HomeMy WebLinkAbout20141567.tiffRESOLUTION
RE: APPROVE PERMIT APPLICATION AND REPORT OF CHANGES FOR A CHANGE OF
MANAGER AND AUTHORIZE CHAIR TO SIGN - SMOKEHOUSE ENTERPRISES,
LLC, DBA OLD HICKORY SMOKEHOUSE AND TAVERN
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 an Application and Report of Changes
from Smokehouse Enterprises, LLC, dba Old Hickory Smokehouse and Tavern, for a Change of
Manager, in connection with its Hotel and Restaurant Liquor License, for the sale of malt, vinous
and spirituous liquors for consumption by the drink on the premises only, located at 3815 State
Highway 119, Longmont, Colorado 80504, and
WHEREAS, after review, the Board deems it advisable to approve said application.
NOW, THEREFORE, BE IT RESOLVED by the Board of County Commissioners of Weld
County, Colorado, that the Application and Report of Changes from Smokehouse Enterprises,
LLC, dba Old Hickory Smokehouse and Tavern, for a Change of Manager, in connection with its
Hotel and Restaurant Liquor License, for the sale of malt, vinous and spirituous liquors for
consumption by the drink on the premises only, and hereby is, approved.
BE IT FURTHER RESOLVED by the Board that the Chair be, and hereby is, authorized to
sign said application.
The above and foregoing Resolution was, on motion duly made and seconded, adopted
by the following vote on the 28th day of May, A.D., 2014.
ATTESTW4thoti (' efes; L
Weld County Clerk to the Board �•C�
ou y orney
Date of signature: to -q-/4
BOARD OF COUNTY COMMISSIONERS
WELD COUNTY, COLORADO
coy.
Doug, =s RademgcIj4r, Chair
cc:50660 A-pet-
'2115hq
2014-1567
LC0014
DR 8442 (O9/24/09) Page I
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT OMSION
DENVER. COLORADO 80261
(303)-205-2300
PERMIT APPLICATION
AND REPORT OF CHANGES
FOR DEPARTMENT USE ONLY
CURRENT LICENSE NUMBER
ALL ANSWERS MUST BE PRINTED
LOCAL LICENSE FEE $ 7t),CX-.)
4014 -2-
TO ORDER CALL (303) 370-2165
IN BLACK INK OR TYPEWRITTEN
APPLICANT SHOULD OBTAIN A COLORADO LIQUOR & BEER CODE BOOK
1 Applicant is a
❑ Corporation .❑ Individual
❑ Partnership E4 Limited Liability Company
47O.2.1 9
2. Name of Licensee
Smokehouse Enterprises, LLC
3. Trade Name
I Ole Hickory Smokehouse and Tavern
4 Location Address
3815 State Highway 119
City
Longmont
SELECT THE APPROPRIATE
- �R-- !plan#Qer re[�]j/chatsYy�
UYv vaSK' fhiY fl
• License Account No. 47v z - i
SECTION BELOW
�i' .... g ..
County
Weld
AND
PROCEED TO THE INSTRUCTIONS
'- �
ZIP
80504
ON PAGE 2.
.- -..,.4--4,4.A.::...
...
. ...
!(
2210-100 (999) ❑ Retail
2200-100 (999) ❑ Wholesale
2260-100 (999) [1 Change
2230-100 (999) 171 Change
Warehouse
Branch
Corp. or
Location
Alter or
x
Storage
House
Trade
Permit
Modify
Total Fee
Premises
Total Fee
Facility
Fee
Permit (ea) $100.00
Permit (ea).... 100.00
Name Permit (ea).50.00
(ea) 150.00
Premises
1983-750 (999) Manager's Registration (Hotel & Restr.)..$75.00
2012-750 (999) Li Manager's Registration (Tavern) $75.00
111 Change of Manager (Other Licenses) NO FEE
2280-100 (999) ■ Change.
$150.00
2220-100 (999) ❑ Addition
$100.00
( 1988-100 (999) ❑ Addition
$75.00
Section B — Duplicate License
of Optional
x
to Existing H/R
• Liquor License No.
of Related
x Total
to Resort Complex
2270-100 (999) C] Duplicate License $50.00
DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY
DATE LICENSE ISSUED
LICENSE ACCOUNT NUMBER
PERIOD
-750 (999) -100 (999)
The State may convert your check to a oho time eledronic banking transadron.
