Public Transportation, Wholesale, Manufacturer, Importer License Application Form Page 4
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4DR 8409 (06/02) Page 4
12.
Colorado Manufacturer, Wholesaler or Limited Winery applicants, answer the following:
Yes
No
(a) Will the applicant store or sell alcoholic beverages at more than one location in Colorado? If yes, provide the address of each
location and explain the activity to be conducted at each location (e.g., warehouse, salesroom, etc.).
(b) If applicant is a wholesaler, does or did any owner, partner, shareholder, director, officer, member or manager have any
direct or indirect financial interest in a wholesaler, retailer, manufacturer or importer already licensed by the State of Colorado
to sell malt, vinous or spirituous liquor? If yes, attach explanation in detail.
(c)
Does the applicant have a valid Federal Basic Permit or Brewers Notice? If yes, attach a copy; if no, explain whether one
has been applied for.
13.
Nonresident Manufacturer (3.2% beer or malt liquor) or Importer (3.2% beer, malt, vinous or spirituous liquor) applicants, answer
the following:
(a) To what Colorado licensed wholesaler do you intend to ship your merchandise?
(b) Does or did any owner, partner, shareholder, director, officer, member or manager have any direct or indirect financial
interest in a wholesaler, retailer, manufacturer or importer already licensed by the State of Colorado to sell malt, vinous or
spirituous liquor? If yes, attach explanation in detail.
(c) Does the applicant have a valid Federal Basic Permit or Brewers Notice? If yes, attach a copy; if no, explain in detail.
(d) Are you the primary source of supply in the U.S.? If no, explain.
(e) Are all your products registered in Colorado? If no, attach DR 8440 and register said products.
14.
Public Transportation System license applicants, answer the following:
(a) How many vehicles; cars, buses, planes or other conveyances ("units") will serve alcoholic beverages in Colorado?
__________________
(b) Does the applicant have possession by title or lease of all of the units described above?
(c) Does applicant have PUC authority? (attach copy of authority)
(d) Where will liquor be stored? (list address)
______________________________________________________________
______________________________________________________________
OATH OF APPLICANT
I declare under penalty of perjury in the second degree that this application and all attachments are true, correct, and complete
to the best of my knowledge. I also acknowledge that it is my responsibility and the responsibility of my agents and employees
to comply with the provisions of the Colorado Liquor or Beer Code which affect my license.
Authorized Signature
Title
Date
REPORT AND APPROVAL BY STATE LICENSING AUTHORITY
Yes No
Each person required to file DR 8404-I
a. Has been fingerprinted
b. Background and NCIC and CCIC check for outstanding warrants conducted
For Wholesalers and Manufacturers only
The liquor licensed premises has been inspected by an agent of the State Licensing Authority.
If "no", the building will be completed and ready for inspection by
(date)
By
Title
Date
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