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DR 8442(09/24/09) Page 3 <br /> 5. Retail Warehouse Storage Permit or a Wholesalers Branch House Permit <br /> l <br /> ❑Retail Warehouse Permit for: <br /> ~ ❑On—Premises Licensee(Taverns, Restaurants etc.) <br /> re ! ❑Off—Premises Licensee (Liquor stores) <br /> W ❑Wholesalers Branch House Permit <br /> • • Address of storage premise: <br /> N City , County , Zip <br /> Attach a deed/lease or rental agreement for the storage premises. <br /> Attach a detailed diagram of the storage premises. - <br /> Y <br /> 6. Change of Trade Name or Corporation Name <br /> O ❑Change of Trade name/DBA only <br /> w w: <br /> n 2 ❑Corporate Name Change(Attach the following supporting documents) <br /> zz 1. Certificate of Amendment filed with the Secretary of State, or <br /> p I- 2. Statement of Change filed with the Secretary of State, and <br /> re c; 3. Minutes of Corporate meeting, Limited Liability Members meeting, Partnership agreement. <br /> l— o; <br /> (.9 E Old Trade Name New Trade Name <br /> QO <br /> Old Corporate Name New Corporate Name <br /> 7.Change of Location <br /> NOTE TO RETAIL LICENSEES:An application to change location has a local application fee of$750 payable to your local licensing <br /> -,! authority.You may only change location within the same Jurisdiction as the original license that was issued.Pursuant to 12-47- <br /> i 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. <br /> Date filed with Local Authority Date of Hearing <br /> �' (a)Address of current premises <br /> •_o:,; City County Zip <br /> ¢. i <br /> 1/4) ; (b)Address of proposed New Premises(Attach copy of the deed or lease that establishes possession of the <br /> premises by the licensee) <br /> ww 41 Address <br /> :t <br /> o <br /> j: a .! City County Zip <br /> (c)New mailing address if applicable. <br /> Address <br /> i.. . i <br /> ! City County State Zip <br /> I. (d)Attach detailed diagram of the premises showing where the alcohol beverages will be stored, served, <br /> possessed or consumed. Include kitchen area(s)for hotel and restaurants. <br /> • <br />