Your bank account may be debited as early as the sarne day received by the
Stale. If converted, your check wilt not be returned. If your check is rejected TOTAL
due to insutfioentoruncoiectedfands.t eeDepartmentofRevenuemayknpect
the payment amount directly from your bank account electronically AMOUNT DUE
$ .00
2014-1567
LL DU/4/
DR 8442 (09/24/09) Page 3
5. Retail Warehouse Storage Permit or a Wholesalers Branch House Permit
II Retail Warehouse Permit for:
Li On —Premises Licensee (Taverns, Restaurants etc.)
E] Off —Premises Licensee (Liquor stores)
Li Wholesalers Branch House Permit
Address of storage premise:
City , County , Zip
Attach a deed/ lease or rental agreement for the storage premises.
Attach a detailed diagram of the storage premises.
6. Change of Trade Name or Corporation Name
Ill 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
Old Corporate Name
New Trade Name
New Corporate Name
7. 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 12-47-
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 Date of Hearing
(a) Address of current premises
City County Zip
(b) Address of proposed New Premises (Attach copy of the deed or lease that establishes possession of the
premises by the licensee)
Address
City County Zip
(c) New mailing address if applicable.
Address
City County State Zip
(d) 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.
OR 8442 (09/24/09) Page 4
8. Change of Manager or to Register the Manager of a Tavern or a Hotel and Restaurant liquor license.
(a) Change of Manager (attach Individual History DR 8404-I H/R and Tavern only)
Former manager's name
New manager's name Larry Thomas Moon
(b) Date of Employment September 01.2013
Has manager ever managed a liquor licensed establishment? Yes ❑ No l '
Does manager have a financial interest in any other liquor licensed establishment? Yes ❑ No i
If yes, give name and location of establishment
9. Modification of Premises, Addition of an Optional Premises, or Addition of Related Facility
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 (mo/day/year) End (mo/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?
(If yes, explain in detail and describe any exemptions that apply) Yes ❑ No 0
(d) 1s the proposed change in compliance with local building and zoning laws? Yes O No ❑
(e) If this modification is for an additional Hotel and Restaurant Optional Premises or Resort Complex Related
Facility, has the local authority authorized by resolution or ordinance the issuance of optional premises?
Yes ❑ 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.
OATH OF, AEPl. T.
in the send degree that I have reed the foregoing application and all attachments
.01 true, correct, CoffipIete-to the bestqmy knowledge.
LICENSING
I ing a Rio # examine d and the premises, buatt ondc d t1 nd oft a ap ant
•�k , and we do ' raped that -such permit, if granted, will comply witt4 the applicable. + ions of T 12, Articles ;.
elm .as amended; THEREFORE, THIS Alf 4 APPRO
Local Licensing Authority (City or County)
Weld County, olo;adc
Signature_ n --( e�4n*�
�ilr �iLc �LQgr,n..r l� C.�
Douglas Rademacher
REPEL Of STATE LICENSING AUTHORITY
��€T aeAcarl#M40nti ;,410°:--
Title Chair, Board of Weld
County Commissioners
0D/y /5‘7
DR 8404-I (07/25/11)
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
1881 PIERCE STREET RM 108A
DENVER CO 80261
INDIVIDUAL HISTORY RECORD
To be completed by the following persons, as applicable: sole proprietors; general partners regardless of percentage ownership,
and limited partners owning 10% or more of the partnership; all principal officers of a corporation, all directors of a corporation,
and any stockholder of a corporation owning 10% or more of the outstanding stock; managing members or officers of a
limited liability company, and members owning 10% or more of the company; and any intended registered manager of
Hotel and Restaurant or Tavern class of retail license.
NOTICE: This individual history record requires information that is necessary for the licensing investigation or inquiry. All questions
must be answered in their entirety or the license application may be delayed or denied. If a question is not applicable, please indicate
so by "N/A". Any deliberate misrepresentation or material omission may jeopardize the license application.
1. Name of Business
Smokehouse Enterprises, LLC, dba Ole Hickory Smokehouse and Tavern
2. Your Full Name (last, first, middle)
Moon, Larry Thomas
3. List any other names you have used.
NA
4. Mailing address (if different from residence)
3815 State Highway 119, Longmont, CO. 80504
5. List current residence address. Include any previous addresses within the last five years (attach separate sheet if necessary).
STREET AND NUMBER
CITY, STATE, ZIP
FROM
TO
Current
12863 Columbine Circle
Thornton, CO. 80421
05-12
04-14
Previous
10429 Durango Place
Longmont, CO. 80504
10-11
05-12
6. List all employment within the last five years. Include any se
f employment. (Attach separate sheet if necessary)
NAME OF EMPLOYER OR BUSINESS
ADDRESS (STREET, NUMBER, CITY, STATE, ZIP)
POSITION HELD
FROM
TO
Ole Hickory Smokehouse & Tavern
3815 State Highway 119,Longmont,CO. 80504
Kitchen Manager
09-13
04-14
T -Bones Restaurant & Lounge
3815 State Highway 119,Longmont,CO. 80504
Kitchen Help
02-11
09-13
Moon Enterprises,LLC
6860 West Floyd Ave,Lakewood,CO. 80227
Owner
02-99
02-11
7. List the name(s) of relatives working in or holding a financial interest in the Colorado alcohol beverage industry.
NAME OF RELATIVE
RELATIONSHIP TO YOU
POSITION HELD
NAME OF LICENSEE
NA
NA
NA
NA
8. Have you ever applied for, held, or had an interest in a Colorado Liquor or Beer License, �or loaned money, furniture, fixtures, equipment or
inventory to any licensee? If yes, answer in detail. CI Yes Ir I No
9. Have you ever received a violation notice, suspension, or revocation for a liquor law violation, or have you applied for or been denied a liquor or beer
license anywhere in the United States? If yes, explain in detail. LJ Yes ❑ No
L
(A)A5 1,<Jr<12t,J6 l) iieviir 1Jb1' rodgmz, 1.44k JU2 rrrE.c r -n 1,75 L g TTL E /tin)
1LT(t. Borrix5
10. 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
or do you have any charges pending? (If yes, explain in detail-)
1 Yes No
DUI
11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a deferred sentence? (if yes, explain in detail.)
6t Yes ❑ No Under probation for DUI conviction
12. Have
❑Yes
you
FA
ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.)
No
PERSONAL AND FINANCIAL INFORMATION
Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential.
The personal information required in question #13 is solely for identification purposes.
13a. Date of Birth
b. Social Security Number SSN
c. Place of Birth
Denver, CO.
d. U.S. Citizen?
Z Yes ❑ No
e. If Naturalized, State where
f. When
g. Name of District Court
h. Naturalization Certificate Number
i. Date of Certification
j. If an Alien, Give Alien's Registration Card Number
k. Permanent Residence Card Number
I. Height
5' 10"
m. Weight
160
n, Hair Color
Grey
o. Eye Color
Brown
p. Sex
Male
q. Race
White
r. Do you
❑ Yes
have
FA
a current Driver's License? If so, give number and state
No
14. Financial Information.
a. Total purchase price $ NA (if buying an existing business) or investment being made by the applying entity, corporation,
partnership, limited liability company, other $ NA
b. List the total amount of your investment in this business induding any notes, loans, cash, services or equipment, operating capital,
stock purchases or fees paid $ NA
c. Provide details of the Investment described in 14.b. You must account for all of the sources of this investment. Attach a separate sheet if needed.
Type: Cash, Services or Equipment
Source
Amount
NA
NA
NA
d. Loan Information (attach copies of all notes or loans)
Name of Lender
Address
Term
Security
Amount
NA
NA
NA
NA
NA
Oath of Applicant
I declare under penalty of perjury that this application and all attachments are true, correct, and complete to the best of my knowledge.
Authorized Si t /
Title
Date/
05/26/2014 17:22 3036824161
KING SOOPERS 105 PAGE 02/04
I am writing on behalf of Larry Moon. Larry and I have worked together for over 3 years at 7 -
Bones Restaurant and Lounge, and now at Ole Hickory Smokehouse. During that time I have
gotten to know Larry on a personal and professional level. Larry is a great manager to work for.
He is fair, understanding, and I would have to say a bit of a workaholic. He makes customers
feel right at home when they come into our establishment, and I have never heard anyone
complain about him. On a personal level, he has always been there for me, my husband, and
my children in any way needed. I know I can count on him for anything.
