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ads STATE OF COLOR WO '(`/�� <br /> • DEPARTMENT OF RE NUE �IItw►) <br /> RENEWAL APPLICATION FOR MALT,VINOUS Dtf NOT YMIT a IN TNta •r►C <br /> ANO SPIRITUOUS LIQUOR LICENSES <br /> :GET APPROVAL OF LOCAL LICENSING AUTHORITY FIRST) LIQUOR ENFORCE:FEAT OFFICER'S ACTION <br /> . 1 - <br /> �� RaT4; ^•,�. � �0-23y7� APPROVED ex� r--- <br /> ra to «.3 L I.:JCR <br /> •a lira <br /> 31, •a'I I V ST DISAPPROVED <br /> .i moo tr L�.1(SY TILE c� a..)./27 DATE . <br /> Ins t. <br /> •....se., <br /> M.O. -L1Cii014117SLR tti sio. <br /> p 3rat <br /> '1 TIFY THAT THERE ARE NO CHANGES TO MY ORIGINAL APPLICATION LOCAL LICENSING AUTHORITY COPY <br /> - •;EPT CHANGE OF MANAGER,TRADE NAME OR CORPORATE STRUCTURE, , <br /> w TrtAOB IRANI <br /> •.4.Tulff Ma•lingAddress - - - 4 <br /> {IF THERE IS A CHANGE IN OWNERSHIP DO NOT USE THIS FORM. USE AN ORIGINAL APPLICATION.) <br /> t L MANAt3BR'B NAME- _ _ MAKE e'►HECK OR MONEY <br /> INSTRUCTIONS IF APPLICANT IE A CORPORATION,FILL IN REVERSE EIDE. ORDER PAYABLE TOTHN 1 ' <br /> `t THE REVERSE COLORADO DEPARTMENT <br /> 13E. BUSMEN PHONE NO.. OF REVENUE. <br /> •E'IEWALAPPLICATION FOR LIQUOR LICENSEIS)FOR THE YEAR ENDING- - - - 10 TOTAL FEES) <br /> " 1Als ":"sit1.". er-z..10 a{WIN'aoa�cti"`a:inn, • / MO two <br /> • :'.:-a hat:.!i,r. -.c C70o1O <br /> • 'PE {•i [. • NAME AND DESCRIPTION OF LICENSE FEE <br /> TYE) a CI L i..tre4E — :{L Et 'ILrecuy. ANU - - - <br /> I I- <br /> Alaw - <br /> .1d :RLEiT JAI' rCF rI • ,f <br /> . nsve Igo)p, t,ia1':on <br /> of die pram.w Ion h trim low;cation for 1 .nw Is made? _ <br /> •'a orern•eW:vaned or rented? �r� - • .N rented.effective&expiration data of IMse- /.e0• <br /> ,a•camas)or al,officers of the corporation.ciftonls)or Ipyfalty/dm trod of the Un•ted States of A•t.ar.car /�"_-, <br /> -r aooltant.a arty of Ow patners.or any of the officers.stockholders or defectors of Laid appl•cant(.f it Is a eorparat,ifi}, <br /> •oloyeea of any luck s der the sae of,wart y.one years? _ Yes No 'r- <br /> . 'Mr applicant,or any of the partner.or any of the offcas.stockhotdars or d•►actora of said applicant(tf it 44 corpora- <br /> roar been convicted of a felony in ttta State of Colorado or been convicted of a crime Ntevrltare ernes?maid constitute <br /> • .ny if as&crime hod been committed I„tits Sate of Colorado?If to.hats full desalts vas _ No <br /> . •na apoiiaant.or arty of the partners,or any offktr,director c . •ckhotdar of mice appliont(if it it a corporation)aver: <br /> d...-'''' <br /> ...n.tented a Itcans.Ian&this liquor law? . . - Yes No <br /> - ' I <br /> • ,.t.fn alcoholic tsatiweie license eilderded or revoked' Yes- - No ;ii <br /> • n war is yet.al.pfaln fully(attach separate sheet,if needed, <br /> . in any members of your family stave a financial interest to any uthp I.quor l,cMtat tSkoch ftranc,al Interest to include •. a <br /> f-- ° <br /> r ,nt..#at or smarts,if thlaret s(N yea,explain in datad__-- ,a ,_ No - l' ' <br /> iJ <br /> . •ny parfpn,form or corporation he+a a f,rienclat interest,evidenced'tithM by POant or equity vwnarthip in tha business <br /> ,.,It this Iic.rii.ii r.qu4ilad It thaamwar Is yak stilts names andaddrasNS.rd amount of suetflnancial inform aroreMed <br /> . ■.I011ars or ut1tM stems of yatut,such e/iNYantOly,furMtur.',WVet and aqutpmant_ - _._...Yrs No_ <br /> - • -an•et arts.tddrettas of all businassas in which ail),o• the parpne,n trs pav,pci iurltion a,n ant&asstd. <br /> Name •?tines Address <br />