Fillable Permit Application And Report Of Changes (Town of Buena Vista)

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Permit Application And Report Of Changes (Town of Buena Vista)

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1
DR 8442 (03/22/19)
COLORADO DEPARTMENT OF REVENUE
Liquor Enforcement Division
(303)-205-2300
FOR DEPARTMENT USE ONLY
Current License Number ____________________________
All Answers Must Be Printed in Black Ink or Typewritten
Local License Fee $ _________________________________
1. Applicant is a
Corporation ..................................... Individual
Partnership ...................................... Limited Liability Company
Present License Number
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
Permit Application
and Report of Changes
• 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
44-3-301(8), C.R.S.) NO FEE
Retail Warehouse Storage Permit (ea) ...........................$100.00
Wholesale Branch House Permit (ea) ..............................100.00
Change Corp. or Trade Name Permit (ea) ...................... 50.00
Change Location Permit (ea) ............................................150.00
Change, Alter or Modify Premises $150.00 x _______________
Total Fee __________________________________________
Addition of Optional Premises to Existing H/R $100.00 x ______
Total Fee __________________________________________
Addition of Related Facility to an Existing Resort or Campus
Liquor Complex $160.00 x ______ Total Fee _______________
Campus Liquor Complex Designation No Fee
Sidewalk Service Area $75.00
Section B – Duplicate License
• Liquor License No. _______________________________
Duplicate License ....................................................... $50.00
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 insufcient or uncollected funds, the Department
of Revenue may collect the payment amount directly from your bank account electronically.
TOTAL
AMOUNT DUE
$
.00
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 5. Proceed to the Oath of Applicant for signature. Submit to State Licensing Authority
for approval.
Section B
For a Duplicate license, be sure to include the liquor license number in section B on page 1 and
proceed to page 5 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 5 for Oath of Applicant signature.
Submit to State Licensing Authority for approval.
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 5 for Oath of Applicant signature.
Submit to State Licensing Authority for approval.
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 5 for Oath of Applicant
signature. Retail Liquor License submit to Local Liquor Licensing Authority (City or County). Manufacturer,
Wholesaler and Importer's Liquor Licenses submit to State Liquor Licensing Authority.
4) To modify Premise, or add Sidewalk Service Area, go to page 4 and complete question 9. Submit the
necessary information and proceed to page 5 for Oath of Applicant signature. Retail Liquor License submit
to Local Liquor Licensing Authority (City or County). Manufacturer, Wholesaler and Importer's Liquor
Licenses submit to State
Liquor Licensing Authority.
5)
For Optional Premises go to page 4 and complete question 9. Submit the necessary information
and
proceed to page 5 for Oath of Applicant signature. Retail Liquor License submit to Local Liquor Licensing
Authority (City or County).
6) To Change Location, go to page 3 and complete question 7. Submit the necessary information and
proceed to page 5 for Oath of Applicant signature. Retail Liquor License submit to Local Liquor Licensing
Authority (City or County). Manufacturer, Wholesaler and Importer's Liquor Licenses submit to State
Liquor Licensing Authority.
7) Campus Liquor Complex Designation, go to page 4 and complete question 10. Submit the necessary
information and proceed to page 5 for Oath of Applicant signature.
8) To add another Related Facility to an existing Resort or Campus Liquor Complex, go to page 4 and
complete question 11.
DR 8442 (03/22/19)
3
DR 8442 (03/22/19)
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. Certicate of Amendment led with the Secretary of State, or
2. Statement of Change led 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
Change of Location
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
44-3-311(1) C.R.S. Your application must be on le with the local authority thirty (30) days before a public hearing can be held.
Date led with Local Authority _______________________ Date of Hearing ________________________
(a) Address of current premises ______________________________________________________________
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.
4
DR 8442 (03/22/19)
Change of Manager
8.
Change of Manager or to Register the Manager of a Tavern, Hotel and Restaurant, Lodging & Entertainment
liquor license or licenses pursuant to section 44-3-301(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? Ye
s
No
Does manager have a nancial interest in any other liquor licensed establishment?
Ye
s
No
If yes, give name and location of establishment
_______________________________________________
________________________________________________________________________________________
Modify Premises or Addition of Optional
Premises, Related Facility, or Sidewalk Service Area
9. Modication of Premises, Addition of an Optional Premises, Addition of Related Facility, or Addition of
a Sidewalk Service Area
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 modication is temporary, when will the proposed change:
Start _________________ (mo/day/year) End _________________ (mo/day/year)
NOTE:
THE TOTAL STATE FEE FOR TEMPORARY MODIFICATION IS $300.00
(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 modication is for an additional Hotel and Restaurant Optional Premises
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 modication.
(h) For the addition of a Sidewalk Service Area per Regulation 47-302(A)(4), include documentation received
from the local governing body authorizing use of the sidewalk. Documentation may include but is not limited
to a statement of use, permit, easement, or other legal permissions.
Campus Liquor
Complex Designation
10. Campus Liquor Complex Designation
An institution of higher education or a person who contracts with the institution to provide food services
(a) I wish to designate my existing ________________ Liquor License # ________________ to a Campus
Liquor Complex Yes No
Additional
Related Facility
11. Additional Related Facility
To add a Related Facility to an existing Resort or Campus Liquor Complex, include the name of the Related
Facility and include the address and an outlined drawing of the Related Facility Premises.
(a) Address of Related Facility ______________________________________________________________
(b) Outlined diagram provided Yes No
5
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
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 44,
Articles 4 and 3, C.R.S., as amended. Therefore, This Application is Approved.
Local Licensing Authority (City or County)
Date led with Local Authority
Signature Title Date
Report of STATE Licensing Authority
The foregoing has been examined and complies with the ling requirements of Title 44, Article 3, C.R.S., as amended.
Signature Title Date
DR 8442 (03/22/19)
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Permit Application And Report Of Changes (Town of Buena Vista)

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Completed 14 July 2020

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