Lindsay Shaw
307-689-6224
Undsrockstarl@comcast.net
05/26/2014 17:22 3036824161 KING SOOPERS 105
PAGE 03/04
Larry Moon has been an asset to Ole Hickory Smokehouse, and to have him as a registered
manager of the Smokehouse would better serve the establishment, and its employees. I have
worked with Larry for over a year, and he continues to improve our workplace, maintain
leadership, and provides an overall positive experience for all of us that work with him.
With Larry's excellent work ethic and knowledge of managing, he is trusted to complete
inventory and accounting, along with ordering bar and restaurant supplies. I would highly
recommend Larry Moon for a management position, not only as a friend, but as an employee
and co-worker.
Kelsey Coldasure
720-254-8335
kelseycolclasure@gmail.com
05/26/2014 17:22 3036824161
KING SOOPERS 105 PAGE 04/04
To Whom This May Concern:
I have had the pleasure of working with Larry Moon since Sept 2013. My husband and I bought the
former restaurant "T -Bones" and originally kept all the employees. Larry has many years in the business
and was a "God Send". He proved to be the best asset I could have asked for in our new business. He has
assisted us with every aspect of the business- Together we have changed the menu, clientele and
reputation of the former establishment which was a major undertaking. He has spent countless hours of
his own time, effort and energy to help us get where we are today which finally is in the "Black". He has
been our Kitchen manager since the beginning and helped us put our ideas into action. With his
experience and knowledge we have finally seen the light at the end of the tunnel. He is as dedicated to
seeing our plan realized as if he were the owner himself. He has been instrumental in setting up our
kitchen with a brand new menu, training staff, working after hours to get the place in shape. One week
after purchasing the restaurant the Longmont Floods came down upon us, then the road was closed for
two and a half weeks while the bridge/roads were being repaired. He worked endless hours helping us
get back on our feet when we were "disheartened" to say the least. He not only took control of the
kitchen, but helped with repairs and provided us with an endless source of contacts to accomplish our
goals. It was a very stressful time and he did not walk out on us or look for another job, but worked with
us in the trenches until we could open the doors once again. This to me shows his character. My staff
loves him and works hard for him. His management style makes my staff want to please him. This is a
win -win situation. My husband's parents came down with health issues in December and he felt the
need to go back to Tennessee to assist with their care which left me alone to run the new business. If it
had not been for Larry's help and unending support we would have had to close the doors, loose the
investment and our dream. During this time we did consider selling the restaurant, but thanks to his
dedication and commitment we have been able to weather the storm. Presently my husband still
remains in Tennessee with an unknown timeframe of when he will be able to return to Colorado. I,
myself spend most of my time here in Colorado running the business and watching out for our
investment, but I do make trips back and forth. While I am away, I am not worried since I know I am
leaving it in very capable hands. Larry has stepped up to the plate and spent unending hours not only
running the kitchen, but managing the entire operation from personnel scheduling, inventory, placing
orders with vendors, maintenance needs, paying bills, making daily bank deposits —in short everything
needed to keep our doors open —even without any extra compensation. To me that shows his
dedication, professionalism and pride in doing whatever it takes when needed. The liquor board
inspector has requested that due to my travels back and forth that we have our kitchen manager whom
acts as general manager in my absence put on the existing liquor license for Ole Hickory Smokehouse.
Larry Moon has my highest recommendation as the person for the job of General Manger and I would
like to have him added to our Liquor License.
Sincerely,
Susan Williams, Present Owner, Manager Ole Hickory Smokehouse 901-301-8593/303-678-9100
a-rt- 9-Zti
Previous address:
6860 West Floyd Avenue, Lakewood, CO. 80227 12-98 to 10-11
To: Weld County Board of Commissioners
From: Deputy Mark Mellon
Date: April 28, 2014
RE: Smokehouse Enterprises, LLC dba! Ole Hickory Smokehouse and Tavern
Dear Commissioners,
I have researched and found one reported call for service at the Smokehouse Enterprises,
LLC dba/Ole Hickory Smokehouse and Tavern, located at 3815 HWY 119, Longmont CO
80504, for the Calendar year of 2013 to present day.
