Fillable Fermented Malt Beverage License Application

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Fermented Malt Beverage License Application

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The Fermented Malt Beverage License Application form is 4 pages long and contains:

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  • 41 check-boxes
  • 115 other fields

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U.S.A. forms for City of Evans Colorado

BROWSE CITY OF EVANS COLORADO (CO) FORMS

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1
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: www.colorado.gov/enforcement/liquor
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. Email 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 Fermented Malt Beverage Beer License Fees
Application Fee for New License $550.00
Application Fee for New License - w/Concurrent Review $650.00
Application Fee for Transfer $550.00
Retail Fermented Malt Beverage On-Premises (City) $96.25
Retail Fermented Malt Beverage On-Premises (County) $117.50
Retail Fermented Malt Beverage Off-Premises (City) $96.25
Retail Fermented Malt Beverage Off-Premises (County) $117.50
Master File Location Fee ............... $25.00 x _________ To _________
Master File Background ............... $250.00 x ________ Total ________
Questions? Visit www.colorado.gov/enforcement/liquor 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
$
DR 8403 (12/27/18)
COLORADO DEPARTMENT OF REVENUE
Liquor Enforcement Division
(303) 205-2300
Colorado Fermented Malt Beverage
License Application
2
Application Documents Checklist and Worksheet
Instructions: This check list should be utilized to assist applicants with ling 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 nal State
approval the license will be mailed to the local licensing authority. Application fees are nonrefundable.
Questions? Visit: www.colorado.gov/enforcement/liquor for more information.
Items Submitted, Please Check all Appropriate Boxes Completed or Documents Submitted
I. Applicant Information
A. Applicant/Licensee identied
B. State sales tax license number listed or applied for at time of application
C. License type or other transaction identied
D. Submit originals to local authority
E. Additional information may be required by the local licensing authority
II. 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 oor (if multiple levels)
D. Bold/Outlined licensed premises
III. Proof of Property Possession (One Year Needed)
A. Deed in name of the applicant ONLY (or) (matching question #2) date stamped/led 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)
IV. Background Information and Financial Documents
A. Individual History Record(s) (Form DR 8404-I)
B. Fingerprints taken and submitted to the appropriate Local Licensing Authority through an approved State Vendor.
Master File applicants submit results to the State using code 25YQHT with IdentoGO.
The Vendors are as follows:
IdentoGO - https://uenroll.identogo.com/
Phone: (844)539-5539 (toll-free)
IdentoGO FAQs: https://www.colorado.gov/pacic/cbi/identication-faqs
Colorado Fingerprinting by American BioIdentity – Details to be announced
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 Identication Card for each Applicant
VI. Corporate Applicant Information (If Applicable)
A. Certicate of Incorporation (date stamped by Colorado Secretary State's Ofce) and/or
B. Certicate of Good Standing
C. Certicate of Authorization if foreign corporation
D. List of ofcers, directors and stockholders of parent corporation (designate one person as "principal ofcer")
VII. Partnership Applicant Information (If Applicable)
A. Partnership Agreement (general or limited). Not needed if husband and wife
B. Certicate 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 Ofce)
B Certicate of Good Standing if organized more than two years
C. Copy of operating agreement
D. Certicate of Authority (if foreign company)
DR 8403 (12/27/18)
3
7. Is the applicant (including any of the partners if a partnership; members or managers if a limited liability company;
or ofcers, 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
ofcers, 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 Fermented Malt Beverage license for the premises to be licensed been denied within the preceding one year? If
"yes," explain in detail.
10. Is the proposed Retail Fermented Malt Beverage Off Premises license within 500 feet of any public or parochial school,
the principal campus of any college, university, or seminary? NOTE: The distances are to be computed using the methods
outlined under C.R.S. 44-3-313(1)(d)(II). Some limited exceptions apply under C.R.S. 44-3-313.
11. 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 ofcers, stockholders or directors if a corporation)? If yes, identify the name of the
business and list any current or former nancial interest in said business including any loans to or from a licensee.
12. 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".
13. Who, besides the owners listed in this application (including persons, rms, 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 prot or gross proceeds of this establishment,
and any agreement relating to the business which is contingent or conditional in any way by volume, prot, sales, giving of advice or
consultation.
14. Name of Manager(s) for all on premises applicants.
Last Name First Name Date of Birth
15. Does this manager act as the manager of, or have a nancial interest in, any other liquor licensed establishment in the
State of Colorado? If yes, provide name, type of license and account number.
16. Tax Distraint Information. Does the applicant or any other person listed on this application including its partners,
ofcers, directors, stockholders, members (LLC) or managing members (LLC) and any other persons with a 10% or greater
nancial 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.
DR 8403 (12/27/18)
4
17. If applicant is a corporation, partnership, association or limited liability company, applicant must list all Ofcers, 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 make an appointment to be ngerprinted by an approved State
Vendor through the Vendor's website. See application checklist, Section IV, for details.
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 led with local authority Date of local authority hearing – for new license applicants cannot be less
than 30 days from date of application 44-3-311(1) C.R.S.
Each person required to le 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
For new Retail Fermented Malt Beverage Off Premises licenses, distance requirements of Senate Bill 18-243 are satised
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 44, Article 4 or 3, 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
DR 8403 (12/27/18)
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Fermented Malt Beverage License Application

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Completed 12 July 2020

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