Fillable Printable Liquor Licence Application Form - Colorado
Fillable Printable Liquor Licence Application Form - Colorado
Liquor Licence Application Form - Colorado
•
State
City
2180-100 (999)
County
2190-100 (999)
Managers Reg
______-750 (999)
TOTAL
License Account Number
County
City
Industry Type
LIABILITY INFORMATION
Liability Date
FROM
DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY
ZIP Code
ZIP Code
4. Mailing Address (Number and Street)
State
State
City
Present Trade Name of Establishment (DBA)
Present Expiration Date
1. Applicant is applying as a
2. Applicant If an LLC, name of LLC; if partnership, at least 2 partner's names; if corporation, name of corporation Fein Number
2a.Trade Name of Establishment (DBA)
3. Address of Premises (specify exact location of premises)
Present Class of License
County
City or Town
Present State License No.
Partnership (includes Limited Liability and Husband and Wife Partnerships)
•
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)
Corporation
5. If the premises currently have a liquor or beer license, you MUST answer the following questions:
NEW LICENSE TRANSFER OF OWNERSHIP LICENSE RENEWAL
COLORADO LIQUOR
RETAIL LICENSE APPLICATION
DR 8404 (05/07/09) Page 1
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
DENVER CO 80261
2310-100
(999)
Cash Fund Transfer License
2300-100
(999)
Cash Fund New License
21
DEPARTMENT USE ONLY
State Sales Tax No.
Business Telephone
Individual
Association or Other
Limited Liability Company
License Issued Through
(Expiration Date)
TO
_____-750 (999)
LIAB SECTION A NONREFUNDABLE APPLICATION FEES LIAB SECTION B (CONT.) LIQUOR LICENSE FEES
$
2300 Application Fee for New License ............................... $1,025.00
2302 Application Fee for New License -
w/Concurrent Review ................................................. $1,125 00
2310 Application Fee for Transfer ...................................... $1,025.00
LIAB SECTION B LIQUOR LICENSE FEES
1905 Retail Gaming Tavern License (City) ............................ $500.00
1906 Retail Gaming Tavern License (County) ....................... $500.00
1940 Retail Liquor Store License (City) ................................. $227.50
1941 Retail Liquor Store License (County) ............................ $312.50
1950 Liquor Licensed Drugstore (City) .................................. $227.50
1951 Liquor Licensed Drugstore (County) ............................. $312.50
1960 Beer and Wine License (City) ....................................... $351.25
1961 Beer and Wine License (County) .................................. $436.25
1970 Hotel and Restaurant License (City) ............................. $500.00
1971 Hotel and Restaurant License (County) ........................ $500.00
1975 Brew Pub License (City) ............................................... $750.00
1976 Brew Pub License (County) .......................................... $750.00
1980 Hotel and Restaurant License w/opt premises (City) .... $500.00
1981
Hotel and Restaurant License w/opt premises (County)
$500.00
1983 Manager Registration - H & R ....................................... $ 75.00
1985 Resort Complex License (City) ................................. $500.00
1986 Resort Complex License (County) ............................ $500.00
1988 Add Related Facility to Resort Complex ... $ 75.00 X ____ Total ___
1990 Club License (City) ................................... $308.75
1991 Club License (County) .............................. $308.75
2010 Tavern License (City) ............................... $500.00
2011 Tavern License (County) .......................... $500.00
2012 Manager Registration - Tavern ................. $ 75.00
2020 Arts License (City) .................................... $308.75
2021 Arts License (County) ............................... $308.75
2030 Racetrack License (City) .......................... $500.00
2031 Racetrack License (County) ..................... $500.00
2040 Optional Premises License (City) ............. $500.00
2041 Optional Premises License (County) ........ $500.00
2045 Vintners Restaurant License (City) ........... $750.00
2046 Vintners Restaurant License (County) ...... $750.00
2220 Add Optional Premises to H & R .............. $100.00 X ____ Total ___
2370 Master File Location Fee .......................... $ 25.00 X ____ Total ___
2375 Master File Background ............................ $250.00 X ____ Total ___
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.
APPLICATION DOCUMENTS
CHECKLIST AND WORKSHEET
DR 8404 (05/07/09) Page 2
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
V. 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").
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.
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.
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).
VII. 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).
VI. PARTNERSHIP APPLICANT INFORMATION (If Applicable)
A. Partnership Agreement (general or limited). Not needed if husband and wife.
IV. 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.
NoYes
Landlord Tenant Expires
DR 8404 (05/07/09) Page 3
NoYes
16. Brew-Pub License or Vintner Restaurant Applicants answer the following:
(a) Has the applicant received or applied for a Federal Permit?
(Copy of permit or application must be attached)
NoYes
14. Liquor Licensed Drug Store applicants, answer the following:
(a) Does the applicant for a Liquor Licensed Drug Store have a license issued by the Colorado Board of
Pharmacy? COPY MUST BE ATTACHED.
15. Club Liquor License applicants answer the following and attach:
(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?
(c) How long has the club been incorporated? (d) Has applicant occupied an establishment for three years
(Three years required) __________ that was operated solely for the reasons stated above?
17a. Name of Manager (for all on-premises applicants) ________________________________________ (If this is an
application for a Hotel,
Restaurant or Tavern License, the manager must also submit an Individual History Record (DR 8404-I).
17b. 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.
18. Tax Distraint Information. Does the applicant or any other person listed on this application and including its partners, officers,
directors, stockholders, members (LLC) or managing members (LLC) and any other persons with a 10% or greater financial interest
in the applicant currently have an outstanding tax distraint issued to them by the Colorado Department of Revenue?
If yes, provide an explanation and include copies of any payment agreements.
NoYes
NoYes
6. Is 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 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,
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.
8. 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.
9. 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?
10. 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 or former financial interest in said business including any loans to or from a licensee.
11. Does the Applicant, as listed on line 2 of this application, have legal possession of the premises by virtue of 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:
Attach a diagram and outline or designate the area to be licensed (including dimensions) which shows the bars, brewery, walls, partitions,
entrances, exits and what each room shall be utilized for in this business. This diagram should be no larger than 8 1/2" X 11". (Doesn't have
to be to scale)
12. 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.
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.
13. Optional Premises or Hotel and Restaurant Licenses with Optional Premises
Has a local ordinance or resolution authorizing optional premises been adopted?
Number of separate Optional Premises areas requested. (See License Fee Chart)
Date of Birth
INTEREST
NAME
FEIN OR SSNDATE OF BIRTH
No
Yes
No
Yes
19. If applicant is a corporation, partnership, association or limited liability company, applicant must list ALL OFFICERS, DIRECTORS,
GENERAL PARTNERS, AND MANAGING MEMBERS. In addition applicant must list any stockholders, partners, or members with OWNER-
SHIP OF 10% OR MORE IN THE APPLICANT. ALL PERSONS LISTED BELOW must also attach form DR 8404-I (Individual History record),
and submit finger print cards to their local licensing authority.
DR 8404 (05/07/09) Page 4
Registered Agent (if applicable) Address for Service
REPORT AND APPROVAL OF LOCAL LICENSING AUTHORITY (CITY/COUNTY)
Date application filed with local authority Date of local authority hearing
(for new license applicants; cannot be less
than 30 days from date of application 12-47-311 (1)) C.R.S.
TOWN, CITY
COUNTY
Authorized Signature Title Date
Date
Date
The foregoing application has been examined; and the premises, business to be conducted, and character of the applicant are satisfactory.
We do report that such license, if granted, will meet the reasonable requirements of the neighborhood and the desires of the adult inhabitants,
and will comply with the provisions of Title 12, Article 46 or 47, C.R.S. THEREFORE, THIS APPLICATION IS APPROVED.
DOB
% OWNED*
NAME POSITION
HOME ADDRESS, CITY & STATE
TitleSignature
Signature (attest)
Title
Local Licensing Authority for
Telephone Number
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.
PARTNERSHIP Partnership Agreement (General or Limited) Husband and Wife partnership (no written agreement)
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
CORPORATION Cert. of Incorp. Cert. of Good Standing (if more than 2 yrs. old) Cert. of Auth. (if a foreign corp.)
Additional Documents to be submitted by type of entity
*If total ownership percentage disclosed here does not total 100% applicant must check this box
Applicant affirms that no individual other than these disclosed herein, owns 10% or more of the applicant
THE LOCAL LICENSING AUTHORITY HEREBY AFFIRMS:
That each person required to file DR 8404-I (Individual History Record) has:
Been fingerprinted .........................................................................................................................................................................................
Been subject to background investigation, including NCIC/CCIC check for outstanding warrants ...............................................................
That the local authority has conducted, or intends to conduct, an inspection of the proposed premises to ensure that the applicant is in
compliance with, and aware of, liquor code provisions affecting their class of license .......................................................................................
(Check One)
Date of Inspection or Anticipated Date _____________________________________
Upon approval of state licensing authority.
Yes
No
