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PRL 404-A <br /> Rev 9/73 STATE or COLORADO, DEPARTMENT OF P.E`lI';!JC <br /> LIQUJR Lic!MSE APPLICATION AC'DENDL'M <br /> Date /,- i.5-- 7 : <br /> 1. Corporate Name or>1P A. `;-� <br /> 2. Trade Name ;_/. �liE� ... -- <br /> 4. State Address ��c. 4e4C Q.c t to o sa a or c ange /O- - 1 - — <br /> �. State L quor cens4 ' • .! <br /> 5. List below the officers or directors ut tie corporation: ' to <br /> Name Home Street No. 8 City of Birth <br /> President. . . ► � ; !_ . / __� e e� r t ; -,e0—..1 —#s y <br /> Vice PreS.: <br /> i 116--tGLi4t-- 1a.... ; !1—ill . V P <br /> Treasurer: ; ; <br /> Secretary:.`.. . :.� z�_, __; ev, m , -c .-c.v.,' -see <br /> ►e• -c.v.,' �..•1 - is <br /> Manager: - - <br /> 6. DIRECTORS: List all Directors (at least 3 are r 'e'tired by .a':) Date <br /> Nape Hone Street :4e. A City of Birth <br /> /4,yew•Art- .Li■ d 741 LLIf p.! /2s 14....,1.-IA d el.A <br /> : . ./..r-.4. Az- <br /> ' <br /> �ifi/r vw la/�dsCLL a !1S —. .dam-,-,L s-..44ac/,1. ,1. i9 _? <br /> - ` <br /> `ee AL..r G <br /> Az- .e• v/ <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 if needed. <br /> Percent of Date <br /> Name . Home Street No. & City Stock Owned of Birth <br /> iA•lB______ _ -"'aAii A.m."f../LL! /0"1., ; SO i /J-ar-.13 <br /> _ iris -o(+arY L 411. OLi.gAg :4A4h L.- C ; _r o : —7 -■ 'J- 3.E <br /> ; ; <br /> ; ; <br /> 8. Have any of the above named officers or stockholders ever hcen 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? /t/G If so, explain fully <br /> 9. Do any of the persons listed in peraor:phs 5 and- b above now ohn any stock or <br /> have an interest, financially or otherwise, in any other alcehoiic liquor or <br /> fermented malt beverage license in the State of Colorado? .t/� . 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. /�/.7 <br /> 11. Date of filing last annual corporate report to the Secretary or State. .,--i- 2_ <br /> Sign here: . cf- •-- 1c1 .X--- <br /> Corporate Name) <br /> By: - -- . sue' sa <br /> s uent or cretary <br /> 7 OVID-UY LOCAL LT 4: (3! TS': <br /> Date <br /> By: <br /> Title <br /> APPROVED BY STATE LICCNStnr. AU1?IO4ITY: • <br /> Date _ -,-__ <br /> 1 <br />