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<br /> ,OT(Ra,.��l7 rtztx.`r�- ST RE OF COLORADO '.,.
<br /> D1PARTMINT OF REVINUI N.
<br /> f 7 4,504 REIIEWAL MFPU�CAT1ON FON MALT.VINOUS - se%el*t ttt w?me wads
<br /> r LIQUOR EI POi10EMENT OPPICER'S ACTIOM
<br /> MT AP OVAL CAL LMC�AUTHORITY FIRST)
<br /> • - APPRO V go �..a
<br /> ,-. 1; •:L ■• 4.. 14)—..34)32 . .
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<br /> ••••..... L.01:1,..c h a t... 4io 401:4.7 pow .�►
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<br /> SEE INSTRUCTiCAS A-
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<br /> 04 THE REVERSE MAKE CHECK OR MONEY ORDER PAYAILE TO THE
<br /> SIDE. COLORADO DEPARTMENT OF REVENUE.
<br /> _• mot.APPLICATION 4 O uOtIOR L.ICI Nit 110,1 7.•E LIC[N$INO PERIOD ENO04O - TOTAL FEES _
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<br /> I SS No. 2 'FEIN
<br /> I CERTIFY THAT THERE ARE NO CHANGES TO MY ORIGINAL A1KICAT1011
<br /> EXCEPT CHANGE OF MANAGER. TRADE NAME OR CORPORATE STRUCTURE.
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<br /> :-TRADE tAME ... SAme as a b o,r;C, a�.P4
<br /> NATUFA d1:t.i�i4.�r % �t Paseit+tMdaa p . ii
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<br /> %IFTHERE IS ACHAriGE I%OW0.E5465OP 00 NOT USE THIS FORM,USE AN ORIGINAL APPLICATIONJ
<br /> • • f r•...MANAGER'S MAUI
<br /> ! j . - . • If APPLICANT IS A COAeoleAlIOW,SILL I• t1IVtRSE$101. —
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<br /> -"af f., ,, �t. _ NAME AND DESCRIPTION OF LICENSE __ —_.-7_-- FIR Y
<br /> I :V :',,. t..1.4 . . < LaC4:.IC — ■••11.71 V1;+..USe . "ttL.
<br /> • _.- %,.i F Y t.1 v 7 1 4 .C.1.%)., . _. - I E 276 r.
<br /> nu PM'.MMI poS.sai i of M i l'MOM MS tot...Opel t1.4I011+CabOI for I.00no II nerds? _ .lift - - - - - ..
<br /> •• •ha e+itstsas wood or noted, tebrke41. If weed.r►frctwt$stioirabon dflto 0 Imo .
<br /> •aol.c•rat(s)or MI off.carttl of Ike cotootat.on.et.aen W or p.nttanant nl.dattt)of the Weed Sop*of n a a'4 Cai.at io? Nit
<br /> _vnt.tfnt,or My of t%s prri.srs,at any of the of►•can.rtockholdan M dwaston of said yoltaawt ttt is Y•aotpar•[Iaal.
<br /> -awveaa Of say WO.Under'tt+a OM Of tr4ntyvont years? w0 _r.. . Yet___ _Ns x - -
<br /> •t11all=S.tt,or any of tM pannrn, or any of the off•crn.stockholders or d..actors of mid ap101.cant (if it to•cerpwt4.iI a+n�MM , X11 '.
<br /> •• ^o'•RCM*an the 3taw of Colo'sdo or ilsthtrrtfrtr _. _ .__. vs. ._ - -— NO . .__,_•, " . ` 141
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<br /> •:al*fail eetaJ/ �....—..+ __ ___ 1
<br /> • ••.sl.Ignt.or My of the(WV,et or anti off.cv,d.rector Or ttockko $f of too Nokcset tit K Ise t ('tame sour: !!' `, , t)
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<br /> - -gnats('a 1.crnsa undo.th•l lageo•tow? Vas _ _,_ No .___..� ...f f Jr . ,
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<br /> • sitokol•c t,e,rare5s 11Cense twwn('.5 o'•livO I•dl tes. ., . . No X .._
<br /> ,.•.war.s ytt.captain%A',(arise%MOMar sh.et.•1'is dl
<br /> or any m.mba('Of yow fanmly ho**a ftnanc.at.ntarett in any otlwr Itquos I.certset Ouch t,.ii Icial IuWr*I1 to Ache". i
<br /> .•1v int.:nit Or foam).If ti.('nest is yes....p'a.n tu11y%attach arparate Mneet,.1 Mrdada. Yo. .. _ No K
<br /> :••. potion,f.re or co''porat•on hen•6nanciat.nma1Nt,tvideectd either by•oars or ecslty ostivardsio In ISIS ItemeMaa
<br /> - •..+ 'hi" %.tunsta 41 Iaq,,stsdr If the answer •s ..:. ::ate noon aid 'dW+ua+ and amount of high firtanpal wtaweet
<br /> . a t•rtfwr to dolIari of Other IISnt1 of vattr..tech II.nwntory,turn.tunt.ftatur4 and sourcesom VON )IC No
<br /> he..arnel.Sul rddr w.a of an buunssms...troth int.of tM totem in the oetas MAMI n an"'creed- -
<br /> TeLe P arse Tux ytv r ci.s oat► - ,3 S.Ee'a.ra.aa.at .. .itO4I. S a
<br /> • ■•-1,i4 - n1I"Oyen ldrntil Caton hwnM• IFEINI .t we-pone., In 1b,r ayes%Awe.Maaae clock raw records to sat.5 ye
<br /> ,r. If 1,r.0 Stave a dlffertnt n.►nble.correct ma Ong above to that■t COIF rs akin lr weds yew r.cOrda.if eta netehot('Roars M • 11 illb
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