Colorado Fermented Malt Beverage (3.2 Beer) License Application {DR 8403}

DR 8403 (06/28/16) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division (303) 205-2300 Colorado Fermented Malt Beverage (3.2% Beer) License Application New License New-Concurrent Transfer of Ownership · All answers must be printed in black ink or typewritten · Applicant must check the appropriate box(es) · Local license fee $ __________________________ · Applicant should obtain a copy of the Colorado Liquor and Beer Code: www.colorado.gov/enforcement/liquor 1. Applicant is applying as a/an Corporation Individual Partnership (includes Limited Liability and Husband and Wife Partnerships) Limited Liability Company Association or Other FEIN Business Telephone 2. Applicant(s) If an LLC, name of LLC; if partnership, at least 2 partners' names; if corporation, name of corporation 2a. Trade Name of Establishment (DBA) 3. Address of Premises (specify exact location of premises) City 4. Mailing Address (Number and Street) 5. Email Address 6. If the premises currently has 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 Section A Nonrefundable Application Fees Section B County City or Town State State State Sales Tax No. ZIP Code ZIP Code Present Expiration Date 3.2% Beer License Fees Application Fee for New License Application Fee for New License - w/Concurrent Review Application Fee for Transfer $920.00 $1020.00 $920.00 Retail 3.2% Beer On-Premises (City) Retail 3.2% Beer On-Premises (County) Retail 3.2% Beer Off-Premises (City) Retail 3.2% Beer Off-Premises (County) Retail 3.2% Beer On/Off Premises (City) Retail 3.2% Beer On/Off Premises (County) $96.25 $117.50 $96.25 $117.50 $96.25 $117.50 Master File Location Fee ............... $25.00 x _________ To _________ Master File Background ............... $250.00 x ________ Total ________ Questions? Visit www.colorado.gov/enforcement/liquor for more information Do Not Write In This Space - For Department Of Revenue Use Only License Account Number Liability Date: License Issued Through: (Expiration Date) Liability Information Total $ American LegalNet, Inc. www.FormsWorkFlow.com 1 Application Documents Checklist and Worksheet Instructions: This check list should be utilized to assist applicants with filing all required documents for licensure. All documents must be properly signed and correspond with the name of the applicant exactly. All documents must be typed or legibly printed. Upon final State approval the license will be mailed to the local licensing authority. Application fees are nonrefundable. Questions? Visit: www.colorado.gov/enforcement/liquor for more information. Items Submitted, Please Check all Appropriate Boxes Completed or Documents Submitted I. Applicant Information A. Applicant/Licensee identified B. State sales tax license number listed or applied for at time of application C. License type or other transaction identified D. Submit originals to local authority E. Additional information may be required by the local licensing authority Diagram of the Premises A. No larger than 8 1/2" X 11" B. Dimensions included (does not have to be to scale). Exterior areas should show control (fences, walls, etc.) C. Separate diagram for each floor (if multiple levels) D. Bold/Outlined licensed premises Proof of Property Possession (One Year Needed) A. Deed in name of the Applicant ONLY (or) (matching question #2) date stamped/filed with County Clerk B. Lease in the name of the Applicant ONLY (matching question #2) C. Lease Assignment in the name of the Applicant (ONLY) with proper consent from the Landlord and acceptance by the Applicant D. Other Agreement if not deed or lease (attach prior lease to show right to assumption) Background Information and Financial Documents A. Individual History Record(s) (Form DR 8404-I) B. Fingerprints taken and submitted to local authority. (State authority for master file applicants.) C. Purchase agreement, stock transfer agreement, and or authorization to transfer license D. List of all notes and loans. Sole Proprietor/Husband and Wife Partnership A. Form DR 4679 B. Copy of State Issued Driver's License or Identification Card for each Applicant Corporate Applicant Information (If Applicable) A. Certificate of Incorporation (and/or) B. Certificate of Good Standing C. Certificate of Authorization if foreign corporation D. List of officers, directors and stockholders of 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 B. Certificate of Good Standing (if formed after 2009) II. III. IV. V. VI. VII. VIII. Limited Liability Company Applicant Information (If Applicable) A. Copy of articles of organization (date stamped by Colorado Secretary of State's Office) B Certificate of Good Standing if organized more than two years C. Copy of operating agreement D. Certificate of Authority (if foreign company) 2 American LegalNet, Inc. www.FormsWorkFlow.com 7. Is the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or officers, stockholders or directors if a corporation) or manager under the age of twenty-one years? 8. Has the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or officers, stockholders or directors if a corporation) or manager ever (in Colorado or any other state): (a) been denied an alcohol beverage license? (b) had an alcohol beverage license suspended or revoked? (c) had interest in another entity that had an alcohol beverage license suspended or revoked? If you answered yes to 8a, b or c, explain in detail on a separate sheet 9. Has a 3.2 beer license for the premises to be licensed been denied within the preceding one year? If "yes," explain in detail. 10. Has a liquor or beer license ever been issued to the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or officers, stockholders or directors if a corporation)? If yes, identify the name of the business and list any current or former financial interest in said business including any loans to or from a licensee. 11. Does the Applicant, as listed on line 2 of this application, have legal possession of the premises by virtue of ownership, lease or other arrangement? Ownership Lease Other (Explain in Detail) _____