity has
been assigned entity identification number 20071378251.
This certificate reflects facts established or disclosed by documents delivered to this office on paper
through 04/28/2015 that have been posted, and by documents delivered to this office electronically
through 04/29/2015 @ 15:31:43.
I have affixed hereto the Great Seal of the State of Colorado and duly generated, executed, authenticated,
issued, delivered and communicated this official certificate at Denver, Colorado on 04/29/2015 @
15:31:43 pursuant to and in accordance with applicable law. This certificate is assigned Confirmation
Number 9173464.
Secretary of State of the State of Colorado
*********************************************End of Certificate********************************************
Notice: A certificate issued electronically from the Colorado Secretary ofStale 's Web site is fully and immediately valid and effective. However.
as an opiton. the issuance and validity of a certificate obtained electronically may be established by visiting the Certificate Confirmation Page of
the Secretary of State's Web site hap. Innr.su' stair QL61 1 I ( nfrcatcS ar litTitrrta do entering the certificate's confirmation number
displayed on the certificate. and following the instructions displayed. Confirming the issuance of a certificate is merely opttonal and is not
necessary to the valid and effective issuance ofa certificate. For more information. visit our Web site. Imp : avet . cosstnr.eo.ns click Business
Center and select "Frequently Asked Questions.-
('ERT (1S O Rest.*ed 08 20 2008
STATE OF COLORADO
DEPARTMENT OF PUBLIC HEALTH AND ENVRIONMENT
LICENSE TO OPERATE A RETAIL FOOD ESTABLISHMENT
ACCOUNT NUMBER
use for all references
LIABILITY INFORMATION
county liability date code
tee
ISSUE
DATE
LICENSE VALID TO
DECEMBER 31
94.2912799-0000
069
I 3/5/2013 1
3274
$255.00
01/09/2015
2015
ORIGINS CATERING COMPANY LLC
ORIGINS CATERING COMPANY
PO BOX 348
BERTHOUD, CO 80513
THIS LICENSE MUST BE POSTED AT THE FOLLING LOCATION:
450 S 8TH STREET
BERTHOUD, CO 80513
This vanities that licensee shown hereon
is authonzed and licensed to engage in
business in accordance with the
provisions of the law and regulations of
the Colorado Department of Public Health
and Envrionment Any alterations made
on this license will automa:ically make it
null and void.
POST IN A
CONSPICUOUS
PLACE
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PO Box 758
PO Box 758
Greeley CO 80632
Greeley CO 80632
RECEIPT
RECEIVED FROM
ADDRESS
FOR
MONEY
ORDER
DATE '�
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RECEIPT DATE i-'O ~i5
RECEIVED FROM UAW...AA D'YF i aCi'MU j 5autakuiAt-
ADDRESS
4 { L ' LW1 (Ltd °61,00 s 100. d
FOR eilkeXI F.QAA
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HOW PAID
CASH
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ORDER
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MEMORANDUM
TO: Rafaela Martinez, Clerk to the Board DATE: 04/30/15
FROM: Janet Lundquist, Public Works
SUBJECT: Special Event Ukraine Orphan Outreach
The Weld County Public Works Department has reviewed this proposal. Our requirements are as follows:
REQUIREMENTS:
1. No parking will be allowed on Weld County Roadways.
2. This area is not in a Special Flood Hazard Area (SFHA) as determined by the Federal Emergency
Management Agency (FEMA).
