DR 8177 (12/28/18)
COLORADO DEPARTMENT OF REVENUE
Liquor Enforcement Division
Corporation, Limited Liability Company or Partnership Report of Changes
NOTE: ENCLOSE A CHECK PAYABLE TO THE AUTHORITY WHERE THIS APPLICATION WILL BE FILED FOR
$100.00 FOR EACH PERSON LISTED IN SECTIONS 8 AND 9 ON THE APPLICATION. MASTERFILE APPLICANTS
MUST INCLUDE A FEE OF $250.00 FOR EACH PERSON LISTED PAYABLE TO THE
COLORADO DEPARTMENT OF REVENUE. (Application led directly to the state)
NOTE: Check the appropriate box at the top to indicate whether you are Limited Liability Company (LLC), Partnership
Attach the following supporting documents to the Report of Changes Application:
Certicate of Incorporation (or) Date stamped Articles or, Partnership Agreement (Limited and General
Certicate of Good Standing dated within the last two years
Certicate of Authority (only if a foreign corporation)
Copies of minutes of meetings by the Corporation, Limited Liability Company or Partnership supporting the
changes reected on the front of this application. This includes letters of resignation, or appointment of any
ofcers, or directors of a Corporation, or any managing member or members of a Limited Liability Company,
or any general or limited partner in a Partnership (including husband and wife partnerships).
NOTE: If the Licensee as listed on Line 1 has a sole stockholder that is a Corporation, or LLC, or Partnership,
attach a letter designating one ofcer, or managing member or the general partner to be the "principal person" for
the applicant. This person MUST ALSO ll out a DR8404-I (Individual History Record) and submit ngerprints by
making an appointment with an approved State Vendor through the Vendor's website:
The vendors are as follows:
IdentoGO - https://uenroll.identogo.com/
Phone: (844) 539-5539 (toll-free)
IdentoGO FAQs: https://www.colorado.gov/pacic/cbi/identication-faqs
Colorado Fingerprinting by American BioIdentity – Details to be announced
This application and all supporting documents must FIRST BE FILED WITH, AND APPROVED BY, THE LOCAL
LICENSING AUTHORITY (CITY, TOWN, COUNTY). Applications will not be accepted unless all applicable questions
are fully answered, all supporting documents correspond exactly with the name of the applicant.
1. List the name of the Corporation or Limited Liability Company or Partnership
2. List the State Sales Tax Number.
3. List the Applicant's State Liquor License Number.
4. List the Trade name of the business.
5. List the area code and telephone number of the business.
6. List the complete address, City, State and Zip Code, of the licensed premises.
7. List your mailing address if different than number 6 above.
8. List all ofcers, directors of a corporation, or all managing members of the LLC, or General Partners of Limited
or General Partnerships. List the person's Position, Home Address, Date of Birth and the name of the person
being replaced (if applicable).
9. List all 10% (or more) stockholders or members or Partners, and indicate ownership percentage, Home
Address, Date of Birth, and the name of the person they purchased ownership interest from (if applicable).
10. List the name and address for service of the Registered Agent.
11. A person authorized to sign on behalf of the Applicant must sign the application, list their title, and the date the
application was signed.
12. To be lled out by the local licensing authority only. List the name of the authority and indicate if the
authority is a county, town/city. Then sign the application, list your title and attest the city/county
ofcials signature and date the application.