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Colorado Fermented Malt Beverage (3.2 Beer) License Application DR 8403 - Colorado
| Colorado Fermented Malt Beverage (3.2 Beer) License Application Form. This is a Colorado form and can be used in Liquor Enforcement Division Dept Of Revenue Statewide . |
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DR 8403 (03/19/09) COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION 1375 SHERMAN STREET DENVER CO 80261 21 COLORADO FERMENTED MALT BEVERAGE (3.2% BEER) LICENSE APPLICATION NEW LICENSE TRANSFER OF OWNERSHIP LICENSE RENEWAL · · · · ALL ANSWERS MUST BE PRINTED IN BLACK INK OR TYPEWRITTEN APPLICANT MUST CHECK THE APPROPRIATE BOX(ES) LOCAL LICENSE FEE $ __________________________ APPLICANT SHOULD OBTAIN A COPY OF THE COLORADO LIQUOR AND BEER CODE (Call 303-370-2165) DO NOT WRITE IN THIS SPACE 1. Applicant is applying as a Corporation Individual Partnership (includes Limited Liability and Husband and Wife Partnerships) Limited Liability Company Association or Other 2. Applicant(s) If an LLC, name of LLC; if partnership, at least 2 partners' names; if corporation, name of corporation Fein Number 2a. Trade Name of Establishment (DBA) 3. Address of Premises (specify exact location of premises) City 4. Mailing Address (Number and Street) County City or Town State State ZIP Code ZIP Code State Sales Tax No. Business Telephone Present Trade Name of Establishment (DBA) LIAB 5. If the premises currently have a liquor or beer license, you MUST answer the following questions: Present State License No. Present Class of License Present Expiration Date SECTION A NONREFUNDABLE APPLICATION FEES LIAB SECTION B 3.2% BEER LICENSE FEES 2300 2302 Application Fee for New License Application Fee for New License w/Concurrent Review Application Fee for Transfer $ 1,025.00 2121 2124 Retail 3.2% Beer On-Premises (City) Retail 3.2% Beer On-Premises (County) Retail 3.2% Beer Off-Premises (City) Retail 3.2% Beer Off-Premises (County) Retail 3.2% Beer On/Off Premises (City) Retail 3.2% Beer On/Off Premises (County) $ 96.25 $ 117.50 $ 96.25 $ 117.50 $ 96.25 $ 117.50 $ 1,125.00 $ 1,025.00 2122 2125 2123 2126 2370 2375 2310 Master File Location Fee ...... $ 25.00 x ______ Total ________ Master File Background ........ $ 250.00 x ______ Total ________ DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY LIABILITY INFORMATION County City Industry Type License Account Number Liability Date FROM State City County 3 3 3210987654321098765432121098765432109876543210987654321 21098765432109876543212109876543210987654321098765432 3210987654321098765432121098765432109876543210987654321 21098765432109876543212109876543210987654321098765432 3210987654321098765432121098765432109876543210987654321 21098765432109876543212109876543210987654321098765432 21098765432109876543212109876543210987654321098765432 3210987654321098765432121098765432109876543210987654321 3210987654321098765432121098765432109876543210987654321 1 3 1 License Issued Through (Expiration Date) TO _____-750 (999) 2180-100 (999) 2190-100 (999) Cash Fund Transfer License Cash Fund New License 2300-100 (999) 2310-100 (999) TOTAL · American LegalNet, Inc. www.FormsWorkFlow.com DR 8403 (03/19/09) Page 2 APPLICATION DOCUMENTS CHECKLIST AND WORKSHEET Instructions: This check list should be utilized to assist applicants with filing all required documents for licensure. All documents must be properly signed and correspond with the name of the applicant exactly. All documents must be typed or legibly printed. Upon final State approval the license will be mailed to the local licensing authority. Application fees are nonrefundable. ITEMS SUBMITTED, PLEASE CHECK ALL APPROPRIATE BOXES COMPLETED OR DOCUMENTS SUBMITTED I. APPLICANT INFORMATION A. Applicant/Licensee identified. B. State sales tax license number listed or applied for at time of application. C. License type or other transaction identified. D. Return originals to local authority. E. Additional information may be required by the local licensing authority. II. DIAGRAM OF THE PREMISES A. No larger than 8 1/2" X 11". B. Dimensions included (doesn't have to be to scale). Exterior areas should show control (fences, walls, etc.). C. Separate diagram for each floor (if multiple levels). D. Kitchen - identified if Hotel and Restaurant. III. PROOF OF PROPERTY POSSESSION A. Deed in name of the Applicant ONLY (or) B. Lease in the name of the Applicant ONLY. C. Lease Assignment in the name of the Applicant (ONLY) with proper consent from the Landlord and acceptance by the Applicant. D. Other Agreement if not deed or lease. BACKGROUND INFORMATION AND FINANCIAL DOCUMENTS A. Individual History Record(s) (Form DR 8404-I). B. Fingerprints taken and submitted to local authority. (State authority for master file applicants.) C. Purchase agreement, stock transfer agreement, and or authorization to transfer license. D. List of all notes and loans. CORPORATE APPLICANT INFORMATION (If Applicable) A. Certificate of Incorporation (and/or) B. Certificate of Good Standing if incorporated more than 2 years ago. C. Certificate of Authorization if foreign corporation. D. List of officers, directors and stockholders of parent corporation (designate 1 person as "principal officer"). IV. V. VI. PARTNERSHIP APPLICANT INFORMATION (If Applicable) A. Partnership Agreement (general or limited). Not needed if husband and wife. LIMITED LIABILITY COMPANY APPLICANT INFORMATION (If Applicable) A. Copy of articles of organization (date stamped by Colorado Secretary of State's Office). B. Copy of operating agreement. C. Certificate of Authority (if foreign company). VII. VIII. MANAGER REGISTRATION FOR HOTEL AND RESTAURANT, TAVERN LICENSES WHEN INCLUDED WITH THIS APPLICATION A. $75.00 fee. B. Individual History Record (DR 8404-I). American LegalNet, Inc. www.FormsWorkFlow.com DR 8403 (03/19/09) Page 3 6. 7. Is the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or officers, stockholders or directors if a corporation) or manager under the age of twenty-one years? Has the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or officers, stockholders or directors if a corporation) or manager ever (in Colorado or any other state); (a) been denied an alcohol beverage license? (b) had an alcohol beverage license suspended or revoked? (c) had interest in another entity that had an alcohol beverage license suspended or revoked? If you answered yes to 7a, b or c, explain in detail on a separate sheet. Has a 3.2 beer license for the premises to be licensed been denied within the preceding one year? If "yes," explain in detail. Has a liquor or beer license ever been issued to the applicant (including any of the partners, if a partner
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