3. The applicant will need to supply approximately 100 vehicles will require parking on the property.
4. Please submit a Traffic Control Plan (TCP) prepared by a certified Traffic Control Supervisor (TCS).
5. Please submit an Incident Command Plan for the Office of Emergency Management.
Page - I - of I April 30, 2015
CAUsers\ramartinezVAppDataALocarMicrosoft\Windows \Temporary Internet Files V Content .Outlook \BBCGBZMY\Special Event Ukraine Orphan 033015.doe
MEMORANDUM
Rafaela Martinez, Deputy Clerk to the Board May 11, 2015
From: Bethany Pascoe, Zoning Compliance Officer, Dept. of Planning Services
Subject: LC0022
Review of the following Special Events Permit by the Department of Planning Services the following
recommendations were noted:
Applicant:
Ukraine Orphan Outreach
Kelly Schwalbert
3590 Dilley Cir
Johnstown, Co 80534
Property Owner & Location of Event:
Clarke & Kristine Stoesz
18519 CR 5
Berthoud, CO 80513
Dates and Time of Event:
May 30, 2015 from 5:00 PM — 9:00 PM
General Information:
Zone District:
Comments:
Agriculture
• There are no outstanding violations on this site and staff has no issues with issuance of this
Special Events permit.
• Building Permit application (BCR14-01282) has been submitted for the installation of new 100
Amp Service, Lights and Outlets for an existing Pole Barn built in 2014, but has not been
finalized.
SERVICE, TEAMWORK, INTEGRITY, QUALIFY
Rafaela Martinez
From:
Sent:
To:
Subject:
Lisa Carpenter
Monday, May 18, 2015 8:54 AM
Rafaela Martinez
RE: Special Event Application - Ukraine Orphan Outreach
Re: Ukraine Orphan Outreach
Dear Commissioners,
I have researched and no reported calls for service at the Ukraine Orphan outreach ,located at 18519 Wcr 5, Berthoud
CO, 80513 for the calendar year of 2015,
I do not see a certificate of liability for the event in the submitted packet. Once that is received, I find no grounds for
disapproval of this Permit.
Respectfully Submitted,
County Sheriffs Office
1950 "O" Street
Greeley, CO 80631
From: Rafaela Martinez
Sent: Thursday, April 30, 2015 11:41 AM
To: Bob Choate; Dan Joseph; Bethany Pascoe; Frank Piacentino; Lisa Carpenter; Janet Lundquist; Roy Rudisill
Subject: Special Event Application - Ukraine Orphan Outreach
In accordance with the procedure for Temporary Assembly and Special Event checks, please review all records on the
following document for any associated reports/incidents 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 the
Special Events Permit.
PLEASE RESPOND NO LATER THAN: Friday, May 8, 2015
Applicant: Ukraine Orphan Outreach c/o Kelly Schwalbert
File Location: LC0022
Please note that I have requested a copy of the Food License from Origins Catering.
This is a New Applicant to Weld County so I have also left a message with Jackie over at the Town of Lyons for some brief
history on their past events.
Thank you,
Riffaelu .4. Martinez
Deputy Clerk to the Board
1150 O Street'P.O. Box 758'Greeley, CO 80632
tel: (970) 336-7215 X5226
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NOTICE
Pursuant to the liquor laws of the State of Colorado and the Weld County Code, a public
hearing will be held 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, at the time specified. If a court reporter is desired, please advise the Clerk to the
Board, in writing, at least five days prior to the hearing. The cost of engaging a court reporter
shall be borne by the requesting party. In accordance with the Americans with Disabilities Act, if
special accommodations are required in order for you to participate in this hearing, please contact
the Clerk to the Board's Office at (970) 336-7215, Extension 5226, prior to the day of the hearing.
The complete case file may be examined in the office of the Clerk to the Board of County
Commissioners, Weld County Administration Building, 1150 O Street, Greeley, Colorado 80631.
Petitions and comments may be filed in the office of the Clerk to the Board of County
Commissioners. E -Mail messages sent to an individual Commissioner may not be included in
the case file. To ensure inclusion of your E -Mail correspondence into the case file, please
send a copy to ramartinez@co.weld.co.us.
DOCKET #: 2015-64
HEARING DATE: May 18, 2015
HEARING TIME: 9:00 a.m.
