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•7►r <br /> DPI 404-A <br /> Rev 9/73 STATE OF COLORADO, DEPARTMENT OF REVENUE <br /> LIQUOR LICENSE APPLICATION ADDENDUM <br /> Date October 16_ I973 <br /> 1. Corporate Name Blue Parrot. Inc. <br /> 2. Trade Name @ ue Parrot, Inc_ — <br /> 3. Address 61,0 Main, Lnui soil l e, tranracjel <br /> 4. State Liquor License No. Date of sale or change <br /> 5. list below the officers or directors of the corporation: bate <br /> Name Hose Street No. S City of Birth <br /> Boulder, <br /> President: M,. Richardson ; 7610 Chats Way,. Cell A.; ____ <br /> Vice Pres.: Sp1 it .I.- , _27 e.•l t#f flnr�i r- c�ri <br /> Treasurer: l=>t erti , ; 79S TowdtI Dr_ <br /> F"nail d r, crAt' <br /> - <br /> Secretary: T1 w ri Manager: _+?][ s 79 T tSt_O rI_a_f�wn.,r1t .n <br /> miry_ <br /> 6. DIRECTORS: List all Directors (at least 3 are required by Law) Date <br /> Name Home Street No. & City of Birth. <br /> Hs K. Ri chardson 741e rharhmm rosy. l o <br /> Bryce E. Cjllant 79S Toedtli DF._ Bo der.' CnIQ_B. M. Titchenal 27c0 lliff, Bou der+ Colo_ <br /> 7. List all stockholders owning or controlling 10% or more of the capital stock of <br /> the corporation. (Include actual owner or pledgee.) Use separate sheet it needed. <br /> Percent of Date <br /> Name Home Street No. & City Stock Owned of Birth <br /> --T <br /> United Bank of Boulder P. 0. Baas 299 , ; <br /> as Admi rr)�1 strator C.T.A. Boulder. Co or l9 100 <br /> of the Estete of Mike <br /> Colacci a/k/a Michael Arcengelo Colacci .; deceased ; <br /> 8. Have any of the above named officers or stockholders ever been convicted of any <br /> felony or violation of any liquor law in any Federal or State court of record in <br /> the State of Colorado or any other state? No If so, explain fully <br /> . <br /> 9. 1 • any o t e persons st • n paragrap s a • • a• •ve now own any stoc or <br /> have an interest, financially or otherwise, in any other alcoholic liquor or <br /> fermented malt beverage license in the State of Colorado? No . If so, <br /> explain fully by separate letter. <br /> 10. Does any person, firm or corporation have a financial interest, evidenced by <br /> loans or equity ownership in the business for which this license is requested? • <br /> If the answer is yes. state names and addresses and amount. No <br /> Ii. Date of filing last annual corporate report to the Secretary of State. I/30/73 <br /> Sign here: Ow Parr Qt. Inc. <br /> (Corporate Name„, ) <br /> By: 1 <br /> y •res •ent _'+w;'=='•77". <br /> Date <br /> By: <br /> Title <br /> APPROVED BY STATE LICE4SING AUTNOR:TY: <br /> Date <br /> -- Titre <br />