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DR 8442(09/24/09)Page 1 FOR DEPARTMENT USE ONLY <br /> COLORADO DEPARTMENT OF REVENUE <br /> LIQUOR ENFORCEMENT DMSION <br /> DENVER,COLORADO 80261 <br /> (303)-2052300 <br /> PERMIT APPLICATION <br /> AND REPORT OF CHANGES <br /> CURRENT UCENSE NUMBER 42-82971-0000 <br /> ALL ANSWERS MUST BE PRINTED IN BLACK INK OR TYPEWRITTEN <br /> LOCAL UCENSE FEE $ <br /> APPUCANT SHOULD OBTAIN A COLORADO LIQUOR&BEER CODE BOOK TO ORDER CALL(303)370-2165 <br /> 1.p.pplicant isa <br /> ❑ Corporation ❑ Individual <br /> ❑ Partnership I+�Umited Liability Company 42-82971-0000 <br /> 2.Name of Licensee 3.Trade Name <br /> RICHARD N.HAND, LLC RALPHIE'S SPORTS TAVERN <br /> 4.Location Address <br /> 585 S.SOUTH BOULDER ROAD <br /> City County ZIP <br /> LOUISVILLE BOULDER 80227-1329 <br /> SELECT THE APPROPRIATE SECTION BELOW AND PROCEED TO THE INSTRUCTIONS ON PAGE 2. <br /> 7.1 7 1 1:7 1.1 1 Section C <br /> 2210-100(999) ❑ Retail Warehouse Storage Permit(ea) $100.00 <br /> •License Account No. <br /> 2200.100(999) ❑ Wholesale Branch House Permit(ea)....100.00 <br /> 1983-760(999) ❑ Manager's Registration(Hotel&Restr.)..$75.00 <br /> 2260-100(999) ❑ Change Corp.or Trade Name Permit(ea).50.00 <br /> 2012-760(999) ❑ Managers Registration(Tavern) $75.00 <br /> ❑ Change of Manager(Other Licenses)NO FEE 2230-100(999) ❑ Change Location Permit(ea) 150.00 <br /> 2280-100(999) ['Change,Alter or Modify Premises <br /> -T F '7 --- T _ $150.00 x 2 Total Fee 300.00 <br /> Section B' Duplicate License "�1 <br /> 2220-100(999) ❑ Addition of Optional Premises to Existing H/R <br /> • Liquor License No. $100.00 x Total Fee <br /> 2270-100(999) 0 Duplicate License $50.00 1988-100(999) ❑ Addition of Related Facility to Resort Complex <br /> $75.00 x Total Fee <br /> DO NOT WRITE IN THIS SPACE— FOR DEPARTMENT OF REVENUE USE ONLY <br /> DATE LICENSE ISSUED LICENSE ACCOUNT NUMBER PERIOD <br /> The Slate may convert your check toa one the electronic bafdngaansatlrort <br /> Your bank account may be debited as early as the sane day received by the <br /> State.If converted,your check wil not be Mimed.If your check is rejected TOTAL <br /> -750(999) -100(999) yd,1eePayn atloarnridir ytomm'ydourbrdkoea eieRdm` kalyy AMOUNT DUE $ .00 <br />