APPLICANT:
Ukraine Orphan Outreach
18519 County Road 5
Berthoud, CO 80513
DATE OF APPLICATION: April 30, 2015
REQUEST: To grant a Special Event Permit and authorize the sale of malt, vinous and
spirituous liquors, for consumption by the drink on the premises only, for one day only on May 30,
2015, from 5:00 p.m., until 9:00 p.m., for Ukraine Orphan Outreach Barn Dance and Charity Event
LEGAL DESCRIPTION OF NEIGHBORHOOD SERVED: Lot B of Recorded Exemption,
RE -2682, being part of the NE1/4 of Section 32, Township 4 North, Range 68 West of the 6th
P.M., Weld County, Colorado
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
DATED: May 1, 2015
PUBLISHED: May 6, 2015, in the Greeley Tribune
NOTICE
Pursuant to the liquor laws of the State of Colorado and the Weld
Courtly Code, a public hearing will be held in the Chambers of
the Board of County Commissioners ot Weld County, Colorado,
Weld County Administration Building, 1150 O Street, Assembly
Room, Greeley, Colorado 80631, at the time specified. It a court
reporter is desired. please advise the Clerk to the Board, in writ-
ing, at least five days prior to the hearing. The cost of engaging a
court reporter shall be borne by the requesting party. In accor-
dance with the Americans with Disabilities Act, it special accom-
modations are required in order for you to participate in this
hearing, please contact the Clerk to the Board's Office at (970)
336-7215, Extension 5226, prior to the day of the hearing. The
complete case file may be examined in the office of the Clerk to
the Board of County Commissioners, Weld County Administra-
tion Building, 1150 O Street, Greeley, Colorado 80631. Petitions
and comments may be filed in the office of the Clerk to the Board
of County Commissioners. E -Mail messages sent to an Individu-
al Commissioner may not be included in the case file. To ensure
inclusion of your E -Mail correspondence into the case file, please
send a copy to ramartinez@co.weld.co.us.
DOCKET It: 2015-64
HEARING DATE: May 18, 2015
HEARING TIME: 9:00 a.m.
APPLICANT:
Ukraine Orphan Outreach
18519 County Road 5
Berthoud, CO 80513
DATE OF APPLICATION: April 30, 2015
REQUEST: To grant a Special Event Permit and authorize the
sale of malt, vinous and spirituous liquors, for consumption by
the drink on the premises only, for one day only on May 30,
2015, from 5:00 p.m.. until 9:00 p.m., for Ukraine Orphan Out-
reach Barn Dance and Charity Event
LEGAL DESCRIPTION OF NEIGHBORHOOD SERVED: Lot B
of Recorded Exemption, RE -2682. being part of the NE1/4 of
Section 32, Township 4 North, Range 68 West of the 6th P.M..
Weld County, Colorado
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
DATED: May 1. 2015
The Tribune
May 6, 2015
Affidavit of Publication
STATE OF COLORADO
County of Weld,
I Kiara Garrett
SS.
of said County of Weld, being duly sworn, say
that I am an advertising clerk of
THE GREELEY TRIBUNE,
that the same is a daily newspaper of general
circulation and printed and published in the City of
Greeley, in said county and state; that the notice or
advertisement, of which the annexed is a true copy,
has been published in said daily newspaper for
consecutive (days): 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
Sixth day of May A.D. 2015 and the last
publication thereof: in the issue of said newspaper
bearing the date of the
Sixth day of May A.D. 2015 that said The
Greeley Tribune has been published continuously
and uninterruptedly during the period of at least six
months next prior to the first issue thereof
contained said notice or advertisement above
referred to; that said newspaper has been admitted
to the United States mails as second-class matter
under the provisions of the Act of March 3,1879, or
any amendments thereof; and that said newspaper
is a daily newspaper duly qualified for publishing
legal notices and advertisements within the
meaning of the laws of the State of Colorado.
