NEW APPLICATION Checklist page 1 City Clerk s office Civic Center Drive Thornton, Colorado

Transcription

1 NEW APPLICATION Checklist page 1 City Clerk s office Civic Center Drive Thornton, Colorado ONE COMPLETE SET OF DOCUMENTS MUST BE SUBMITTED FOR INITIAL REVIEW For final submittal one original set plus one copy (two if filing a concurrent application) must be submitted. Incomplete application documents will not be accepted. Allow six to eight weeks for background investigation and processing. This application packet is for a location that does not currently have a liquor license. Provide documents in order of the Checklist pages 1 and 2 - Single-Sided - No Staples Please All documents and copies need to be legible and either typed or printed in BLACK ink on 8-1/2 x 11 size paper only. ALL documents must be properly executed and correspond with name of applicant exactly. Fees payable to the City of Thornton and Colorado Department of Revenue as listed on the fee schedule. PLEASE COMPLETE AND SUBMIT THE FOLLOWING: Appropriate City & State fees attached (see Fee Schedule). (If Concurrent Review is requested to allow the State to review the application at the same time as the City, include an additional $ with the Colorado Department of Revenue fee). Colorado License Application (Choose One) State Form DR Colorado Liquor Retail License Application State Form DR Colorado Fermented Malt Beverage License Application Floor Plan of premises to be licensed (8-1/2" x 11" size only) Outline Licensed Premises in BOLD, BLACK ink. Include square footage, occupancy and seating capacity (if applicable). Diagram needs to show seating and kitchen facilities for on-premises licenses and storage areas. State Form DR-8404-I - Individual History Record (each individual). ATTACH CITY OR STATE INVESTIGATION DOCUMENTS (IF APPLICABLE): City Investigation City Form 7 - Background Investigation Report (each individual). City Investigation - City Form 12 - Authorization and Consent to Release Information (each individual). Fingerprints Taken at Thornton Police Department Be sure to indicate to Thornton Police Department (Records) that it is for a liquor/beer license. For individuals who are out of state, please include two original fingerprint cards with the application documents. State Investigation Master File letter (final letter clearing all individuals on the application must be submitted before the application can be considered by the LLA) ( Fingerprints and City Forms 7 and 12 are not required). Purchase Agreements or Stock Transfer Agreements. Notes or Loans (assumed, banks, previous owner). Most recent bank statement for investment and business accounts. ATTACH CORPORATE DOCUMENTS (IF APPLICABLE): Articles of Incorporation date stamped by Secretary of State ( Certificate of Good Standing issued by the Colorado Secretary of State within the past two years (for existing corporations). Minutes of Corporate Meeting (elections, resignations, stock breakdown). Stock Certificates (100%). List of Officers/Stockholders/Directors of Parent Corporation (if applicable).

2 NEW APPLICATION Checklist page 2 ATTACH LIMITED LIABILITY COMPANY DOCUMENTS (IF APPLICABLE): Articles of Organization date stamped by Secretary of State. Copy of operating agreement. Certificate of Authority (if foreign company). Minutes of meetings reflecting acceptance of new members. ATTACH PARTNERSHIP DOCUMENTS (IF APPLICABLE): Partnership Agreement (not needed if Husband and Wife). Partnership Termination (if applicable). ATTACH SOLE PROPRIETOR AND HUSBAND AND WIFE PARTNERSHIP DOCUMENTS (IF APPLICABLE): State Form DR-4679 Affidavit Restrictions on Public Benefits HB 1023, Immigration Law requires that you submit verification of lawful presence in the United States. To verify legal presence, please complete the Affidavit - Restrictions on Public Benefits and submit with a copy of one of the following documents: Colorado Driver s license, or US Military Card or Military dependant s card, or UN Coast Guard Merchant Mariner Card, or Native American Tribal Document ATTACH THE FOLLOWING ADDITIONAL DOCUMENTS (ALL APPLICANTS): Provide a notarized affidavit stating establishment is not within 500 feet of a school - excluding 3.2% beer. Provide a signed copy of Deed or Lease covering entire license period, Assignment of Lease if applicable with consent and acceptance. The Lease must be in applicant's name (same entity name which appears on the application form and liquor license) and contain the address of the premises. Copies of the original lease must be submitted along with an Assignment of Lease, if applicable. City Form 5 - Zoning Referral signed by City Development Department. For Management other than licensee, refer to Manager's Registration Checklist and Instructions and submit appropriate forms including the fingerprinting fee (excluding Retail Liquor Store & 3.2% Beer). INSTRUCTIONS: Retain New Application Instructions, attached, to refer to throughout the application process. Contact City of Thornton Building Inspection Division to submit six sets of plans for review before starting construction and/or to obtain a Certificate of Occupancy. If a development permit is required it must be issued before a Certificate of Occupancy can be issued. The City Clerk s office requires a copy of the Certificate of Occupancy AFTER approval of application and BEFORE licenses will be issued. A training video will be provided to applicants by the City Clerk s office. Picture of posted hearing sign due one week before the hearing. Contact Tri-County Health Department for an inspection, if applicable, prior to licenses being issued. Contact City of Thornton Sales Tax Division to submit City Sales Tax License Application. State Sales Tax License (4-6 weeks to process) Contact Colorado Department of Revenue, 1375 Sherman Street, Room 112, Denver ( Contact City Clerk s office for an Amusement Device License Application (5 or more machines), if applicable. (authority/forms/packet forms/new application/ )