The reported call for service was a Burglary.
I find no grounds for disapproval for the report of change for the liquor license.
Respectfully Submitted,
Deputy Mark Mellon
Community Resource Officer
Weld County Sheriffs Office
1950 "O" Street
Greeley, CO 80631
WELD COUNTY SH'ERIFF'S OFFICE
Communityllesource Office
LIOL.IOR ENFORCEMENT WORKSHEET
1950`O'Sti•eet
Greeley, Colorado 80631
Voice (970) 356-4015 • Fax (970) 304-6467
Inspection Report
Incident Report
CRit:
License Trade dame:UCensee
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Name: 54"276, /, 2y - 4 '.,^4Y' t
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License / Type.
Dale of Report / Indent:
Address: 36
Person Contacted:
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Telephone #.
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State Liquor License Posted
X
Manager Registered
A
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License in Control of Premises
V
County Liquor License Posted
_
Trade Name Properly Registered
Federal Form 11 ' Cali (800) 398-2822
c
Premises Physical Control Adequate
V
Food Service License Posted
Acceptable Dispensing System
Minor Warning Sign Posted
Oft Premise Storage Licensed
Meals and Snacks Available
}
Only Permitted Items Sold
Cleanhness Adequate
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_
I Alcohol From Permitted Source
7C
Books & Invoices Available
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Discuss Sales of Liquor to Minors
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,
Alcohol Beverage Stock Acceptable
Discs Sales to Intoxicated Persons
X
OVVarning OFoliow-Up Inspection
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Licensee / Representative Signature Date
Violation:
1 Dale:
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Address:
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CERTIFIED MAILTM RECEIPT
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Postage
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Is Complete items 1, 2, and 3. Also complete
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Is Print your name and address on the reverse
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D. Is delivery address different from item 1? O Yes
If YES, enter delivery address below: O No
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C. Date of Delivery
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2. Article Number
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PS Form 3811, February 2004 Domestic Return Receipt
7004 2890 0003 5709 0383
102595-02-M-1540
20140501-11411
UNITED STATES DEPARTMENT OF JUSTICE
FEDERAL BUREAU OF INVESTIGATION
CRIMINAL JUSTICE INFORMATION SERVICES DIVISION
CLARKSBURG, WV 26306
THE ENCLOSED RECORD, DATED 2014/04/19, WITH THE FBI NUMBER 877777WA6 AND
IAFIS CONTROL NUMBER (ICN) IS BEING PROVIDED AS THE
RESULT OF CIVIL RETURN IDENT TEN -PRINT SUBMISSION.
A CRIMINAL HISTORY REQUEST NOTIFICATION(S) WAS SENT BY THE FBI
TO THE FOLLOWING ORGANIZATIONS, EXCEPT FOR THOSE INDICATING THAT THE
REFERENCED SUBJECT IS DECEASED.
COLORADO - STATE ID/
FBI - FBI/877777WA6
SINCE THIS RESPONSE CONTAINS NATIONAL FINGERPRINT FILE (NFF) REGULATED
DATA, THE RESPONSE MAY NOT BE COMPLETE. IF THE RESPONSE IS INCOMPLETE,
PLEASE CONTACT THE CRIMINAL JUSTICE INFORMATION SERVICES DIVISION
OR THE STATE BUREAU(S) TO REQUEST A COMPLETE RECORD.
000620000
WELD COUNTY
SHERIFF'S OFFICE
1950 o ST
GREELEY,CO 80631
Page 1
20140501-11411
UNITED STATES DEPARTMENT OF JUSTICE
FEDERAL BUREAU OF INVESTIGATION
CRIMINAL JUSTICE INFORMATION SERVICES DIVISION
CLARKSBURG, WV 26306
AGENCY CASE C00620000
THE FBI IDENTIFIED YOUR TEN -PRINT SUBMISSION WHICH CONTAINED
THE FOLLOWING DESCRIPTORS:
NAME MOON,LARRY THOMAS
DATE ARRESTED/FINGERPRINTED 2014/04/17
SEX
M
STATE ID
C0714489
RACE
W
CITIZENSHIP
UNITED STATES
OTHER BIRTH
DATES
NONE
ALIAS NAME(S)
NONE
BIRTH DATE
BIRTH PLACE
COLORADO
HEIGHT
510
SCARS -MARKS -TATTOOS
END OF COVER SHEET
NONE
WEIGHT EYES
160 BROWN
SOCIAL
SECURITY
HAIR
GRAY
MISC NUMBERS
NONE
UNITED STATES DEPARTMENT OF JUSTICE
FEDERAL BUREAU OF INVESTIGATION
CRIMINAL JUSTICE INFORMATION SERVICES DIVISION
Page 2
20140501-11411
CLARKSBURG, WV 26306
BECAUSE ADDITIONS OR DELETIONS MAY BE MADE AT ANY TIME, A NEW COPY
SHOULD BE REQUESTED WHEN NEEDED FOR SUBSEQUENT USE.