May 6. 2015
Total Charges: $10.23
f((ULOLK. (L5uxt1 Q
6th day of May 2015
My Commission Expires 6/14/2017
4-4,yze
Notary Public
ROBERT LITTLE
NOTARY PUBLIC
STATE OF COLORADO
NOTARY ID 20014018494
MY COMMISSION EXPIRES JUNE 14, 2017
SURROUNDING PROPERTY OWNERS
2015-63 - Ukraine Orphan Outreach
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FT. MORGAN, CO
80513-8008
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CERTIFICATE OF MAILING
I hereby certify that I have placed a true and correct copy of the surrounding property owners in accordance with the notification
requirements of Weld County in Case Number 2015-63 in the United States Mail, postage prepaid First Class Mail by letter as
addressed on the attached list this 1st day of May, 2015.
Deputy Clerk to the Board
N
C
WELD COUNTY COLORADO LAND RECORDS
AFFIDAVIT OF INTERESTED LAND OWNERS
SURFACE ESTATE
4/30/2015
12:18:17 PM
THE UNDERSIGNED, States that to the best of his or her knowledge the attached list is a true and
accurate list of the names, addresses, and the corresponding Parcel Identification Number assigned
by the Weld County Assessor of the owners of the property (the surface estate) within 500 feet of
the property being considered. This list was compiled utilizing the records of the Weld County
Assessor available on the Weld County Internet Mapping site, http://www.co.weld.co.us, and has
not been modified from the original. The list compiled for the records of the Weld County Assessor
was assembled within thirty days of the applications submission date.
Signature
let —?)0—a015
Property Owners Within 500 ft of Parcel # 106132000076
Date
Account
Parcel
Owner
Mailing Address
R1041002
106132000030
YUSKAANNE
R1041002
106132000030
YUSKA JEFFREY L
18417 COUNTY ROAD 5
BERTHOUD, CO 805138008
R1041102
106132000031
YUSKA ANN E
R1041102
106132000031
YUSKA JEFFREY L
18417 COUNTY ROAD 5
BERTHOUD, CO 805138008
R0335995
106132000072
MARKHAM FAMILY FARMS LLC
1283 COUNTY ROAD 38
BERTHOUD, CO 805138023
R1129196
106132000073
BROMLEY WILLIAM V JR (1/2 INT)
R1129196
106132000073
BROMLEY WILLIAM V JR & JEAN A(1/2 INT)
18581 COUNTY ROAD 5
BERTHOUD, CO 805138008
R1129996
106132000074
BROMLEY JEAN A
R1129996
106132000074
BROMLEY WILLIAM V JR
18581 COUNTY ROAD 5
WELD COUNTY COLORADO LAND RECORDS
AFFIDAVIT OF INTERESTED LAND OWNERS
SURFACE ESTATE
4/30/2015
12:18:17 PM
THE UNDERSIGNED, States that to the best of his or her knowledge the attached list is a true and
accurate list of the names, addresses, and the corresponding Parcel Identification Number assigned
by the Weld County Assessor of the owners of the property (the surface estate) within 500 feet of
the property being considered. This list was compiled utilizing the records of the Weld County
Assessor available on the Weld County Internet Mapping site, http://www.co.weld.co.us, and has
not been modified from the original. The list compiled for the records of the Weld County Assessor
was assembled within thirty days of the applications submission date.