3 NEW APPLICATION City Clerk s office Instructions page 3 DOCUMENT SUBMITTAL INSTRUCTIONS: ONE COMPLETE SET OF DOCUMENTS MUST BE SUBMITTED FOR INITIAL REVIEW For final submittal one original set plus one copy (two if filing a concurrent application) must be submitted. Incomplete application documents will not be accepted. Allow six to eight weeks for background investigation and processing. This application packet is for a location that does not currently have a liquor license. Provide documents in order of the Checklist pages 1 and 2 - Single-Sided - No Staples Please All documents and copies need to be legible and either typed or printed in BLACK ink on 8-1/2 x 11 size paper only. ALL documents must be properly executed and correspond with name of applicant exactly. Fees payable to the City of Thornton and Colorado Department of Revenue as listed on the fee schedule. You may copy the City forms as needed. City and State forms are also available on the website at Contact Karren Werft, Agenda and Licensing Coordinator at if you have questions, need assistance, or to schedule an appointment for initial review. Obtain a Sales Tax License from both the City Sales Tax Division ; and the Colorado Department of Revenue (4-6 weeks to process) , 1375 Sherman Street, Room 112, State Sales Tax License. The City and State can not issue the liquor/beer licenses until the sales tax licenses have been issued. Contact the Building Inspection Division to submit six sets of plans for review before starting construction. If a development permit is required it must be issued before a Certificate of Occupancy can be issued. The City can not issue the licenses until the Certificate of Occupancy has been issued. If changes are made to the floor plan after the LLA has considered the license application, a request to modify needs to be submitted for approval by the LLA and State. The Lease must be in applicant's name (same entity name which will appear on the application form and liquor license) and contain the address of the premises. Copies of the original signed lease must be submitted along with an Assignment of Lease. If the manager is not the same as the applicant, please submit the required documents from the Manager's Registration Checklist and Instructions including the fingerprinting fee (excluding Retail Liquor Store & 3.2% Beer). If the City is performing the investigation all Officers, Directors, Stockholders, Members of Limited Liability Companies and Partnerships holding more than 10% interest, and Sole-Proprietors and/or Managers will need to be fingerprinted. Be sure to indicate to Thornton Police Department (Records) that it is for a liquor/beer license. For individuals who are out of state, please include two original fingerprint cards with the application documents. ADDITIONAL INFORMATION The LLA Rules of Procedure and Chapter 42, Article II of the Thornton City Code are included in the packet for your information. You may also purchase a copy of the Colorado Liquor and Beer Code, from the State Forms Center, 4200 Garfield, Denver, Colorado 80216, telephone number (commodity number ), or view the publications by visiting the State s website: If you have any exhibits or training materials you would like the LLA to consider, please provide nine copies at the hearing. It is the responsibility of the licensee to provide training for personnel involved in the sale and service of liquor and beer. In addition to the Thornton Police Department training video and classes, a complete list of trainers that comply with State standards is on the State s website: Pursuant to State Statute (1)(c), the City Clerk's office needs verification that the establishment is properly zoned prior to accepting a new license application. Please complete the first three questions on City Form 5 - Zoning Referral, then submit it with a copy of the site plan to the City Development Department. Submit signed copies of this form with your application.

4 NEW APPLICATION Instructions page 4 BOUNDARY, POSTING, AND PUBLISHING REQUIREMENTS After final submittal of the complete application documents - one original set plus one copy (two if filing a concurrent application), the City Clerk's office will notify the applicant of the public hearing date and boundaries of the neighborhood. The hearing date must be at least 30 days from the date of filing the application per State Statute; however, final submittal of documents must be made to the City Clerk's office six to eight weeks prior to the LLA meeting to allow sufficient time to complete the background investigation (meetings are generally held the third Wednesday of each month). If the boundaries are unacceptable the applicant has five days to notify the Agenda and Licensing Coordinator and the matter will be scheduled for a boundary hearing at the next LLA meeting. The City Clerk s office will publish the notice of hearing in the Northglenn/Thornton Sentinel two weeks prior to the hearing. The Applicant will need to post the public notice sign(s) prepared by the City Clerk's office on the proposed premises at least ten days prior to the public hearing and submit pictures of the posted sign(s) at least one week prior to the hearing. The Applicant needs to ensure that the sign(s) remain posted for at least ten consecutive days prior to the hearing, including the hearing date, and verify by completing the Posting Verification Affidavit (supplied by the City Clerk s office), which includes the date posted, exact location, and daily log used to check the condition of the sign(s). The Affidavit needs to be notarized and submitted to the Agenda and Licensing Coordinator just prior to the public hearing. If the City s posting board is used to display the sign, it will need to be returned to the City Clerk s office the day after the public hearing. PUBLIC HEARING AND OTHER PROCEDURES The applicant must appear before the Authority when the public hearing is held for a new license. Please refer to the Public Hearing Procedures and Types of Relevant Evidence (Rules of Procedures) for Public Hearings included in the application packet. All applicants have the burden of proving (1) that the inhabitants of the neighborhood desire that a license be issued, and (2) that the reasonable requirements of the neighborhood are not being met by existing outlets (with the exception of club licenses), C.R.S Present your evidence in the form of verbal testimony, petitions, or other means to support this as concisely as possible, and avoid repetitive testimony. Petitions - One manner of showing the needs and desires is by circulating petitions within the designated relevant neighborhood as shown on the boundary map. Many applicants use a marketing survey firm to circulate petitions. Sample petitions are available in the City Clerk's office should you decide to do your own survey. Petitions are due no later than 5:00 p.m. the Friday prior to the hearing. Pursuant to City Code , the LLA may require applicants to circulate petitions within the boundaries of the designated neighborhood prior to the public hearing. This may result in your public hearing being continued for one month if petitions are not done prior to the initial public hearing date. Following the hearing - If approved by the LLA allow two months for the State to process the application, unless you have requested concurrent review. The State will mail the approved license to the City Clerk's office. Prior to issuance of licenses you will need to provide copies of the City Sales Tax License, Certificate of Occupancy, and Tri-County Health Department inspection to the City Clerk s office. (authority/forms/packet forms/new application/ )

5 FEE SCHEDULE Effective July 1, 2017 FOR LIQUOR/BEER LICENSES City Clerk s office Civic Center Drive Thornton, Colorado NEW &/OR TRANSFER INVESTIGATION, APPLICATION, LICENSE (*PLUS ADDITIONAL FEES): CITY STATE New Application Investigation/Application Fee (Non-refundable) , Transfer Application Investigation/Investigation Fee (Non-refundable) , % Fermented Malt Beverage License Beer & Wine License (Malt & Vinous) Club License (Malt, Vinous & Spirituous) Hotel and Restaurant License (Malt, Vinous & Spirituous) Retail Liquor Store - and/or - Liquor Licensed Drug Store (Malt, Vinous & Spirituous) Tavern License (Malt, Vinous & Spirituous) *Concurrent Review New Application only (Optional Non-refundable) *Temporary Permit for Transfer of Ownership only (Optional) *Fingerprinting for each individual if City performs investigation *Manager's Registration - Hotel & Restaurant and Tavern (City amount includes fingerprinting fee) *Manager's Registration - Beer & Wine, Club, Etc. (amount includes fingerprinting fee) TOTALS RENEWAL FEES CITY STATE 3.2% Fermented Malt Beverage License Beer & Wine License (Malt & Vinous) Club License (Malt, Vinous & Spirituous) Hotel and Restaurant License (Malt, Vinous & Spirituous) Retail Liquor Store - and/or - Liquor Licensed Drug Store (Malt, Vinous & Spirituous) Tavern License (Malt, Vinous & Spirituous) OTHER FEES CITY STATE Change of Corporate Structure City Investigation - each individual (amount includes fingerprinting fee) / person Change of Location Change of Trade/Corporate Name Duplicate City and/or State License Petition fee for fine-in-lieu of suspension (Non-refundable) Replacement fee for Public Hearing Signs (each) Request to Change, Alter, or Modify Premises State Liquor Code (if purchased through City) Violation Signs (each) 5.00 (authority/forms/packet forms/fee schedule/july 2017)

6 LIQUOR & BEER LICENSING Information Brochure City Clerk s office Civic Center Drive Thornton, Colorado Introduction This Information Brochure is provided to give new licensees a brief summary of information to supplement the process pertaining to various applications. If you need to apply for a change in the status of your license, please contact the City Clerk s office first for the appropriate packet. The City Clerk s office can only accept complete application packets, which include the appropriate fees for both the City of Thornton and Colorado Department of Revenue. When are Local Licensing Authority Meetings The Local Licensing Authority generally meets on the third Wednesday of each month at 6:00 p.m. in the Council Chambers on the first floor of the City Hall. The applicant must appear before the Authority for all applications unless they have been approved administratively. Filing Renewals Approximately 90 days prior to the expiration date, you will receive a renewal application from the state. The one page application form (DR 8400) needs to be filed with the Thornton City Clerk's office. The deadline for filing renewals is 45 days prior to the expiration date. The City Clerk s Office sends a reminder letter to licensees of active licenses as a courtesy before the renewal is due. Please complete the first page of the reminder letter to reflect any changes that have occurred and submit it with your renewal. To avoid any processing delay, it is recommended that the renewal be filed prior to the 45-day deadline. Transfer of Ownership Application If there will be a transfer of possession or ownership of the licensed premises by the purchase, transfer or sale of the premises or by operation of law, the applicant must file application forms provided by the City Clerk. A background investigation will be conducted, which takes approximately 45 days to complete. If requested by the applicant, a temporary permit may be issued when a complete transfer of ownership application is accepted to allow the applicant to operate the establishment until the Authority considers the application. Change of Corporate/LLC Structure If you have a change in officers, directors or stockholders within your Corporation, or a change of members within your Limited Liability Company (LLC), you will need to complete a Report of Changes Form along with other documents as required by the State and City of Thornton. These changes need to be reported to the Local Licensing Authority within 30 days after they occur. Manager s Registration Hotel and Restaurant, Tavern, Beer and Wine, Club, Arts and Racetrack establishments are required to register a separate and distinct manager, if this individual is not currently listed on the license as a corporate officer or member of a LLC. If there has been a change in management, a new registered manager needs to be designated within 30 days. Modification of the Premises If you want to make a physical change, alteration or modification that materially or substantially alters the licensed premises, contact the City Clerk s office for an application, which can only be processed after plans have been approved by the Building Inspection Division. In instances where an expansion involves the outside of the establishment, such as the addition of a patio, it may be necessary to receive approval for a Development Permit through the City Development Department. If a permit is required, it must be obtained before the Local Licensing Authority considers the application for Modification of the Premises.

7 LIQUOR & BEER LICENSING Information Brochure - Continued Change of Location To change the location of a license, you must submit an application to the City Clerk first. All applications are subject to the same procedures and requirements as for the issuance of a new license, except that the background investigation regarding the applicant is not required. Change of Trade Name or Corporate Name To change the corporate name or trade name of an establishment or business to which the license is issued, the required forms need to be submitted to the City Clerk s office at least ten days prior to the change. Training Opportunities As you are aware, it is the responsibility of the licensee to provide training for personnel involved in the sale and service of liquor and beer. There are various organizations that offer formal training that covers pertinent topics such as acceptable identification and how to identify behavior of a customer who may be intoxicated. A complete list of trainers that comply with State standards is on the State s website: proved-responsible-vendors-training. Some organizations that offer training include: Training for Intervention Procedures by Servers TIPS Phone: GET-TIPS ( ) Colorado Restaurant Association (ServSafe Alcohol), Phone: Please contact the individual organization for more information concerning the cost and how to schedule a class. In addition, the Thornton Police Department has produced a training video which may be picked up from the City Clerk s office on the second floor of City Hall. For questions contact the Thornton Police Department Detective Division at to speak to the Detective in charge of Liquor Enforcement. Amusement Device Licenses The City of Thornton requires businesses, including liquor/beer-licensed establishments that have five or more amusement devices to obtain an amusement device license. The annual fees are $35 per machine and the term of the license coincides with the liquor license. Amusement Device is defined as being any machine or device that is played for a fee which is directly or indirectly charged, or operated with a coin, token, slug, ticket or otherwise, and includes the payment of a general admission charge in order to play such devices. An amusement device is considered to be played for entertainment of the player or to test a skill, such as video games, darts, pool, etc. Amusement devices do not include such things as bowling lanes, vending machines, juke boxes or rides for small children. To receive an application for an amusement device license call Compliance Checks The Thornton Police Department periodically conducts law compliance checks, which is a controlled buy, at all liquor establishments to ensure compliance with Colorado Liquor Code Laws and Regulations. Compliance checks are conducted due to a concern by the City and its Police Department about the possibility of alcoholic beverages reaching the hands of juveniles in the community. Compliance checks are also an effort to identify and target juveniles purchasing alcohol and individuals who purchase it for juveniles. When identified, those juveniles will be issued a summons or arrested when appropriate. A summons may also be issued to a server for a liquor code violation. However, the State Liquor Code gives the licensee of a liquor establishment the responsibility for employees selling to juveniles or for other violations of the Liquor Laws or Regulations that occur on the licensed premises. If violations are proven to have occurred, sanctions will probably be imposed against the Liquor License when appropriate and (Authority/Forms - Packet & Meeting/City Liquor Forms/Liquor & Beer Licensing Information Brochure July 2016)

8 LIQUOR & BEER LICENSING Information Brochure - Continued in accordance with the Local Licensing Authority guidelines. Please ensure that you and your staff are always compliant with Liquor Code Laws and Regulations. Internet Sites for Liquor Licensing The LLA website has links to Chapter 42, Article II of the City Code, the Rules of Procedure, City and State forms, checklists and instructions for filing various applications, as well as the Agendas and Minutes from current and previous meetings. You can access this information at The State s website for Liquor/Beer Licensing is ply-license-or-permit-liquor-enforcement-division which contains State Liquor and Beer Codes, application forms, information pamphlets, and answers to frequently asked questions. State Liquor Publications The publications, produced by the State Liquor Enforcement Division, are brief information sheets that cover topics of interest to licensees, such as: age requirements for employees valid proof of age hours during which liquor may be sold food service requirements where alcohol may be consumed signs of alcohol intoxication The publications can be accessed on the State Liquor Enforcement website: uor-tobacco-publications (Authority/Forms - Packet & Meeting/City Liquor Forms/Liquor & Beer Licensing Information Brochure July 2016)

9 ZONING REFERRAL Form 5 City Clerk s office Civic Center Drive Thornton, Colorado Applicant - complete the first three questions, check appropriate box, and submit this form with a copy of the site plan of the premises to the City Development Department Return the signed form with your application to the Agenda and Licensing Coordinator in the City Clerk's office Business Name: Business Address: Type of License applying for: Applicant Complete this Section Only Is the existing building going to be expanded/enlarged? Yes No New License Change of Location Modification of Premises To Be Completed & Signed By City Development / Zoning Division Zoning for the property is: Is the property zoned for the type of license applied for? Yes No Will the Development Review Process be required for this application? Yes No If so, what type of Development Permit is required? Major Minor If a review is scheduled, please indicate the anticipated hearing date for the Development Permits and Appeals Board (DPAB)*: Is there sufficient parking for the proposed use? Comments: *If this matter goes to DPAB, please attach the staff report and minutes. City Development/Zoning Division Signature: Date: (authority/forms/city liquor forms/form 05/7.2016)

10

11

12

13

14

15

16

17 DR 8403 (12/20/16) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division (303) Colorado Fermented Malt Beverage (3.2% Beer) License Application New License New-Concurrent Transfer of Ownership 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: 1. Applicant is applying as a/an Corporation Partnership (includes Limited Liability and Husband and Wife Partnerships) Individual 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 2a. Trade Name of Establishment (DBA) State Sales Tax No. Business Telephone 3. Address of Premises (specify exact location of premises) City County State ZIP Code 4. Mailing Address (Number and Street) City or Town State ZIP Code 5. Address 6. If the premises currently has a liquor or beer license, you MUST answer the following questions Present Trade Name of Establishment (DBA) Present State License No. Present Class of License Present Expiration Date Section A Nonrefundable Application Fees Section B 3.2% Beer License Fees Application Fee for New License $ Application Fee for New License - w/concurrent Review $ Application Fee for Transfer $ Retail 3.2% Beer On-Premises (City) $96.25 Retail 3.2% Beer On-Premises (County) $ Retail 3.2% Beer Off-Premises (City) $96.25 Retail 3.2% Beer Off-Premises (County) $ Retail 3.2% Beer On/Off Premises (City) $96.25 Retail 3.2% Beer On/Off Premises (County) $ Master File Location Fee... $25.00 x To Master File Background... $ x Total Questions? Visit for more information Do Not Write In This Space - For Department Of Revenue Use Only Liability Information License Account Number Liability Date: License Issued Through: (Expiration Date) Total $ 1

18 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. Questions? Visit: for more information. 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. Submit originals to local authority E. Additional information may be required by the local licensing authority II. III. IV. Diagram of the Premises A. No larger than 8 1/2" X 11" B. Dimensions included (does not have to be to scale). Exterior areas should show control (fences, walls, etc.) C. Separate diagram for each floor (if multiple levels) D. Bold/Outlined licensed premises Proof of Property Possession (One Year Needed) A. Deed in name of the applicant ONLY (or) (matching question #2) date stamped/filed with County Clerk B. Lease in the name of the applicant ONLY (matching question #2) 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 (attach prior lease to show right to assumption) 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. V. Sole Proprietor/Husband and Wife Partnership (if applicable) A. Form DR 4679 B. Copy of State Issued Driver's License or Identification Card for each Applicant VI. Corporate Applicant Information (If Applicable) A. Certificate of Incorporation (date stamped by Colorado Secretary State's Office) and/or B. Certificate of Good Standing C. Certificate of Authorization if foreign corporation D. List of officers, directors and stockholders of parent corporation (designate one person as "principal officer") VII. Partnership Applicant Information (If Applicable) A. Partnership Agreement (general or limited). Not needed if husband and wife B. Certificate of Good Standing (if formed after 2009) VIII. Limited Liability Company Applicant Information (If Applicable) A. Copy of articles of organization (date stamped by Colorado Secretary of State's Office) B Certificate of Good Standing if organized more than two years C. Copy of operating agreement D. Certificate of Authority (if foreign company) 2

19 7. Is 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 under the age of twenty-one years? Yes No 8. 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? (c) had interest in another entity that had an alcohol beverage license suspended or revoked? If you answered yes to 8a, b or c, explain in detail on a separate sheet 9. Has a 3.2 beer license for the premises to be licensed been denied within the preceding one year? If "yes," explain in detail. 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: Landlord Tenant Expires b. Is a percentage of alcohol sales included as compensation to the landlord? If yes complete question 12. c. Attach a diagram or designate the area to be licensed in black bold outline (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". 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. Last Name First Name Date of Birth FEIN or SSN Interest Last Name First 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. 13. Name of Manager(s) for all on and on/off applicants. Last Name First Name Date of Birth 14. 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. 15. Tax Distraint Information. Does the applicant or any other person listed on this application 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. 3

20 16. 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 ownership of 10% or more in the Applicant. All persons listed below must also attach form DR 8404-I (Individual History Record), and submit fingerprint cards to the local licensing authority. Name Home Address, City & State Date of Birth Position % Owned Name Home Address, City & State Date of Birth Position % Owned Name Home Address, City & State Date of Birth Position % Owned Name Home Address, City & State Date of Birth Position % Owned ** Limited Liability Companies and Partnerships - 100% of ownership must be accounted for on question #16 ** Corporations - The President, Vice-President, Secretary and Treasurer must be accounted for on question #16 (Include ownership percentage if applicable) 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 Printed Name and Title Date 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 (1) C.R.S.) Each person required to file DR 8404-I has been: Fingerprinted 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 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. and Liquor Rules. Therefore, this application is approved. Local Licensing Authority for Telephone Number Town, City County Signature Printed Name Title Date Signature (attest) Printed Name Title Date 4

21 DR 8404-I (08/10/16) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division (303) Individual History Record To be completed by the following persons, as applicable: sole proprietors; general partners regardless of percentage ownership, and limited partners owning 10% or more of the partnership; all principal officers of a corporation, all directors of a corporation, and any stockholder of a corporation owning 10% or more of the outstanding stock; managing members or officers of a limited liability company, and members owning 10% or more of the company; and any intended registered manager of Hotel and Restaurant, Tavern and Lodging and Entertainment class of retail license Notice: This individual history record requires information that is necessary for the licensing investigation or inquiry. All questions must be answered in their entirety or the license application may be delayed or denied. If a question is not applicable, please indicate so by N/A. Any deliberate misrepresentation or material omission may jeopardize the license application. (Please attach a separate sheet if necessary to enable you to answer questions completely) 1. Name of Business Home Phone Number Cellular Number 2. Your Full Name (last, first, middle) 3. List any other names you have used 4. Mailing address (if different from residence) Address 5. List current residence address. Include any previous addresses within the last five years. (Attach separate sheet if necessary) Street and Number City, State, Zip From To Current Previous 6. List all employment within the last five years. Include any self-employment. (Attach separate sheet if necessary) Name of Employer or Business Address (Street, Number, City, State, Zip) Position Held From To 7. List the name(s) of relatives working in or holding a financial interest in the Colorado alcohol beverage industry. Name of Relative Relationship to You Position Held Name of Licensee 8. Have you ever applied for, held, or had an interest in a Colorado Liquor or Beer License, or loaned money, furniture, fixtures, equipment or inventory to any licensee? (If yes, answer in detail.) Yes No 9. Have you ever received a violation notice, suspension, or revocation for a liquor law violation, or have you applied for or been denied a liquor or beer license anywhere in the United States? (If yes, explain in detail.) Yes No

22 10. Have you ever been convicted of a crime or received a suspended sentence, deferred sentence, or forfeited bail for any offense in criminal or military court or do you have any charges pending? (If yes, explain in detail.) Yes No 11. Are you currently under probation (supervised or unsupervised), parole, or completing the requirements of a deferred sentence? (If yes, explain in detail.) Yes No 12. Have you ever had any professional license suspended, revoked, or denied? (If yes, explain in detail.) Yes No Personal and Financial Information Unless otherwise provided by law, the personal information required in question #13 will be treated as confidential. The personal information required in question #13 is solely for identification purposes. 13a. Date of Birth b. Social Security Number c. Place of Birth d. U.S. Citizen Yes No e. If Naturalized, state where f. When g. Name of District Court h. Naturalization Certificate Number i. Date of Certification j. If an Alien, Give Alien s Registration Card Number k. Permanent Residence Card Number l. Height m. Weight n. Hair Color o. Eye Color p. Gender q. Race r. Do you have a current Driver s License/ID? If so, give number and state. Yes No # State 14. Financial Information. a. Total purchase price or investment being made by the applying entity, corporation, partnership, limited liability company, other. $ b. List the total amount of the personal investment, made by the person listed on question #2, in this business including any notes, loans, cash, services or equipment, operating capital, stock purchases or fees paid. $ * If corporate investment only please skip to and complete section (d) ** Section b should reflect the total of sections c and e c. Provide details of the personal investment described in 14b. You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Account Type Bank Name Amount d. Provide details of the corporate investment described in 14 (a). You must account for all of the sources of this investment. (Attach a separate sheet if needed) Type: Cash, Services or Equipment Loans Account Type Bank Name Amount e. Loan Information (Attach copies of all notes or loans) Name of Lender Address Term Security Amount Oath of Applicant I declare under penalty of perjury that this application and all attachments are true, correct, and complete to the best of my knowledge. Authorized Signature Print Signature Title Date

23 DR 4679 (03/24/14) COLORADO DEPARTMENT OF REVENUE Affidavit - Restrictions On Public Benefits I,, swear or affirm under penalty of perjury under the laws of the State of Colorado that (check one): I am a United States citizen. I am not a United States citizen but I am a Permanent Resident of the United States. I am not a United States citizen but I am lawfully present in the United States pursuant to Federal law. I am a foreign national not physically present in the United States. I understand that this sworn statement is required by law because I have applied for a public benefit. I understand that state law requires me to provide proof that I am lawfully present in the United States prior to receipt of this public benefit. I further acknowledge that making a false, fictitious, or fraudulent statement or representation in this sworn affidavit is punishable under the criminal laws of Colorado as perjury in the second degree under Colorado Revised Statute and it shall constitute a separate criminal offense each time a public benefit is fraudulently received. Signature Date (MM/DD/YY)

24 MANAGER'S REGISTRATION Checklist and Instructions City Clerk s office Civic Center Drive Thornton, Colorado ONE COMPLETE SET OF DOCUMENTS MUST BE SUBMITTED (Incomplete sets will be returned) Allow six weeks for processing. Provide documents in order of the Checklist - Single-Sided - No Staples Please All documents and copies need to be legible and either typed or printed in BLACK ink on 8-1/2 x 11 size paper only. ALL documents must be properly executed and correspond with name of applicant exactly. LICENSEE DOCUMENTS (COMPLETE AND SIGN BEFORE SUBMITTING): State Form DR Permit Application & Report of Changes (complete appropriate sections licensee signature required). Affidavit (notarized statement) showing duties, limitations, & compensation of manager or Management Contract or Agreement (acceptable employer-employee contract). MANAGER DOCUMENTS (COMPLETE AND SIGN BEFORE SUBMITTING): State Form DR-8404-I - Individual History Record. City Form 7 - Background Investigation Report. City Form 12 - Authorization and Consent to Release Information. Fingerprints - taken at Thornton Police Department (specify that it is for a liquor license manager s registration). HOTEL AND RESTAURANT OR TAVERN APPLICATION FEES: $75.00 Colorado Department of Revenue ($ concurrent review fee if applicable). $ City of Thornton (includes $75.00 investigation and $38.50 fingerprinting fee) BEER AND WINE, CLUB, ARTS AND RACETRACK APPLICATION FEES: $ City of Thornton (includes $75.00 investigation and $38.50 fingerprinting fee) INSTRUCTIONS: Contact the City Clerk s Office at to schedule an appointment for initial review with the Agenda and Licensing Coordinator. Any subsequent change in managers must be reported within the time frame designated in C.R.S (8) and C.R.S (10). The Local Licensing Authority generally meets on the third Wednesday of each month. The completed application packet must be returned to the City Clerk's office no later than six weeks prior to the meeting at which time the Authority will consider the application. This time period is necessary for the City to complete its background investigation on the manager. The Manager is required to attend the meeting to answer any questions the Authority may have pertaining to State and Local Liquor Laws to assure that he/she is familiar with the rules and regulations regarding the sale of alcoholic beverages. A copy of Chapter 42, Article II of the Thornton City Code is included for your information. Please stop by the City Clerk s office to pick up a copy of a training video from the Thornton Police Department. In addition to the Thornton Police Department training video a complete list of trainers that comply with State standards is on the State s web site: (authority/forms/packet forms/managers/ )

25 DR 8442 (08/10/16) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division Denver, CO (303) FOR DEPARTMENT USE ONLY Permit Application and Report of Changes Current License Number All Answers Must Be Printed in Black Ink or Typewritten Local License Fee $ 1. Applicant is a Corporation... Individual Present License Number Partnership... Limited Liability Company 2. Name of Licensee 3. Trade Name 4.Location Address City County ZIP SELECT THE APPROPRIATE SECTION BELOW AND PROCEED TO THE INSTRUCTIONS ON PAGE 2. Section A Manager reg/change Section C License Account No. Manager's Registration (Hotel & Restr.)...$75.00 Manager's Registration (Tavern)...$75.00 Manager's Registration (Lodging & Entertainment)...$75.00 Change of Manager (Other Licenses pursuant to section (8), C.R.S.) NO FEE Section B Duplicate License Liquor License No. Duplicate License... $50.00 Retail Warehouse Storage Permit (ea)...$ Wholesale Branch House Permit (ea) Change Corp. or Trade Name Permit (ea) Change Location Permit (ea) Change, Alter or Modify Premises $ x Total Fee Addition of Optional Premises to Existing H/R $ x Total Fee Addition of Related Facility to Resort Complex $75.00 x Total Fee Do Not Write in This Space For Department of Revenue Use Only Date License Issued License Account Number Period The State may convert your check to a one time electronic banking transaction. Your bank account may be debited as early as the same day received by the State. If converted, your check will not be returned. If your check is rejected due to insufficient or uncollected funds, the Department of Revenue may collect the payment amount directly from your bank account electronically. TOTAL AMOUNT DUE $.00

26 DR 8442 (08/10/16) Page 2 Instruction Sheet For All Sections, Complete Questions 1-4 Located on Page 1 Section A To Register or Change Managers, check the appropriate box in section A and complete question 8 on page 4. Proceed to the Oath of Applicant for signature. Section B For a Duplicate license, be sure to include the liquor license number in section B on page 1 and proceed to page 4 for Oath of Applicant signature. Section C Check the appropriate box in section C and proceed below. 1) For a Retail Warehouse Storage Permit, go to page 3 complete question 5 (be sure to check the appropriate box). Submit the necessary information and proceed to page 4 for Oath of Applicant signature. 2) For a Wholesale Branch House Permit, go to page 3 and complete question 5 (be sure to check the appropriate box). Submit the necessary information and proceed to page 4 for Oath of Applicant signature. 3) To Change Trade Name or Corporation Name, go to page 3 and complete question 6 (be sure to check the appropriate box). Submit the necessary information and proceed to page 4 for Oath of Applicant signature. 4) To modify Premise, go to page 4 and complete question 9. Submit the necessary information and proceed to page 4 for Oath of Applicant signature. 5) For Optional Premises or Related Facilities go to page 4 and complete question 9. Submit the necessary information and proceed to page 4 for Oath of Applicant signature. 6) To Change Location, go to page 3 and complete question 7. Submit the necessary information and proceed to page 4 for Oath of Applicant signature.

27 DR 8442 (08/10/16) Page 3 Storage Permit 5. Retail Warehouse Storage Permit or a Wholesalers Branch House Permit Retail Warehouse Permit for: On Premises Licensee (Taverns, Restaurants etc.) Off Premises Licensee (Liquor stores) Wholesalers Branch House Permit Address of storage premise: City, County, Zip Attach a deed/ lease or rental agreement for the storage premises. Attach a detailed diagram of the storage premises. Change Trade Name or Corporate Name 6. Change of Trade Name or Corporation Name Change of Trade name / DBA only Corporate Name Change (Attach the following supporting documents) 1. Certificate of Amendment filed with the Secretary of State, or 2. Statement of Change filed with the Secretary of State, and 3. Minutes of Corporate meeting, Limited Liability Members meeting, Partnership agreement. Old Trade Name New Trade Name Old Corporate Name New Corporate Name 7. Change of Location NOTE TO RETAIL LICENSEES: An application to change location has a local application fee of $750 payable to your local licensing authority. You may only change location within the same jurisdiction as the original license that was issued. Pursuant to (1) C.R.S. Your application must be on file with the local authority thirty (30) days before a public hearing can be held. Date filed with Local Authority Date of Hearing (a) Address of current premises Change of Location City County Zip (b) Address of proposed New Premises (Attach copy of the deed or lease that establishes possession of the premises by the licensee) Address City County Zip (c) New mailing address if applicable. Address City County State Zip (d) Attach detailed diagram of the premises showing where the alcohol beverages will be stored, served, possessed or consumed. Include kitchen area(s) for hotel and restaurants.

28 DR 8442 (08/10/16) Page 4 Change of Manager Modify Premises or Addition of Optional Premises or Related Facility 8. Change of Manager or to Register the Manager of a Tavern, Hotel and Restaurant, Lodging & Entertainment liquor license or licenses pursuant to section (8). (a) Change of Manager (attach Individual History DR 8404-I H/R, Tavern and Lodging & Entertainment only) Former manager's name New manager's name (b) Date of Employment Has manager ever managed a liquor licensed establishment?... Yes Does manager have a financial interest in any other liquor licensed establishment?... Yes If yes, give name and location of establishment 9. Modification of Premises, Addition of an Optional Premises, or Addition of Related Facility NOTE: Licensees may not modify or add to their licensed premises until approved by state and local authorities. (a) Describe change proposed (b) If the modification is temporary, when will the proposed change: Start (mo/day/year) End (mo/day/year) NOTE: THE TOTAL STATE FEE FOR TEMPORARY MODIFICATION IS $ (c) Will the proposed change result in the licensed premises now being located 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? (If yes, explain in detail and describe any exemptions that apply)...yes No (d) Is the proposed change in compliance with local building and zoning laws?...yes No (e) If this modification is for an additional Hotel and Restaurant Optional Premises or Resort Complex Related Facility, has the local authority authorized by resolution or ordinance the issuance of optional premises?...yes No (f) Attach a diagram of the current licensed premises and a diagram of the proposed changes for the licensed premises. (g) Attach any existing lease that is revised due to the modification. Oath of Applicant I declare under penalty of perjury in the second degree that I have read the foregoing application and all attachments thereto, and that all information therein is true, correct, and complete to the best of my knowledge. Signature Title Date No No Report and Approval of LOCAL Licensing Authority (CITY / COUNTY) The foregoing application has been examined and the premises, business conducted and character of the applicant is satisfactory, and we do report that such permit, if granted, will comply with the applicable provisions of Title 12, Articles 46 and 47, C.R.S., as amended. Therefore, This Application is Approved. Local Licensing Authority (City or County) Date filed with Local Authority Signature Title Date Report of STATE Licensing Authority The foregoing has been examined and complies with the filing requirements of Title 12, Article 47, C.R.S., as amended. Signature Title Date

29 ADDITIONAL LEASED EQUIPMENT, VENDING MACHINE, OR AMUSEMENT DEVICE LOCATIONS: Name of Thornton Business Location Address No. of machines or pieces of leased equipment at location PRIVILEGED AND/OR CONFIDENTIAL COMMERCIAL FINANCIAL INFORMATION NAMES AND HOME ADDRESSES OF OWNERS, PARTNERS, OFFICERS, OR MEMBERS OF LLC (Must Be Completed) Name Date of Birth Address (street, city, state, zip wde) Phone Number %owned and title Bank Name Bank Account No. Type of Account. Bank Address Federal Employer Identification No. (FEIN) or SS# Colorado State License No. Drivers License No. (Sole Proprietors Only) FILING FREQUENCY: If average tax owed is: ~$25.001month or less - Annually OUnder $1001month - Quarterly ~$1001monlh or more - Monthly UWholesale only - Annually "I declare, under penalty of perjuly, that this application has been examined by me and the statements made herein are made in good faith pursuant to the City of Thomton tax laws and, to the best of my knowledge and belief, are true, wmect and complete." APPLICANT: (PLEASE PRINT) APPLICANT'S SIGNATURE: TITLE: DATE:

30 THORNTON INITIAL USE TAX RETURN FOR A NEW BUSINESS OR ACQUISI'TION OF AN EXISTING BUSINESS CITY OF THORNTOIV, COLORADO SALES TAX DEPARTMENT 9500 Civic Center Drive Thomton, Colorado COMPLETE AND RETURN ORIGINAL COPY MAKE COPY FOR YOUR RECORDS THE CITY OF THORNTON SALES AND USE TAX ORDINANCE LEVIES A 3.75% USE TAX UPON: a) Tarlgible personal property purchased for use (i.e, items not for resale) in the operation of your business within the corporate limits of Thornton, when no City sales tax was paid at the time of purchase; and b) Tangible personal property (except inventory for resale) acquired through the purchase of a "going or existing business" within the corporate limits of Thomton. To determine if Thornton's 3.75% use tax is due, examine the Purchase Agreement andlor all invoice copies of tangible personal property purchased. If the Purchase Agreement andlor invoices do not include 3.75% sales tax for the City of Thomton, as well as all Colorado State collected sales taxes, then those items should be included on the sched~~le below. Some common items subject to the tax are, but not limited to, furniture, fixtures, office equipment, machinery, shelving, cabinets, preprinted forms, books, factory supplies, office supplies, cleaning supplies, brochures, and leases or rentals of any equipment. If you have questions on the taxability of specific items, contact the City Sales Tax Department at Please schedule below all tangible personal property brought into the City or purchased and delivered to your new Thornton business location. (If necessary, attach additional listings and enter the total amount on the "Total Cost" line below.) If you have purchase documents which show that City tax has been paid attach copies and enter "none" on the "Tax Due" line. In order for this return to be properly reviewed, please enclose copies of all invoices andlor other supportinsr documentation. Purchase Date Name of Vendor Description of Item $ Cost PLEASE NOTE THIS RETURN MUST BE PROPERLY SIGNED Total Cost $ AND RETURNED TOGETHER WITH THE AMOUNT TAX DUE 3.75% of Total Cost $ DUE, IF ANY, ON OR BEFORE THE TWENTIETH (20TH) DAY OF THE MONTH FOLLOWING THE IF RETLIRN IS FILED AFTER THE DLlE DATE, THEN ADD: DATE OF PURCHASE. Penalty: 10% of Tax $ Interest: 37% per month $ Total Due: $ I hereby certify this is a complete list reflecting the total cost of all taxable tangible personal property initially purchased or brought into the City for use in Thomton by the business named below: Business Name: Address: Signature: Title: Date:

31

32

33

34

35 DEPARTMENT OF THE TREASURY ALCOHOL AND TOBACCO TAX AND TRADE BUREAU (TTB) Alcohol Dealer Registration - For Use On and After July 1, 2008 (Please read instructions carefully before completing this form) NAME (Last, First, Middle) or CORPORATE NAME (If Corporation) SECTION 1 - IDENTIFYING INFORMATION Complete all fields in section I to correctly identify your business OMB NO ( ) EMPLOYER IDENTI FlCATlON NUMBER (See Instructions) MAILING ADDRESS (Street address or P. 0. Box) SELECT BOX a, b, or c: c. EXISTING BUSINESS WITH a. NEW BUSINESS CHANGE IN: (comnlete items below) 1. b. ( OUT OF BUSINESS ' NAME I TRADE NAME [7 OWNERSHIP INFO ADDRESS 1 LOCAT~ON EMPLOYER IDENTIFICATION NUMBER DATE OF CHANGE, OR OF ENTRY INTO BUSINESS, OR OF -reriviination BUSINESS CLASS (OLD: - ) OF BUSINESS (~mlddlyyyy) PHONE (NEW: - ) SECTION 2 - BUSlNESS CLASS(ES) AND PREMISES LOCATIONS Enter information below for each business location, usina the a ~~ro~riate class code DEALERCLASS /SUBCLASS CLASS CODE RETAIL DEALER (Anyone who sells, or offers for sale, i~iquors (Distilled Spirits, Wine or Beer) I 11 beverage alcohol products to any person other than a dealer. Beer Only 12 Examples are package stores, restaurants, bars, private clubs, fraternal organizations, grocery stores or supermarkets Liquors (Distilled Spirits, wine or Beer) - At Large* 15 which sell such beverages.) Beer Only - At Large* 16 WHOLESALE DEALER (Anyone who sells, or offers for sale, beverage alcohol products to another dealer. An IMPORTER must register as a wholesaler if he or she sells beverage alcohol products to other dealers.) * A retail dealer at large is one whose business requires him to move from place to place, such as a circus or carnival. CITY Liquors (Distilled Spirits, Wine, or Beer) Beer Or~ly CLASS CODE TRADE NAME PREMISES ADDRESS STREET NUMBER AND NAME CITY, STATE, ZIP CODE TELEPHONE NUMBER ( ) ( ) ( ) ( ) ( ) Under penalties of perjury, I declare that the statements in this registration are true and correct to the best of my knowledge and belief; that this registration applies only to the specified business and location or, where the registration is for more than one location, it applies only to the businesses at the locations specified on the attached list. SIGNATURE TITLE DATE TTB F ( ) Page 1 of 2 I I

36 SECTION 3 - OWNERSHIP INFORMATION OMB NO ( INDIVIDUAL OWNER PARTNERSHIP CORPORATION LLC OTHER (Specify) FULL NAME RESIDENCE ADDRESS POSlTlOlV FULL NAME RESIDENCE ADDRESS POSITION FULL NAME RESIDENCE ADDRESS POSITION FULL NAME RESIDENCE ADDRESS POSITION FULL NAME RESIDENCE ADDRESS POSITION INSTRUCTIONS GENERAL INSTRUCTIONS This registration is for use on and after July 1, If you are engaged in one or more of the alcohol activities listed on this form, you are required to file this form before beginning business. If there is a change in your business, you need to report it on or before the next July 1 (see CHANGES IN OPERATIONS, below). You may file one registration to cover several locations or several types of activity operating under the same Employer Identification Number (EIN). NOTE: The special (occupational) tax on producers and marketers of alcohol beverages was repealed by Section of Public Law , effective July 1, However, tax liability and the registration requirement for periods before that date remain. If you need to file a delinquent or amended registration for a period through June 30, 2008, please use TTB Form a, Alcohol Special (Occupational) Tax Registration and Return - For Periods Ending On or Before June 30, SIGNING YOUR REGIS'rRATION This form must be signed by the individual owner, a partner, or, in the case of a corporation or LLC, an individual authorized to sign on behalf of the corporation or LLC. SEC'TION 1 - IDENTIFYING INFORMATION Complete Section 1, Identifying Information, as specified on the form. Your registration must contain a valid Employer ldentification Number (EIN). The EIN is a unique number for business entities issued by the Internal Revenue Service (IRS). You must have an EIN whether you are an individual owner, partnership, corporation, LLC, oi a government agency. If you do not have an EIN, contact the Internal Revenue Service immediately to obtain one. While TTB may assign a temporary identification number (beginning with XX) to allow initial processing of a return which lacks an EIN, do not delay submission of your registration pending receipt of your Elll. If you have not received a number by the time you file this return, write "number applied for" in the space for the number. Submit your EIN by separate correspondence after receipt from the IRS. SEC'I'ION 2 - PREMISES LOCATIONS Enter the requested information in Section 2 for each premises location even if this repeats the business information listed in Section 1. If you are reporting a change, enter the date of the change in the appropriate space in Section 1. If additional sheets are needed, make a copy of page 1 of this form or enter the requested information on a separate sheet of paper with your EIN and Company's name. SECTION 3 - OWNERSHIP INFORMATION Please complete the ownership information in Section 3. Supply the information specified for each individual owner, partner or responsible person. For a corporation, partnership or association, a responsible person is anyone with the power to control the management policies or buying or selling practices pertaining to alcohol. For a corporation, association, or similar organization, it also means any person owning 10 percent or more of the outstanding stock in the business. CHANGES IN OPERATIONS If there is a change of your company's name, trade name, address, premises location, telephone number, ownership information, type of business, or EIN, complete TTB F d and submit it no later than the next July 1 after the change. Check the box, Existing Business with change(s), complete all fieids in Section 1, and complete Sections 2 and 3 as necessary to show any changes there. Upon going out of business, submit TTB F d within 30 days, checking box b in Section 1. If you are still in business but there are no changes since your last registration, this form does not need to be submitted. MAILING INSTRUCTIONS Please sign and date this registration and mail it to: Alcohol and Tobacco Tax and Trade Bureau 550 Main Street, Suite 8002 Cincinnati, OH CONTACT INFORMATION For further assistance, contact TTB National Revenue Center at or ; or to ttbtaxstamp@ttb.gov. Additional information is also available at our Web site, PAPERWORK REDUC'I'ION ACT NOTICE This request is in accordance with the Papework Reduction Act of This information is used to ensure compliance with Section of Public Law , and the Internal Revenue Laws of the United States. The estimated average burden associated with this collection of information is.8 hour per respondent or record keeper, depending on individual circumstances. Comments concerning the accuracy of this burden estimate and suggestions for reducing this burden should be addressed to the Reports Management Officer, Regulations and Rulings Division, Alcohol and Tobacco Tax and Trade Bureau, Washington, D.C An agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a current, valid OMB control number. Page 2 of 2 TrB F d ( )