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DR e4mn 101=0)
<br />Name
<br />Type of License
<br />Account Number
<br />?. Is the applicant(including any of the partners if a partnership; members or managers if a limited liability company; or oficem, yes No
<br />stockholders or directors it a corporation)or managers under the age of twenyune years? ❑ 0
<br />B. Has the applicant (including any of the partners if a partnership; members or managers if a limited liability company: or offices,
<br />stockholders or directors it a corporation) or managers over (in Colorado or any other slate):
<br />a. Been denied an alcohol beverage license? ❑ 0
<br />b. Had an alcohol beverage license suspended or revoked? ❑ X❑
<br />c. Hart interest in another entity that had an alcohol beverage licen a suspended or revoked? ❑ 0
<br />R YOU answered yes to 8a, b a c, explain in detail on a separate sheet.
<br />9. Has a liquor license application (same license ciass), that was located within 500 feet of the proposed premises, been denied within the ❑ 0
<br />preceding two years? If yes", explain in detail.
<br />10. Are the premises to be licensed within 500 feet, of any public a private school that meets compulsory education requirements of ❑ 0
<br />Cobredo law, or the principal campus of any college, university or seminary?
<br />or
<br />Waiver by local ordinance? ❑ ❑
<br />Other
<br />11. Is your Liquor Licensed Drugstore (LLDS) or Retail liquor Slane (RLS) within 1500 feet of another retail liquor license for off premises
<br />sales in ajunstliction w a WNiation of greater than (>)10,0000? NOTE: The distance shall be determined bye radius measurement
<br />that begins "a principal tloaway of the LLDS RLS premises forwhicir fire application is being made add ends "a principal dos- ❑ X❑
<br />way of the Licensed LLDSIRLS_
<br />12. Is your Lguaw Licensed Drugstore (LLDS) or Retail liquor Stare (RLS) within 3000 feet of another retail liquor license for off premises
<br />sales in asmadiction with a poWlation of less than (<)10 0000? NOTE: The distance shall be determined bye radius measurement
<br />Thal begins "a principal tloaway of the LLDS RLS premises for whicir the application is being made add ends "a prncpal ❑ X❑
<br />doorway of the Licensed LLDSIRLS_
<br />13 a. For additional Retail Liquor Store any Was your Retail Liquor Store License issued on or before January 1, 2016? ❑ 0
<br />13 b. Are you a Colorado resident? ❑ ❑
<br />14. Has a liquor or beer license ever been ¢sued to the applicant (including any of the partners, if a partnership; members a manager 9 a
<br />Limited Liability Company; or officers, stockholders or directors if a corporation)? If yes, identify the name of the business and list any ❑ X❑
<br />current financial interest in said business including any loans to or from a licensee.
<br />15. Does the applici as listed on line 2 of this application, have legal possession of the premises by ownership, lease or other ❑ ❑
<br />aosrganent? March 1, 2026
<br />❑ Ownership R Lease ❑ Other (Wain in Detail)
<br />a. If Ieasai list name of landlatl add tenant, and dale of expiration, exactly as they appear on the lease:
<br />Landlodtl
<br />Tenant
<br />Expires
<br />824 South Inc
<br />South Street Market LLC
<br />03/01/2026
<br />b. Is a percentage of alcohol sales included as compensation to the hung d? 9 yes, complete question 16_ ❑ 19
<br />c. Attach a diagram that designates the area to be licensed in black bold outline (including dimensions) whicir shows the bars, brewery, walls,
<br />partitions, entrances, exits add what each man shall be utilized for in this business. This diagram should be no larger than 8 12" X 1R
<br />16. Who, besides the owners listed in this application (including persons, f ans, partnerships, corporations, limited liability companies) will loan orgive money,
<br />inventory furniture or equipment to or for use in this business; or who will receive money from this business? Attach a separate sheet if necessary
<br />Last Name
<br />First Name
<br />Damof BiM
<br />FEINor SSN
<br />Interest Pencenfage
<br />Last Name
<br />First Name
<br />Dateof BiM
<br />FEINor SSN
<br />Interest Pencenfage
<br />Attach copies of all notes and security instruments and any written agreement or details of any oral agreement, by which any person (including
<br />partnerships, corporations, limited liability companies, etc) will share in the profit or gross proceeds of this establishment, and any agreement
<br />relating to the business which is contingent or conditional in any, way by volume, profit, sales, giving of strike or konsugation.
<br />17. Optional Premises or Hotel and Restaurant Licenses with Optional Premises:
<br />Has a local ordinance or resolution authorizing optional premises been adopted? ❑ ❑
<br />Number of additional Optional Premise areas requested. (See license fee shad)
<br />18. For the addition of a Sidewalk Service Area per Regulabon 41-302(A)(4), include a diagram of the service area and documentation received from
<br />the Iocal governing body au oonadg use of the sidewalk. Documentation may include but is not limited to a statement of use, permit, easement, a
<br />other legal permission¢.
<br />19. liquor Licensed Drugstore (LLDS) applicants, answer the following_
<br />a. Is there a pharmacy, licensed by the COmedo Board of Pharmacy, located whin the applicant's LLDS premise? ❑ ❑
<br />If "yes" a copy of license must be attached.
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