Property Owners Within 500 ft of Parcel # 106132000076
Date
Account
Parcel
Owner
Mailing Address
BERTHOUD, CO 805138008
R0585401
106132000075
SILVA FRANCISCA
R0585401
106132000075
SILVA JESUS
18553 COUNTY ROAD 5
BERTHOUD, CO 805138008
R0585501
106132000076
STOESZ KRISTINE K
R0585501
106132000076
STOESZ CLARKE E
18519 COUNTY ROAD 5
BERTHOUD, CO 805138008
R4702786
106133000001
WELD COUNTY LAND INVESTORS INC
C/O MCFEEDERS REALTY APPR & MGMT
325 W PLATTE AVE
FORT MORGAN, CO 807012338
R4702986
106133000002
WELD COUNTY LAND INVESTORS INC
0/0 MCFEEDERS REALTY APPR & MGMT
325 W PLATTE AVE
FORT MORGAN, CO 807012338
RECEIVED
MAY 012015
WELD COUNTY
COMMISSIONERS
PURSUANT TO THE LIQUOR LAWS
OF COLORADO
U SF'Int
WCO OrNAN 01,17Y,EACH
$EtflOUA, CO 80513
HAS REQUESTED THE LICENSING
OFFICIALS OF VJfla taw/ 1 rmevnno
TO CINJsiDEJZ 51ECIAL [Y(.MS
LICENSE AT: Mow 89 W5
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HEARING ON APPLICATION TO BE AEU) AT:
IC '{9'tASJJR[ GREaLCY,C0 8W'n
TIME AND DATE': Mtn' I$,2i15QF4ODAM
DATE OF APPLICATION:Npni 30 , 20L5 -
BY ORDER OF:WLIeftW11VCOMissia .(s
OFFICERS:
ratnt
Barn Dance
Saturday,
May 30, 2015
5:00 PM
Stoesz Farm
18519 WCR 5
Berthoud, CO
It's a Boot Scootn' Boogie
Ukraine Orphan Outreach
7th Annual Charity Event to Benefit Orphans in Crisis in Ukraine
Bateac
18519 WCR 5
Bert houd, CO 80513
Join us for a night to benefit
orphans in war -torn Ukraine!
The evening will feature a Silent
Auction, Dinner, Live Music by the
'Boom Twang" band and Dancing.
CST YOUR TICKETS AT
hops://everyeventgives.com/event/
uoo-charity-barn-dance
Guest Speaker Panel
yce Hayes. Rose Pauly, Kelly Schwalbert
Boots & Western Wear Required
Adults Only Event
DECLARATIONS
We will provide the
insurance described in
this policy in return for the premium
and compliance with all applicable
provisions of this policy.
06 -CH -7169-4 Policy Number
Named Insured and Mailing Address
STOES3, CLARKE E & KRISTINE K
18519 COUNTY ROAD 5
BERTHOUD, CO 80513-8008
(Coverage afforded by this policy is
I provided by:
1 STATE FARM FIRE AND CASUALTY COMPANY
11555 PROMONTORY CIRCLE
IGREELEY CO 80638-0001
IA Stock Company with Home Offices in
(Bloomington, Illinois.
The Policy Period begins and ends at
12:01 a.m. Standard Time at the residence
premises.
08/14/2014 Effective Date
12months-Policy Period
08/14/2015 Expiration of Policy Period
Limit of Liability - Section 1
$ 300,600 Dwelling (Coverage A)
Policy Type
Homeowners Policy
Dwell Repl Cost - Similar Construction
increase Dwlg Up to $60,120 - Option ID
Location of Premises
18519 COUNTY ROAD 5
BERTHOUD, CO 80513-8008
Automatic Renewal - If the Policy
Period is shown as 12 months, this
policy will be renewed auto-
matically subject to the premiums,
rules and forms in effect each
succeeding policy period. If this
policy is terminated, we will give
you and the Mortgagee/Lienholder
written notice in compliance with
the policy provisions or as
required by law.
Deductibles - Section 1 0.5%/$1503
ALL LOSSES In case of loss under
this policy, the deductible will be
applied per occurrence and will be
deducted from the amount of the
loss. Other deductibles may apply
- refer to your policy.
