CONFIDENTIAL BACKGROUND INVESTIGATION REPORT
City Clerk’s office 303-538-7230
9500 Civic Center Drive
Thornton, Colorado 80229-4326
REFERRAL TO THORNTON
PLEASE TYPE OR PRINT LEGIBLY IN BLACK INK
ATTACH SEPARATE SHEET IF NECESSARY
Name of Individual (please print):
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
My Commission Expires: