Liquor Or 3.2 Beer License Renewal Application {DR 8401}

DR 8401 (02/19/16) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division State-Only Liquor or 3.2 Beer License Renewal Application Instructions 1. Complete entire application and attach detail, if necessary. 2. Submit application 30 days prior to expiration to: Liquor Enforcement Division - 108 PO Box 173350 Denver, CO 80217-3350 3. Submit the appropriate renewal license fee by license type: License Type 3.2% Beer Importer 3.2% Beer Manufacturer 3.2% Beer Wholesale 3.2% Nonresident Manufacturer Importer (malt liquor) Importer (vinous & spirituous) Limited Winery Manufacturer (brewery) Manufacturer (distillery & rectifier) Manufacturer (winery) Nonresident Manufacturer (malt liquor) Public Transportation Wholesale (vinous & spirituous) Wholesale Beer (malt liquor) Wine Delivery Permit Wine Packaging Permit Fee $ 150.00 $ 150.00 $ 150.00 $ 150.00 $ 300.00 $ 300.00 $ 70.00 $ 300.00 $1,050.00 $ 300.00 $ 300.00 $ 75.00 $1,050.00 $ 550.00 $ 50.00 $ 200.00 American LegalNet, Inc. www.FormsWorkFlow.com DR 8401 (02/19/16) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division - 108 PO Box 173350 Denver, CO 80217-3350 Fees Due Renewal Fee Warehouse Branch Permit $100 X ______ Amount Due/Paid $ $ State-Only Liquor or 3.2 Beer License Renewal Application Make check payable to: Colorado Department of Revenue. 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 returned. If your check is rejected due to insufficient or uncollected funds, the Department may collect the payment amount directly from your banking account electronically. Please verify & update all information below Licensee Name Liquor License # Street Address Mailing Address Operating Manager Date of Birth Home Address Email License Type DBA Sales Tax License # Return to address above by due date Expiration Date Due Date Phone Number ( ) Phone Number ( ) 1. Do you have legal possession of the premises at the street address above? Are the premises owned or rented? Owned Rented* Yes No *If rented, expiration date of lease ___________ 2. Since the date of filing of the last application, has there been any change in financial interest (new notes, loans, owners, etc.) or organizational structure (addition or deletion of officers, directors, managing members or general partners)? If yes, explain in detail and attach a listing of all liquor businesses in which these new lenders, owners (other than licensed financial institutions), officers, directors, managing members or general partners are materially interested. Yes No Note to corporation, limited liability company and partnership applicants: If you have added or deleted any officers, directors, managing members, general partners or persons with 10% or more interest in your business, you must complete and return immediately to your Local Licensing Authority, Form DR 8177: Corporation, Limited Liability Company or Partnership Report of Changes, along with all supporting documentation and fees. 3. Since the date of filing of the last application, has the applicant or any of its agents, owners, managers, partners or lenders (other than licensed financial institutions) been convicted of a crime? If yes, attach a detailed explanation. Yes No 4. Since the date of filing of the last application, has the applicant or any of its agents, owners, managers, partners or lenders (other than licensed financial institutions) been denied an alcohol beverage license, had an alcohol beverage license suspended or revoked, or had interest in any entity that had an alcohol beverage license denied, suspended or revoked? If yes, attach a detailed explanation. Yes No 5. Does the applicant or any of its agents, owners, managers, partners or lenders (other than licensed financial institutions) have a direct or indirect interest in any other Colorado liquor license, including loans to or from any licensee or interest in a loan to any licensee? If yes, attach a detailed explanation. Yes No Affirmation & Consent I declare under penalty of perjury in the second degree that this application and all attachments are true, correct and complete to the best of my knowledge. Type or Print Name of Applicant/Authorized Agent of Business Signature Title Date American LegalNet, Inc. www.FormsWorkFlow.com