Policy Premium 51,226.00
Forms, Options, & Endorsements
FP -7955 HOMEOWNERS POL
OPT OL BLD ORD/LAW-10%
OPT ID COV A-INCR DWLG
FE -3425.1 HO -W POL END
FE -8790 CIVIL UNION
LSP B1
FE -5258
LSP Al
FE -2340
LMT RPLC COST -B
JF SPEC LIMIT
SMLR CONST-A
AMENDATORY
Mortgagee
FRANKLIN AMERICAN MORTGAGE CO
ISAOA/ATIMA
CENTRAL LOAN ADMIN & REPORTING
PO BOX 202028
FLORENCE, SC 29502-2028
Loan Number: 0050807676
Agent Name & Address
GARRETT CALLAWAY
MISSION TRACE CENTER
3957 B EAST 120TH AVENUE
THORNTON, CO
80233 (303)452-1572
Prepared: May 21, 2015
559-91600
2180
Agent's Code
MORTGAGEE COPY
PREMIUM NOTICE
STATE FARM INSURANCE COMPANIES
AGENT ISSUED DECLARATIONS
I POLICY NUMBER I BILLING PERIOD AGENT CODE I
106 -CH -7169-4 I FROM 08/14/2014 I TO 08/14/2015 I 2180
LOCATION
18519 COUNTY ROAD 5
BERTHOUD, CO 80513-8008
INSURED
STOESZ, CLARKE E & KRISTINE K
18519 COUNTY ROAD 5
BERTHOUD, CO 80513-8008
MORTGAGEE
FRANKLIN AMERICAN MORTGAGE CO
ISAOA/ATIMA
CENTRAL LOAN ADMIN & REPORTING
PO BOX 202028
FLORENCE, SC 29502-2028
Loan Number: 0050807676
PREMIUM $ 1,226.00
AMOUNT PAID $ 1,183.67
AMOUNT DUE $ 42.33
DATE DUE 05/28/2015
AGENT NAME & ADDRESS
GARRETT CALLAWAY
MISSION TRACE CENTER
3957 B EAST 120TH AVENUE
THORNTON, CO
80233 (303)452-1572
This is the only notice you will receive. Please make check payable
to STATE FARM and return it with this notice to the address shown below.
Your canceled check is your receipt. Thanks for letting us serve you.
STATE FARM INSURANCE COMPANIES
2700 SOUTH SUNLAND DRIVE
TEMPE AZ 85282-3387
Policy Number: 06 -CH -7169-4
STOESZ, CLARKE E & KRISTINE K
18519 COUNTY ROAD 5
BERTHOUD, CO 80513-8008
State FarmT" will provide coverage to the applicant and
his or her legal representative on the property described
for up to 30 business days from the Effective Date,
subject to all terms and conditions of the policy and
endorsements for which application has been made, during
which time State Farm will complete the evaluation of the
application and decide whether to issue the policy. The
30 day period may be extended if necessary to complete
the investigation or repairs, provided both State Farm
and the applicant agree to the extension. If no Effective
Date is indicated, this Binder does not provide any
coverage. This Binder will be void when the Declarations
Page is issued on the policy for which application has
been made or when coverage under this Binder is canceled
in accordance with policy provisions.
State Farm reports claim information to loss history
exchanges. The claim information is used to furnish loss
history reports to insurers. Colorado law requires
insurers to provide information regarding how insureds
may obtain a free copy of their loss history report. If
you are interested in obtaining a report from the loss
history exchanges, you may do so by contacting:
Automated Property Loss Underwriting System
(A -Plus), 1-800-709-8842 or www.iso.com
Comprehensive Loss Underwriting Exchange
(CLUE), 1-866-312-8076 or www.choicetrust.com
T°' is a trademark symbol substitute
1'a► to the
order of
ERIC SCHWALBERT
KELLY SCHWALBERT
3590 UILLEY CIR
JOHNSTOWN, CO 8O534
2503 11th Avenue
Greeley, Colorado 30891
owo.cuolco.org
97036348 or 1'90044.4818
'106
82-7512/3020
Date
ZePrQ ! $
Dollars n
96
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L AND RETAIN THIS COPY BEFORE AFFIXING TO THE PACKAGE. NO POUCH NEEDED.
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AFFIDAVIT OF RECEIPT
State of Colorado
County of Weld
BEFORE ME, a representative of Ukraine Orphan Outreach on this a(A day of, May
20/5 , did receive a a pits Eden+ P111UYU4-(
Representative Signatur
h c (r -
Printed Name of Representative
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Printed Name
Deputy Clerk to the Board
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