Public Transportation - Wholesale - Manufacturer - Importer License Application {DR 8409}

Do not wRite in this space DR 8409 (09/25/09) colorado department of revenue liquoR enfoRcement Division or 1375 sheRman stReet DenveR co 80261 colorado liquor 3.2% fermented malt beverage (0021) public transportation, Wholesale, manufacturer, importer license application license Renewal new license tRansfeR of owneRship · all ansWers must be printed in black ink or typeWritten · applicant must check the appropriate box(es) · applicant should obtain a copy of the colorado liquor and beer code (call 303-370-2165) 1a. applicant is applying as a individual (attach DR 8404-i) limited liability company association or other fein number Business telephone corporation partnership (includes limited liability and husband and wife partnerships) 1b. name of applicant(s) if partnership, list partners' names (at least two); if corporation, name of corporation 2. trade name of establishment (DBa) 3. address of premises (specify exact location of premises) city 4. mailing address (number and street) county city or town state state state sales tax no. Zip code Zip code 5. if the premises currently have a liquor or beer license, you must answer the following questions: present trade name of establishment (DBa) present state license no. present class of license present expiration Date you must make one selection in section a, and you may make only one selection in sections b or d. For additional licenses, you must file a separate application and pay separate fees. liab section a liab section d liquor license fees 2300 2310 application fee for new license.................$1,025.00 application fee for transfer of ownership....1,025.00 section b 2000 2080 2100 2090 2050 2060 1920 2070 1930 1910 public transportation license $75.00 x __________ (# units) total fee ___________ manufacturer's license (brewery) .........................300.00 manufacturer's license (winery)............................300.00 Manufacturer's License (distillery or rectifier)......1,050.00 wholesale liquor license (vinous & spirituous)............................................1,050.00 wholesale Beer license (malt liquor) ...................550.00 importer's license (malt liquor) .............................300.00 importer's license (vinous & spirituous liquor) ......300.00 limited winery license............................................70.00 nonresident manufacturer's license (malt liquor).............................................................300.00 2130 2140 2160 2150 3.2% Beer wholesale license .........................150.00 3.2% Beer manufacturer's license ..................150.00 3.2% Beer importer's license..........................150.00 3.2% nonresident manufacturer license ........150.00 section c 2240 sole source Registration $100.00 X_____ ... total fee_____ product Registration $5.00 X_____ ... total fee_____ 2290 do not Write in this space - for department of revenue use only liability information liability date License Issued Through (Expiration Date) license account number state (999) cash fund new license cash fund Transfer License sole source registration product registration total 2300-100 (999) 2310-100 (999) 2240-100 (999) 2290-100 (999) American LegalNet, Inc. www.FormsWorkFlow.com DR 8409 (09/25/09) page 2 application checklist and Worksheet instructions: This check list should be utilized to assist applicants with filing all documents required for licensure. all documents must be properly signed and correspond with the name of the applicant exactly. copies (other than application) may be accepted if signatures are legible. all documents must be typed or legibly printed in black ink. upon state approval, the license will be mailed to you. items submitted i. documents Please CheCk all aPProPriate Boxes applicant information a. identify applicant/licensee. B. identify license type or other transaction. c. identify state sales tax license number (transportation applicant only). D. submit original application. diagram (Wholesalers, transportation and instate manufacturers) a. 8 1/2" X 11" diagram of property to be licensed. B. address and diagram of premises where liquor is to be stored (transportation and wholesale applicants only). proof of property possession (not required for importers and non resident manufacturers) a. Deed in name of the applicant onlY (or) B. lease in the name of the applicant onlY and valid for at least one (1) year from the date of license issuance, or c. lease assignment in the name of the applicant onlY with proper consent from the landlord and acceptance by the applicant. D. copy of vehicle Registration (transportation applicant only). e. copy of vehicle lease (transportation applicant only). f. other agreement if applicable. background information (dr 8404-i) a. Complete for each principal (stockholder, officer, director, partner, member, etc.). B. Complete fingerprint cards for the same persons mentioned in "A" above. Cards are to be taken to the local police department for fingerprinting. Return the completed cards to this department with a check for $39.50, per card, made payable to COLORADO BUREAU OF INVESTIGATION (Personal checks are not accepted). corporate applicant information (If Applicable) a. copy of articles of of incorporation (date stamped by colorado secretary of state) and/or B. Certificate of Good Standing if incorporated more than two years. C. Certificate of Authorization if foreign corporation (instate applicants only) D. List of officers, directors and stockholders of any paRent corporation (designate one person as "principal officer"). partnership applicant information (If Applicable) a. partnership agreement (general or limited). not needed if husband and wife. limited liability company applicant information (If Applicable) a. copy of articles of organization (date stamped by colorado secretary of state) and/or B. Certificate of Good Standing if organized more than two years c. copy of operating agreement D. Certificate of Authorization if foreign company (instate applicants only) other permits a. copies of all federal Basic permits. B. copy of colorado puc authority (transportation applicants only) product information a. impoRteRs anD nonResiDent manufactuReRs 1. See PROCESSING DOCUMENT FOR ADDITIONAL FEES. 2. sole source of supply/Brand Registration (DR 8440). 3. Copy of Geographic Territory Agreement (beer importers only): a properly executed and binding agreement showing, for each wholesaler, the designated products to be sold and territo