THIS RECORD IS SUBJECT TO THE
FOLLOWING USE AND DISSEMINATION RESTRICTIONS
UNDER PROVISIONS SET FORTH IN TITLE 28, CODE OF FEDERAL
REGULATIONS (CFR), SECTION 50.12, BOTH GOVERNMENTAL AND NONGOVERNMENTAL
ENTITIES AUTHORIZED TO SUBMIT FINGERPRINTS AND RECEIVE FBI IDENTIFICATION
RECORDS MUST NOTIFY THE INDIVIDUALS FINGERPRINTED THAT THE FINGERPRINTS
WILL BE USED TO CHECK THE CRIMINAL HISTORY RECORDS OF THE FBI.
IDENTIFICATION RECORDS OBTAINED FROM THE FBI MAY BE USED SOLELY FOR
THE PURPOSE REQUESTED AND MAY NOT BE DISSEMINATED OUTSIDE THE RECEIVING
DEPARTMENT, RELATED AGENCY OR OTHER AUTHORIZED ENTITY. IF THE INFORMATION
ON THE RECORD IS USED TO DISQUALIFY AN APPLICANT, THE OFFICIAL MAKING THE
DETERMINATION OF SUITABILITY FOR LICENSING OR EMPLOYMENT SHALL PROVIDE THE
APPLICANT THE OPPORTUNITY TO COMPLETE, OR CHALLENGE THE ACCURACY OF, THE
INFORMATION CONTAINED IN THE FBI IDENTIFICATION RECORD. THE DECIDING
OFFICIAL SHOULD NOT DENY THE LICENSE OR EMPLOYMENT BASED ON THE
INFORMATION IN THE RECORD UNTIL THE APPLICANT HAS BEEN AFFORDED A
REASONABLE TIME TO CORRECT OR COMPLETE THE INFORMATION, OR HAS DECLINED TO
DO SO. AN INDIVIDUAL SHOULD BE PRESUMED NOT GUILTY OF ANY CHARGE/ARREST
FOR WHICH THERE IS NO FINAL DISPOSITION STATED ON THE RECORD OR OTHERWISE
DETERMINED. IF THE APPLICANT WISHES TO CORRECT THE RECORD AS IT APPEARS
IN THE FBI'S CJIS DIVISION RECORDS SYSTEM, THE APPLICANT SHOULD
BE ADVISED THAT THE PROCEDURES TO CHANGE, CORRECT OR UPDATE THE RECORD ARE
SET FORTH IN TITLE 28, CFR, SECTION 16.34.
- FBI IDENTIFICATION RECORD -
WHEN EXPLANATION OF A CHARGE OR DISPOSITION IS NEEDED, COMMUNICATE
DIRECTLY WITH THE AGENCY THAT FURNISHED THE DATA TO THE FBI.
NAME
MOON,LARRY THOMAS
SEX RACE BIRTH DATE
M W
BIRTH PLACE
COLORADO
FBI NO.
877777WA6 2014/04/19
HEIGHT WEIGHT EYES HAIR
510 150 BRO BRO
END OF PART 1 - PART 2 TO FOLLOW
DATE REQUESTED
UNITED STATES DEPARTMENT OF JUSTICE
FEDERAL BUREAU OF INVESTIGATION
CRIMINAL JUSTICE INFORMATION SERVICES DIVISION
CLARKSBURG, WV 26306
Page 3
PART 2
20140501-11411
- FBI IDENTIFICATION RECORD - FBI NO-877777WA6
FINGERPRINT CLASS PATTERN CLASS CITIZENSHIP
PO DI TT 15 11 WU UC AU WU RS LS RS AU LS LS UNITED STATES
15 TT AA 19 12 RS LS LS WU
AU WU
RECORD UPDATED 2014/04/19
ALL ARREST ENTRIES CONTAINED IN THIS FBI RECORD ARE BASED ON
FINGERPRINT COMPARISONS AND PERTAIN TO THE SAME INDIVIDUAL.
