Fillable Form 7: CONFIDENTIAL BACKGROUND INVESTIGATION REPORT (City of Thornton)

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Form 7: CONFIDENTIAL BACKGROUND INVESTIGATION REPORT (City of Thornton)

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CONFIDENTIAL BACKGROUND INVESTIGATION REPORT
Form 7
City Clerk’s office 303-538-7230
9500 Civic Center Drive
Thornton, Colorado 80229-4326
REFERRAL TO THORNTON
POLICE DEPARTMENT
PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK
ATTACH SEPARATE SHEET IF NECESSARY
Name of Individual (please print):
Position:
Trade Name of Establishment:
Address of Establishment:
The City of Thornton, by law, has the authority to regulate Liquor and Beer Licenses. Pursuant to that authority, the City
conducts background investigations of applicants for owners and managers of Liquor or 3.2% Fermented Malt Beverage
licensed establishments. The Background Investigation Report provides basic information about the applicant, which is
necessary for the investigation.
Every answer you give will be checked for its truthfulness. A deliberate
falsehood will jeopardize the application, as such falsehood within itself
constitutes evidence regarding the reputation and character of the applicant.
¾ I have read and I do understand the above statement. I further acknowledge that I have obtained and examined
copies of Chapter 42, Article II of the Thornton City Code, pertaining to liquor laws for the City and the Colorado
Liquor Code (Title 12, Colorado Revised Statutes). Note: The Colorado State Liquor and Beer Codes are
available for sale at the Thornton City Clerk's office, Phone Number 303-538-7230 or State of Colorado Central
Stores, 4200 Garfield, Denver, Colorado 80216, Phone Number 303-321-2200.
¾ Excluding the corporate officers, stockholders, directors, partners, members, and/or managers of the licensed
premises, I hereby certify, under penalty of law, that no other individual(s) have any direct or indirect financial
interest in the business to be conducted under the license herein applied for.
¾ As an applicant, excluding managers, I hereby agree to notify the Local Licensing Authority, within 5 (five) days of
any changes in the financing of this business, should the changes occur during the period for which this license is
issued and for the term or terms of any renewals or extension thereof.
¾ I further certify the facts contained within the following Background Investigation Report are true and correct and I
understand that any falsification or misrepresentation will result in a rejection of this application or a revocation of
said license. Also said falsification, omission or misrepresentation is evidence of perjury in the second degree.
Signature Date Signed
Subscribed and sworn to before me by:
in the County of Adams, State of Colorado, this day of , 20
Notary Public:
SEAL
My Commission Expires:
CONFIDENTIAL BACKGROUND INVESTIGATION REPORT
Form 7 – Page 2
SECTION I - TO BE COMPLETED BY ALL APPLICANTS – INCLUDING MANAGERS
Driver’s License Number: State Issued:
Has your driver’s license ever been suspended or revoked? Yes No If yes, complete the following:
Where: When: Reason:
Marital Status: Name of Spouse (include maiden name if applicable): Spouse’s date of birth (if applicable):
Military Service (branch): From: To: Type of Discharge:
List all previous states resided
within (including military service):
If ever discharged from a position, complete the following: Where:
When: Reason:
Name Address Phone Time Known
List bank and
credit references
of applicant
and spouse
(if different):
Name Address Phone Time Known
List four
references
two Professional
& two Personal:
Violation When Where Final Disposition
List all
CONVICTIONS,
including traffic
(attach separate sheet
if necessary):
SECTION II - THE FOLLOWING SECTION DOES NOT APPLY TO MANAGERS
Will the applicant or anyone else, conduct any business other than the sale of alcoholic beverages on the licensed premises?
Yes No If yes, complete the following:
Type of Business:
Full Name of person who will operate business:
Residence Address: Date of Birth:
Has the applicant agreed to permit any person to receive, or agreed to pay to any employee or other person (by way of rent or
otherwise) all or any portion or percentage of the gross or net profits or income derived from the business to be conducted under the
license applied for?
Yes No If yes, please explain in detail:
If applicable, state in detail any form
of entertainment to be offered:
(authority/forms/city liquor forms/form 07/9.2004)
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Form 7: CONFIDENTIAL BACKGROUND INVESTIGATION REPORT (City of Thornton)

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Completed 5 August 2020

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