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WEEltuyislville <br />APPLICATION FOR TEMPORARY LIQUOR LICENSE PERMIT <br />PENDING TRANSFER OF OWNERSHIP APPROVAL <br />FEE: $100.00 <br />Date Received License No. <br />Fee Received Date issued <br />Date Expires <br />NOTICE: ANY PERSON APPLYING FOR A TEMPORARY PERMIT IS CHARGED WfTH THE RESPONSIBILITY OF HAVING <br />KNOWLEDGE OF THE PERTINENT COLORADO STATE STAUTES AND REGULATIONS AS SET FORTH IN THE COLORADO BEER <br />AND LIQUOR CODES, AND RELATED REGULATIONS. C.R.S. TITLE 12, ARTICLES 46 AND 47, AND 1C.C.R. 203-2, <br />Applicant/Transferee Name: l�eS�r_I- <br />Trade Name: 6 a, I G <br />Business. Address-.58 9I I 19 U � c u i, y, ;r &o.') <br />Mailing Address (if different):" 0 . py' (' M r WVt'Vt' [moo La � <br />ti <br />Phone. <br />Transferor/Current Licensee Name: J ?,V G r f Safi -� C, O i l 1_ I-(, <br />Trade Name: SW r aL""fl <br />State Liquor License Number:_�y _. <br />A <br />Type of License: o A w A r:i A Lt yt ,✓T lA/l I fl i✓#/ 1� <br />Note: A temporary liquor license permit may be issued only if a completed application for a transfer of ownership along with all <br />required documentation and associated fees has been submitted to the City Clerk at Louisville City Hall, 749 Main Street, Louisville, <br />CO 80027, <br />A temporary liquor license permit is valid for no more than one hundred twenty (120) days from the date of issuance and is <br />automatically void upon denial of the transfer application or upon approval of the transfer of ownership and issuance of a new <br />permanent liquor license in the name of the above applicant by the Colorado Division of Liquor Enforcement and the Louisville Local <br />Licensing Authority. <br />This permit maybe canceled, revoked, or summarily suspended if the Loral or State Licensing Authority determines there is probable <br />cause to believe that the transferee has violated any provision of the Colorado Liquor/Seer Code or has violated any rule or regulation <br />adopted by the Local or State Licensing Authority or has failed to truthfully disclose those matters required pursuant to the application <br />forms. <br />Transferor Sig Lure Transferee Signature <br />Approved by the City of Louisville Local Licensing Authority: <br />