THE USE OF THIS RECORD IS REGULATED BY LAW. IT IS PROVIDED FOR OFFICIAL
USE ONLY AND MAY BE USED ONLY FOR THE PURPOSE REQUESTED.
HDR/
*
PUR/I
ATN/E201410900000002004269440842
THIS RESPONSE IS THE RESULT OF YOUR INQUIRY:
COLORADO BUREAU OF INVESTIGATION - IDENTIFICATION UNIT
690 KIPLING STREET,SUITE #3000, DENVER, COLORADO 80215 (303)239-4208
THIS IDENTIFICATION RECORD IS FOR LAWFUL USE ONLY AND SUMMARIZES
INFORMATION SENT TO THE COLORADO BUREAU OF INVESTIGATION FROM
FINGERPRINT CONTRIBUTORS IN THE STATE OF COLORADO.
Page 4
UNLESS FINGERPRINTS ACCOMPANIED YOUR INQUIRY, THE COLORADO BUREAU OF
INVESTIGATION CAN NOT GUARANTEE THIS RECORD RELATES TO THE PERSON IN
WHOM YOU HAVE AN INTEREST.
IF THE DISPOSITION IS NOT SHOWN OR FURTHER EXPLANATION OF AN ARREST
CHARGE OR DISPOSITION IS DESIRED, THAT INFORMATION MAY BE OBTAINED FROM
THE AGENCY WHO FURNISHED THE ARREST INFORMATION.
ONLY THE COURT OF JURISDICTION OR THE RESPECTIVE DISTRICT ATTORNEY'S
OFFICE WHEREIN THE FINAL DISPOSITION OCCURRED CAN PROVIDE AN OFFICIAL
COPY TO ANY SPECIFIC DISPOSITION.
STATE LAW GOVERNS ACCESS TO SEALED RECORDS.
BECAUSE ADDITIONS AND DELETIONS TO A CRIMINAL HISTORY RECORD MAY BE MADE
AT ANY GIVEN TIME, A NEW INQUIRY SHOULD BE REQUESTED WHEN NEEDED FOR
SUBSEQUENT USE.
***************************
NAME(S) USED:
PHYSICAL:
DATE(S) OF BIRTH:
PLACE(S) OF BIRTH:
IDENTIFICATION
MOON, LARRY THOMAS
***************************
SEX: M RACE: W HGT: 510 WGT: 150
EYE: BRO HAIR: BRO SKN:
CO
**************************
ARREST
DATE ARRESTED
AGENCY
ARREST NUMBER
NAME USED
CHARGE
CHARGE LITERAL
TYPE/LEVEL
CHARGE
CHARGE LITERAL
TYPE/LEVEL
ARREST
DATE ARRESTED
AGENCY
ARREST NUMBER
NAME USED
CHARGE
CHARGE LITERAL
TYPE/LEVEL
CHARGE
CHARGE LITERAL
TYPE/LEVEL
CHARGE
CHARGE LITERAL
TYPE/LEVEL
CRIMINAL HISTORY
Cycle 1 of 2
**************************
11/22/1994
NORTHGLENN POLICE DEPARTMENT
94A1897
MOON, LARRY THOMAS
01
DRIVING UNDER THE INFLUENCE
MISDEMEANOR
02
TRAFFIC OFFENSE FAIL TO YIELD RIGHT OF WAY
MISDEMEANOR
cycle 2 of 2
03/28/2013
WESTMINSTER POLICE DEPARTMENT
201372007
MOON,LARRY THOMAS
01
DRIVING UNDER THE INFLUENCE
MISDEMEANOR
02
MOVING TRAFFIC VIOLATION CARELESS DRIVING
MISDEMEANOR
03
MOVING TRAFFIC VIOLATION FAILED TO PROVIDE VALID
PROOF OF IN
MISDEMEANOR
Page 5
** CRIMINAL JUSTICE AGENCIES MAY NOT HAVE PROVIDED ALL ARRESTS, **
** CHARGES OR DISPOSITIONS TO THE CBI. THIS RECORD SHOWS ALL **
** ARRESTS, CHARGES & DISPOSITIONS THAT WERE PROVIDED, UNLESS **
** ACCESS TO THEM HAS BEEN LIMITED BY COURT ORDER. **
*FALSIFYING OR ALTERING THIS RECORD WITH THE INTENT TO MISREPRESENT*
*THE CONTENTS OF THE RECORD IS PROHIBITED BY LAW, AND MAY BE *
*PUNISHABLE AS A FELONY WHEN DONE WITH THE INTENT TO INJURE OR *
*DEFRAUD ANY PERSON. *
---- END OF RECORD
Page 6
ULL AND RETAIN THIS COPY BEFORE AFFIXING TO THE PACKAGE. NO POUCH NEEDED.
