Laserfiche WebLink
STATE OP COLORADO•DEPARTMENT OP REVENUE <br /> LIQUOR LICENSE APPLICATION ADDENDUM <br /> To be co,plewd by esdn letiglividuel,partnership,or corporation liquor licenses. NO liquor liana renewal will be <br /> processed uniesea gwsroess are sompiaaMy answered Any FALSE answer or stesement made by applicant eaar - <br /> selrutw PERJURY.and the person making surfs false statement auliscts any Ikons.issued herein sosogggeshppL <br /> 1. Flans Of iioanreie TRo tlo at bland Corporation <br /> 2. ?dads Mess of Eolobikkgravat 7-1110wn $ItQEss <br /> a Address of .. •,• <br /> • Liquor Unease N , <br /> RL Do yaw luso MMi paasraslset of doe deemed pwwisse? . Yoe <br /> a Ars the perwdesd mewed or warted? Denagia <br /> 7. If swNe4,from whom tUis. <br /> I. Effective dew of the lass(:— N1'A Expiration date: Ili► <br /> S. Do you ar ow member of your immediate family (fattier,mother,brother.sister,children)have•financial <br /> Insareet in any other liquor license or in any corporation that holds a liquor license? (Such financial Interest <br /> to Include any equity.interest or loan.) If answer is yes,explain in detail. SO Yes CI No <br /> Rene 7ti odor liquor establishment If your answer bye r <br /> that have 3_2 off premise beer licenses. <br /> 10. Does any person,,firm or corporation hawse a financial Interest in your business? 1i? CI No <br /> 11. If the answer Is yes,stew the name,and the address`of the person holding ouch financial interest.and Chow <br /> the amount of such financial mores( <br /> The Phi10 Co. is th9 only holder of more than 5% of The Southland <br /> Corporation's stock. - <br /> ''• �-� <br /> 12. Aenwint of your investment in the business: . 5150-090-CC <br /> 13. Paestum,of ownership the above will represent: 100%•r.-.---.14.0,Ahs you now an active participant In the management and operation of your licensed premises? <br /> ® Yee CI No <br /> _ 15. If sorneboIy else will man your establishment,give name,address.data of birth of the MANAGER,and <br /> embank copy of the"Illanagernent Agreement"with this quastionaire: <br /> Da , •.. .•7 .. le _•to _do <br /> D.O.B. 9.12312_5 <br /> 10. Did you enter into a"EAenagarnsnt- Lease"agreement with your manager or any other person? <br /> D Yes ® No. If the agreement h in writing. attach a copy. <br />