DR 8400 (02/18/16)
COLORADO DEPARTMENT OF REVENUE
Liquor Enforcement Division
Submit to Local Licensing Authority
Retail Liquor or 3.2 License Renewal
Application
Fees Due
Renewal Fee
Storage Permit $100 X _____ $
Optional Premise $100 X ______ $
Amount Due/Paid $
Make check payable to: Colorado Department of
Revenue. 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
insufcient or uncollected funds, the Department
may collect the payment amount directly from your
banking account electronically.
Please verify & update all information below Return to city or county licensing authority by due date
Licensee Name DBA
Liquor License # License Type Sales Tax License # Expiration Date Due Date
Business Address Phone Number
( )
Mailing Address Email
Operating Manager Date of Birth Home Address Phone Number
( )
1. Do you have legal possession of the premises at the street address above?
Yes
No
Are the premises owned or rented?
Owned
Rented* *If rented, expiration date of lease_____________
2. Since the date of ling of the last application, has there been any change in nancial interest (new notes, loans, owners, etc.) or
organizational structure (addition or deletion of ofcers, directors, managing members or general partners)? If yes, explain in detail
and attach a listing of all liquor businesses in which these new lenders, owners (other than licensed nancial institutions), ofcers,
directors, managing members, or general partners are materially interested.
Yes
No
3. Since the date of ling of the last application, has the applicant or any of its agents, owners, managers, partners or lenders (other
than licensed nancial institutions) been convicted of a crime? If yes, attach a detailed explanation.
Yes
No
4. Since the date of ling of the last application, has the applicant or any of its agents, owners, managers, partners or lenders (other
than licensed nancial institutions) been denied an alcohol beverage license, had an alcohol beverage license suspended or
revoked, or had interest in any entity that had an alcohol beverage license denied, suspended or revoked? If yes, attach a detailed
explanation.
Yes
No
5. Does the applicant or any of its agents, owners, managers, partners or lenders (other than licensed nancial institutions) have
a direct or indirect interest in any other Colorado liquor license, including loans to or from any licensee or interest in a loan to
anylicensee? If yes, attach a detailed explanation.
Yes
No
Afrmation & Consent
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.
Type or Print Name of Applicant/Authorized Agent of Business Title
Signature Date
Report & Approval of City or County Licensing Authority
The foregoing application has been examined and the premises, business conducted and character of the applicant are satisfactory,
and we do hereby report that such license, if granted, will comply with the provisions of Title 12, Articles 46 and 47, C.R.S.
Therefore this application is approved.
Local Licensing Authority For Date
Signature Title Attest
