Fillable Form Dr 8404 - Colorado Liquor Retail License Application (Page 3 of 4) in pdf

Is the applicant (including any of the partners if a partnership; members or managers if a limited liability company; or officers, stockholders

Yes No

or directors if a corporation) or managers under the age of twenty-one years?

Has the applicant (including any of the partners if a partnership; members or managers if a limited liability company; or officers,

stockholders or directors if a corporation) or managers ever (in Colorado or any other state):

(a) Been denied an alcohol beverage license?

(b) Had an alcohol beverage license suspended or revoked?

If you answered yes to 8a, b or c, explain in detail on a separate sheet.

Has a liquor license application (same license class), that was located within 500 feet of the proposed premises, been denied within the

preceding two years? If "yes", explain in detail. _______________________________________________________________________

10. Are the premises to be licensed within 500 feet, of any public or private school that meets compulsory education requirements of Colorado

law, or the principal campus of any college, university or seminary?

Waiver by local ordinance?

Other: ________________

11. Is your Liquor Licensed Drugstore (LLDS) or Retail Liquor Store (RLS) within 1500 feet of another retail liquor license for off-premises sales in a

jurisdiction with a population of greater than (>) 10,0000? NOTE: The distance shall be determined by a radius measurement that begins at the

principal doorway of the LLDS/RLS premises for which the application is being made and ends at the principal doorway of the Licensed LLDS/RLS.

12. Is your Liquor Licensed Drugstore (LLDS) or Retail Liquor Store (RLS) within 3000 feet of another retail liquor license for off-premises sales in a

jurisdiction with a population of less than (<) 10,0000? NOTE: The distance shall be determined by a radius measurement that begins at the principal

doorway of the LLDS/RLS premises for which the application is being made and ends at the principal doorway of the Licensed LLDS/RLS.

13a. For additional Retail Liquor Store only. Was your Retail Liquor Store License issued on or before January 1, 2016?

13b. Are you a Colorado resident?

14. 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.

15. Does the applicant, as listed on line 2 of this application, have legal possession of the premises by ownership, lease or other arrangement?

Ownership

Lease

Other (Explain in Detail) _________________________________________________________________________

a. If leased, list name of landlord and tenant, and date of expiration, exactly as they appear on the lease:

Landlord

Tenant

Expires

b. Is a percentage of alcohol sales included as compensation to the landlord? If yes, complete question 16.

c. Attach a diagram designates the area to be licensed in black bold outline (including dimensions) which shows the bars, brewery, walls, partitions, en-

trances, exits and what each room shall be utilized for in this business. This diagram should be no larger than 8 1/2" X 11".

16. Who, besides 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; or who will receive money from this business? Attach a separate sheet if necessary.

Last Name

First Name

Date of Birth FEIN or SSN

Interest/Percentage

Last Name

First Name

Date of Birth FEIN or SSN

Interest/Percentage

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.

17. Optional Premises or Hotel and Restaurant Licenses with Optional Premises:

Has a local ordinance or resolution authorizing optional premises been adopted?

Number of additional Optional Premise areas requested. (See license fee chart)

18. Liquor Licensed Drugstore (LLDS) applicants, answer the following:

(a) Is there a pharmacy, licensed by the Colorado Board of Pharmacy, located within the applicant's LLDS premise?

If "yes" a copy of license must be attached.

19. Club Liquor License applicants answer the following: Attach a copy of applicable documentation

(a) Is the applicant organization operated solely for a national, social, fraternal, patriotic, political or athletic purpose and not for pecuniary gain?

(b) Is the applicant organization a regularly chartered branch, lodge or chapter of a national organization which is operated solely for the

object of a patriotic or fraternal organization or society, but not for pecuniary gain?

(d) Has applicant occupied an establishment for three years (three years required) that was operated solely for the reasons stated above?

20. Brew-Pub, Distillery Pub or Vintner's Restaurant applicants answer the following:

(a) Has the applicant received or applied for a Federal Permit? (Copy of permit or application must be attached)

21. For all on-premises applicants.

a. Hotel and Restaurant, Lodging and Entertainment or Tavern License, the Registered Manager must also submit an Individual History Record

- DR 8404-I and fingerprints.

b. For all Liquor Licensed Drugstores (LLDS) the Permitted Manager must also submit an Manager Permit Application

- DR 8000 and fingerprints.

Last Name of Manager

First Name of Manager

22. Does this manager act as the manager of, or have a financial interest in, any other liquor licensed establishment in the State of Colorado?

If yes, provide name, type of license and account number.

Form Dr 8404 - Colorado Liquor Retail License Application Page 3

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