Total Declared Value,
0415722399
M
L
L
RECEIVED
DR 9442 (09/24/09) Page 1
COLORADO DEPARTIMENT OF REVENUE
Uo(xa1 ENFORC�..� DMaON
DENVER. COL a92a,
(303)-205-2300
SEP 0 4 2014
WELD COUNTY
COMMISSIONERS
PERMIT APPLICATION
AND REPORT OF CHANGES
FOR DEPARTMENT USE ONLY
ACKNOWLEDGED RECEIVED
JUL 11 2014 JUN 0 4 2014
AC LIQUOR ENE Div
CURRENT LICENSE
ALL ANSWERS
LOCAL LICENSE
APPLICANT SHOULD
NUMBER
MUST BE PRINTED
FEE $ 76O9
___,7-0 14 ^ L
TO ORDER CALL (303) 370-2165
IN BLACK INK OR TYPEWRITTEN
OBTAIN A COLORADO LIQUOR & BEER CODE BOOK
1. Applicant is a
❑ Corporation
O Individual
Limited Liability company
PRESENT LICENSE NUMBER
4 7070a/ 9
U Partnership
2. Name of Licensee
Smokehouse Enterprises, LLC
3. Trade Name
Ole Hidcary Smokehouse and Tavern
4.Location Address
3815 State Highway 119
City
Lid
SELECT THE
Section
• LicenseAccount
999 C�1
1983-750 ( )
2012-750 (999)
APPROPRIATE SECTION BELOW
A — Manager reg/change
No. 4 702 Z ! 9
County
Weld
AND
PROCEED TO THE
2210-100 (999) O Retail
2200-100 (999) O Wholesale
INSTRUCTIONS
Section
Warehouse
Branch
Corp. or
Location
Alter or
ZIP
80504
C
Storage
House
Trade
Permit
Modify
Total Fee
Premises
Total Fee
Facility
Fee
ON PAGE 2.
Permit (ea) $100.00
Pennit (ea).... 100.00
Name Permit (ea).50.00
(ea) 150.00
Premises
(Hotel & Restr.)..$75.00
(Tavern) $75.00
Licenses) NO FEE
Man er s R
ag egisbetiun
O Manager's Registration
(Other
2260-100 (999) ■ Change
2230-100 (999) O Change
■
Change of Manager
2280-100 (999) ■ Change,
$150.00x
2220-100 (999) O Addition
$100.00
Section B — Duplicate License
of Optional
x
to Existing H/R
• Liquor License
2270-100 (999)
No.
of Related
x Total
to Resort Complex
O Duplicate License $50.00
1988-100 (999) ■ Addition
$75.00
DO NOT WRITE IN THIS SPACE — FOR DEPARTMENT OF REVENUE USE ONLY
DATE LICENSE ISSUED
LICENSE ACCOUNT NUMBER
PERIOD
-750 (999)
-100 (999)
The Sale may co net your diecicbacne tine electronic tadagVansaaou.
Your bank aobdml may bedet td as early as thesomeday mice? by the
8e to 'ut^d°ma'u L i'uIa. Kt armenttalRevewenoyr collect TOTAL
paymentamount dredyrmmyaw bmkammtebmaady. AMOUNT DUE
(`.4ar ZLiz%
O (o • 04' 14 U1f--
$ t5.00
2014-1567
Le, 00/4
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