Local Licensing Authority Agenda and Packet 2021 04 26

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DR e4r4 (01=0) Name Type of License Account Number Oath Of Applicant I declare under penalty of peniury in the second tlegree that this application and all attachments are no, coned, and complete to fire best of my knowledge. I also acknowledge that it is my responsibility and the resters dirty of my agents and (Hmpbyees an comply with the provisions of the Colorado Liquor or Beer Code which affect my license. Aut11o1ized gnature A Printed Name and Tie Date O Cuc2 Cy Barbara Iglesias 4/0612021 Report and Approval of Local Licensing Authority (City/County) Data application filed with localauthonty 77 auPvily hearing 0a new manse applicants; event be restrain 30 days from dale of application) The Loral Licensing Authority HerebyAffions that each person required to fib DR UN-1 (Individual History Record) or a DR $000 (Manager Permit) has been ❑ Fingerprinted! ❑ Subject to background investigation, including NCIC/CCIC check for outstanding warrants That the local authority has conducted, or intends to conduct, an inspemon of the goposed premises to ensure that the applicant is in compliance with and aware of, liquor code provisions affecting their class of license (Check One) ❑ Date of inspection or anticipated sate ❑ Will conduct inspection upon approval of state licensing authority ❑ Is the Liquor Licensed Drugstore (LIDS) or Retail Liquor Sthre (RLS) whin 1,500 feet of another retail liquor license for off- yes No premises sales in a junsdicion win a population of> 10,00009 ❑ ❑ ❑ Is Me Liquor Licensed Drgsfore(LLDS) or Retail Liquor Store (RLS)wfhin 3,0110 feet of another retail liquor license for of- premises sales in a junsdicion win a population of < 10,00009 ❑ ❑ NOTE: The dislsnce shall be determined by a radius measurement that begins at the principal doorway of the LLDSIRLS premises for which the application a being made and ends at the principal doorway of the Licensed LLDSIRLS_ ❑ Dons the LiquorLicensedDrugstore (LLDS) have at least twenty percent (20%) of the applicants gross annual income denved from fire sale of herd, during the prior twelve (12) month period? ❑ ❑ The foregoing application has been examined, and the premises, business to be conducted, and character of the applicant are satisfactory We do repot that such license, if granted, will meet the reasonable requirements of the neghbodrood and fire desires of the adult inhabitants, and will comply with Re provisions of TOe 44, Mcle 4 or 3, C R S., and Lguer Rules_ Therefore, this application is approved. Loral Licensing Authority for Telephone Number El Town, City ❑ courry Signature Print Tie Date Signature Print Tie Date