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wow <br /> STATE OF COLORADO•DEPARTMENT OF REVENUE Do nor whirr IN 7wss SPACt <br /> 1 MANAQER'$REStSTRAT1OU FORM 1 <br /> ALt+AMEMttIM MET R P*JWTfio IN MK OR TYTIRIs1ttTYUt <br /> sgrieiklsatarr Eourralow ems:k asamwod. Arty labs s olowent or answer - <br /> 1y HPPI sot COASS SIORll parit ry•'end mew rassatt M tyl•wsaoatrFon of Ow <br /> Oyes, MasSTRATIOe,PEE 0,1176 MUST ACCOMPANY THU POONA. <br /> 1. Nom of Licensee: I!Rtw R iI.Lna Ca Mtimil .-. <br /> Sodom Tons No. 666-9920 - <br /> 2. Trade Name of Eaaraiis t: 7—E1,seran Rt sr� <br /> 3. Ateseves of t.ieanood EatabiithwNM.: B 4.. > Cuder gA_ sir mnr 42 <br /> 4. Ctty or Town: IOtiiNvi lle - <br /> 41 -24 f I A COO T No.se L+Ctt t 1t-Smoot <br /> S. N of Mir: - Daniel Ogilvie <br /> 8 Managers Birth oats: 9-22-25 7. M s Sodas security No. 523-22-Q629 <br /> a- Mangers}kw.Address: 1607 Cis(,je Dr. . Loyis r e. Colorado <br /> 0. Managtrr rPrevious Employment for the fast five(53 yeah: - • <br /> t_ 19 3 .Hume )973 - Awl f r► rIye►AV�,r•sa rt t.1 flan- .Tab rt.,s ry_ 14172 <br /> to AtoLUat. 1973 • self emooll•Ovildltrucisj.na kinese <br /> 10. Is Manager a citizen of the United States of America? ® Yes 0 No <br /> 11_ Has Manager ever been convicted of a felony in the Stag of Colorado or of•crime elsewhere? O Yes ® No <br /> If yes,state full details: <br /> 12. Has Manager ever: N)been denied a liquor license under liquor laws of any state 0 Yes GO No; (b)had an*lcohahit beat**. <br /> license suspended or revoked 0 Yes 10 No; (c)been convicted in court for violation of liquor law.rpuiatIon 0 Yes ® No <br /> If yes.state fun details: <br /> 13. Effective date of Manager's employment: 4-1-71- _ 14. Expiration date: bV ill <br /> 15. Compensation of Manager: $350. every 2 Wks. <br /> 16. Did Manager ever menage liquor establishment in any other state? 0 Yes ® No <br /> 17. Does Manager have financial interest in this or any other liquor establishment? 0 Yes Q No if answer is yes.give name and <br /> location of establishment: -- — <br /> 18_ Does Manager manage another"Hotel or Restaurant"licensed liquor establishment in Colorado? 0 Yes ® No If answer Is <br /> yes,give name end location of establishment: <br /> (The follow/Iv affidavit Is to be signed and xknowkdged by lndividhnafs and each member of partntrshlp and by corporation.) <br /> STATE OF COLMAIM ( f '��, end <br /> SS. A4e .being <br /> County of by me first duly�swornm4If for himself,d end y s that he is the <br /> Sobacibed and • u • bas• me this licensee above named;or that he Is ...- 've" <br /> dry or rii , t• . of the above named corporation;that he regiis- <br /> ayr.ervre a Notary: • fie ' ATTACH tration form and that he knows the oonwr.ts I..ireat.and that all met- <br /> ,My oa r/ mision snorer •t,',-14444L'3,0 0' • ' lit: tens and things therein set forth are true of his own knowledge. <br /> .- for Daafl�s.Counts. Teo <br /> s#IOIVIDUALS AIJO ALL MEM I141RS OF rMTN�en1 i 3', 19JCowror..T1ON algal HERS: CAM*.SIMS .--... <br /> MUST SIGN HERE: . <br /> - THE SOUTHLAND CORPORATION • • <br /> Worrs+es. • <br /> OPT gip 4 t• 'u I I u 1 MY: <br /> sneer. '•al inau not _Meyyt orL ammt <br /> DRL 3.7 (Rt..a/7q (12-47-11e1 wr aril . Team <br /> UM <br /> APPROVAL OF LOCAL LICENSING AUTHORITY ON REVERSE SIDE <br /> i - <br />