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• <br /> • SdrATI 'Of COLO (r71 <br /> DIPAITMENT OF REVlN . <br /> 44„ . #APPLICATION FOR MALT,VINOUS 00 NOT WRITE Of THIS PACE <br /> AND van stctftrssfo MfTI TT A!*AOYAl <br /> (err APPROVAL OF LOCAL morrows_ �AUTHORITY NMI) - y <br /> r+.aMn.r. a. • DATE <br /> .watrra. <br /> • rl+t;SaU ChArkL1iS J 10—1. -27 <br /> ▪ ::.. TRACK INN TN:: <br /> - <br /> StORATtJNF <br /> .».n 1006 P IN f ST <br /> •.•i""" <br /> I flJ I.iV I L I E <br /> IOW IOW <br /> r••tPMM►ei <br /> ▪.v1.11 tare <br /> • <br /> 1M{• <br /> O ;''N Vat ( @ Y <br /> • <br /> RENEWAL APPLICATION FOR LIQUOR LICENSE FOR THE LICENSING PERIOD ENDING <br /> 1 . AlR u ANU«no.r.w.�f oeuww tiO. <br /> .. ... <br /> 1.I -? lur. 07 O ,1 5a1.s I L:5..� 7t 050id2 <br /> Soc.floe No.1 //6 • .,�y/ 013 - Soc.2 'FEIN <br /> I CERTIFY THAT THERE ARE NO CHANGES TO MY LAST ANNUAL APPLICATION <br /> IF THERE IS A CHANGE DO NOT USE THIS FORM.USE AN ORIGINAL APPLICATION. <br /> NEW TRADE NAME <br /> SIGNATURE <br /> � <br /> SUSiNESS LOCATION ADDRESS /00 Cr . �4-rf. .� T. L.nv.,fAd' C'Cirtl 03J+I0 <br /> Street Guy Pilate Ziy Cads <br /> MANAGE R'S NAME C iPir .• J GcCSret .. <br /> IF APPLICANT IS A CORPORATION.FILL IN REVERSE SIDE. <br /> TYPE NAME AND DESCRIPTION OF LICENSE FEE <br /> • i..J. .2y 1_ rVl/uR LlCir'.SE — piALi . VINOUS, 4N.) SPI. l1lltrUS >; 25.33 <br /> 4.. it v .15 PiihCFINT LA? I hi: : 276.25 <br /> MAKE CHECK OR MONEY ORDER PAYAIIL E TO THE TOTAL FEELS) + 302,25 <br /> COLORADO OEPARMEN,OF REV1ENUE • <br /> Do you Iwo legal powrstlon of the premises for which this application for license is Pleader U4%1 <br /> Are the prsenisrs owned Of rented? d lv4,f Q if rented.*trio**&r*p Patron dam of ten _ • _ <br /> H eppticantls)or all officer(1)of the corporation.cmeanfs)tx tewfully admitted rsidentlsl of the United Sutra of Amid o! 1,6 3 <br /> Ii the sppticanr,or any of thep.rrners„or any of the off/rms.stoe hotd..s or directors of sad appl.calu(If it Is•corywetron). <br /> a sertpsoyees of any such under the ape Of twenty-one yaws? Yes No V <br /> Hee the applicant,or any Of die partners.or any of the officers.stock holders or directors of said applicant III it is a r:wporatton)skier been eon- <br /> tihttd of■crime in the State of Colorado or else hare? Yes N• <br /> If so,stem lull details <br /> ties any parson.as applicant.partner.cfacer,ttrr•ctor stockholder or sn'wfoyell,ever: <br /> la)been denied a beano under this liquor WO Yee No V <br /> b)had an alcoholic beverage Ikanw swpended Of nrookod? Vas fit• 1wo° <br /> If the viewer it yes.explain fully lattaeh separate sheet,d ne.dedi. <br /> Do you or eny mernbsrs of your family have a fininclat interest in any ether t,quor license(such fine/KW tntarest to.naiads <br /> •eny equity interest or loans).It ilw emirs is yes.captain tufty(attach separate sheet.rr needed). Yes Pin <br /> Does any person.thin or corporation have a fotanciet interest.rv.daric.rl either by toms u•equity tomnifsh,p in the bu.inese <br /> for which this license is requested?If the answer n yes,stets names end alktrastlt and amount of such ItnerKral„Immo <br /> expressed either In dopers or other items Of value,inch as rIlY.ntory,fwn.ture.'kraut VI a,xr equ pc ,st Yes No <br /> Liu the names and addresae►of aft busawiws in which any of the Persons in the WeriOus question ire intrrasted. <br /> 'e a i s6 a u t i s m — 7lfa,.•s• , - <br /> 'If Federal Employers Identification Number ?FEIN) is pr.-p• nu.f on the above spice.presse check your recoruls nos <br /> rumber.tf you have'drfferentnurmber.Carets the one above in that It 4Crr'coo reit vyrth your recOrOS.ft no numb.,apc <br /> Phase fell in with the F EIN you have on your records, <br /> StF 1QFVFr1SE SInF <br />