Public Transportation, Wholesale, Manufacturer, Importer License Application Form Page 3
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4DR 8409 (06/02) Page 3
6.
Is the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or officers, stockhold-
Yes
No
ers or directors if a corporation) or manager under the age of twenty-one years?
7.
Has the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or officers, stock-
holders or directors if a corporation) or manager ever (in Colorado or any other state);
(a) been denied an alcoholic beverage license?
(b) had an alcoholic beverage license suspended or revoked?
(c) had interest in another entity that had an alcoholic beverage license suspended or revoked?
If you answered yes to 7a, b or c, explain in detail on a separate sheet.
8.
Has a liquor or beer license ever been issued to 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)? If yes, identify the name of the business and list any
current financial interest in said business including any loans to or from a licensee.
9.
Does the Applicant, as listed on line 1b of this application, have legal possession of the premises for at least 1 year from the date that
this license will be issued by virtue of ownership, lease, or other arrangement?
Ownership
Lease
Other (Explain in Detail) ___________________________________________________________________
a. If leased, list name of landlord, tenant, and date of expiration EXACTLY as they appear on the lease:
Landlord
Tenant
Expires
10.
Who, beside the owners listed in this application (including persons, firms, partnerships, corporations, limited liability companies), will loan or give money,
inventory, furniture or equipment to or for use in this business; who will receive money from this business? Attach a separate sheet if necessary.
NAME
DATE OF BIRTH
FEIN OR SSN
INTEREST
Attach copies of all notes and security instruments, and any written agreement or details of any oral agreement, by which any person
(including partnerships, corporations, limited liability companies, etc.) will share in the profit or gross proceeds of this establishment, and any
agreement relating to the business which is contingent or conditional in any way by volume, profit, sales, giving of advice or consultation.
11.
If applicant is a corporation, partnership, association or a limited liability company, it is required to list all officers and directors, general
partners, managing members and all stockholders, partners (including limited partner) and members who have a 10% or greater financial interest
in the applicant. All persons listed here or by attachment must submit a DR 8404-I (Individual History Record) and provide fingerprint
cards to the state licensing authority. If a report of changes, then only provide background information for persons checked or new.
DATE OF
NAME
HOME ADDRESS, CITY & STATE
POSITION
% OWNED
BIRTH
Additional Documents to be submitted by type of entity
CORPORATION
Cert. of Incorp.
Cert. of Good Standing (if more than 2 yrs. old)
Cert. of Auth. (if a foreign corp.)
PARTNERSHIP
Partnership Agreement (General or Limited)
Husband and Wife partnerships
LIMITED LIABILITY COMPANY
Articles of Organization
Cert. of Authority (if foreign company)
Operating Agrmt.
ASSOCIATION OR OTHER
Attach copy of agreements creating association or relationship between the parties
Registered Agent (if applicable)
Address for Service
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