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.+• . , DIPARTMRNT OF RIVINUI �, 0. <br /> RENEWAL APPLICATION FON MALT,IIINSON r oo HOF WOW Ri 11111 IMO �.. . <br /> AD RINITIUON$ UOYON UC*MN 4.�.:.. <br /> NIT APPUVAL OF LOCAL Li'CEM M A A$T$U TT HEST) <br /> moos RP1POACiMRtfT OPPItS1I's ACTIpM <br /> 41 ra t*". -.. APPROVED •f Q <br /> c,tOCAt SULLIVAh VERNICt E <br /> =2 bUAGALCM CRLG STOKE DAIS <br /> ,t wilt aim 1 • )c 712 MAIN ST OKAftROVED am_ _ _ <br /> . "�"' <br /> PIMA* LOUISVILLE C . HE E.47 ` L — . / -7 <br /> 114 VlR,t <br /> ti s ♦1� <br /> n„+vM.COIF V V4.4,014/1 <br /> CHANGE OF MANAGED,TRADE CHANGES AME OR CORPORATE STRUCTURE. {3[ 11jJ[3[] � NPV- <br /> EXCEPT <br /> $ONATVIE L tom- < . ;•.tom <br /> (If THERE 'i CHANGE IN OWNERSHIP DO NOT USE THIS FORM.USE AN ORIGINAL APPLICATION.) <br /> kfitiZOLO. MANAGER3 NAME . MAKE CHECK OR MONEY <br /> SEE INSTRUCTIONS IF APPLICANT IS A CORPORATION,FILL IN REVERSE SIDE. ORDER PAYAEME TO THE <br /> ON THE REVERSE • COIORAOO DEPARTMENT <br /> SIDE. NEW TRADE NAME Of REVENIX. <br /> RENEWAL APPLKATION FOR LiOVOR LICENSES)FOR THE YEAR ENDING MEMOIR 31^7---• -7 TOTAL PER(S) _ • <br /> rue Acmes morem roe MAe4e1Y.MONAA1t0M . <br /> _ AU ttgtiMeCt _ ,- COP+r+' Ctfi.., maw. _Mt AMP,M1t <br /> • <br /> 10-0482G–001 07 041 1018 1 1231°9 1974 S a(i.0.? <br /> TYPE NAME AND DESCRIPTION OF LICENSE FEE <br /> t LIGUCP LIC11SE0 LRI;G SIUKL LII.EhbE – MALT, VIi,CL , A00 <br /> SPIRITLOUS $ 5u.trtl <br /> (The following affidavit to be sipr d and ochnw4ed4Wd by individu.is and each member of partnerships and by corpor.tiAAt)(ff.pp5cati.e is <br /> importer's kern*.Wort dote of busireu residaae. ) <br /> STATE Of COLORADO- - <br /> County of SS <br /> .bring by me first defy swore,if for h awif,deposes sad soli.that S.is the applicant oba+n <br /> nomad.or that he Is of the above mooted c*pOotiaa.That he hot rood his original application cod <br /> that he taws the awaken Ihsnsef•sled shat ail enettors sad Mnagt*wok'set foe%ors true of his own baowl.dge.oat he agrees to conform to ail <br /> riles owl reguluti.ns promulgated by the DEPARTMENT OF REVENUE IN CONNECTION THEREWITH. <br /> SUISCRISED AND SWORN TO WORE ME INCH ALS AND ALL MEMRRS Of PARTNERSHIP OR PEES. OR SECY. <br /> �1 OF C MUSTAION PIE'Rf, s <br /> THIS . - DAY 11.wLC.[ a. <br /> OF r .I. ; 9 - _ ., _ . <br /> •Att4C14 I . N01ARY WMIIC f COe►O*ATOOM I CA MINT (COM'OUArt tiA&? <br /> MY goMMIUIQN LAMES el �// ` `4 coerolure roost _ .. • <br /> is (•etseo.NT Oe$IKetteeY) <br /> 1 REPORT AMD APPROVAL OF LOCAL UCESSIM4 AUTHORITY <br /> IMANU a.CTUety.wttOi11M M.warms Ar+D WliOADS DssilOAUb host SICnOM) <br /> The here hos beam Imendaed and the promises investigated and wide o report that the proposed prewtites will comply with t1w provi- <br /> sions.f CH.;1°1111.ART.E CRS,1963 es sweswded,rslat��'wwgq M this hanso,and we do further stole that the chorocter of MM appiicaut is totidoctary <br /> .ad Shot such Hawse,If growtod,will awe she revwrwltla respire wa Ss of the nwghbar$ood and the desires of the lohabitants. <br /> THEREFORE THIS AFRICAN:*1S HERESY A/PROVED. <br /> DATED AT THIS DAY OF ,A.D. 19 <br /> (NAME OF TOWN,CITY OR COUNTY) <br /> VC, <br /> (*Am*05 CMrueac.N Of MDAIO OF COut+ry Cr AAUSS$OriIS 04 Orrtt Teter OF oak/n.4 AUTMOatft.) <br /> ATTEST, • <br /> . (CLIK at st011At1 ea 0H44 OH1CN KAVWG T+1t Ortici.t tom 0f TK r.ekme ra AtOWCatfll.l <br /> of fhe promise.ore located within a town or city,the*bore appr.va)Avoid Ire crgned by the awyg,and clef&if in a c.srey.thew by the rhos www <br /> of the boord of covroy comwsissrone.t and the clerl to the boord ii,by ordinance or otherwise, hid local 13ceasiwg authority is some other official. <br /> 0,-,. .I •,n•,r•vol skov'.1 1,. .• -e. • • - •'” il. •r.' - <br />