1
Retail Liquor or Fermented Malt Beverage
License Renewal Application
Instructions
1. Complete entire application and attach details, if necessary.
2. Submit application 45 days prior to expiration to your local city or county licensing. Do not submit to the State.
3. Submit the appropriate renewal license fee by license type:
License Type Fee License Type Fee
Fermented Malt Beverage Off Premise (city) $ 96.25 Hotel & Restaurant / Optional Premise (city) $ 600.00*
Fermented Malt Beverage Off Premises (county) $ 117.50 Hotel & Restaurant / Optional Premise (county) $ 600.00*
Fermented Malt Beverage On Premise (city) $ 96.25 Liquor Licensed Drug Store (city) $ 227.50
Fermented Malt Beverage On Premises (county) $ 117.50 Liquor Licensed Drug Store (county) $ 312.50
Fermented Malt Beverage On/Off Premises (city) $ 96.25 Liquor Store (city) $ 227.50
Fermented Malt Beverage On/Off Premises (county)
$ 117.50 Liquor Store (county) $ 312.50
Arts License (city) $ 308.75 Optional Premises (city) $ 500.00
Arts License (county) $ 308.75 Optional Premises (county) $ 500.00
Beer & Wine (city) $ 351.25 Racetrack License (city) $ 500.00
Beer & Wine (county) $ 436.25 Racetrack License (county) $ 500.00
Brew Pub (city) $ 750.00 Resort Complex (city) $ 500.00
Brew Pub (county) $ 750.00 Resort Complex (county) $ 500.00
Campus Liquor Complex (city) $ 500.00 Related Facility - Campus Liquor Complex (city) $ 160.00
Campus Liquor Complex (county) $ 500.00 Related Facility - Campus Liquor Complex (county) $ 160.00
Campus Liquor Complex (state) $ 500.00 Related Facility - Campus Liquor Complex (state) $ 160.00
Club License (city) $ 308.75 Retail Gaming Tavern (city) $ 500.00
Club License (county) $ 308.75 Retail Gaming Tavern (county) $ 500.00
Distillery Pub (city) $ 750.00 Tavern (city) $ 500.00
Distillery Pub (county) $ 750.00 Tavern (county) $ 500.00
Hotel & Restaurant (city) $ 500.00 Vintner’s Restaurant (city) $ 750.00
Hotel & Restaurant (county) $ 500.00 Vintner’s Restaurant (county) $ 750.00
* Plus $100.00 for each additional optional premise(s)
DR 8400 (07/24/19)
COLORADO DEPARTMENT OF REVENUE
Liquor Enforcement Division
2
Retail Liquor or Fermented Malt Beverage License Renewal Application
Fees Due
Renewal Fee
Storage Permit $100 X ______ $
Sidewalk Service Area $75.00 $
Additional Optional Premise Hotel &
Restaurant $100 X ______
$
Related Facility - Campus Liquor
Complex $160.00 per facility
$
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 insufcient 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 Doing Business As 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. Are you renewing a storage permit, additional optional premises, sidewalk service area, or related facility? If yes, please see the
table in upper right hand corner and include all fees due.
Yes
No
3a. Since the date of ling of the last application, has the applicant, including its manager, partners, ofcer, directors, stockholders,
members (LLC), managing members (LLC), or any other person with a 10% or greater nancial interest in the applicant, been
found in nal order of a tax agency to be delinquent in the payment of any state or local taxes, penalties, or interest related to a
business?
Yes
No
3b. Since the date of ling of the last application, has the applicant, including its manager, partners, ofcer, directors, stockholders,
members (LLC), managing members (LLC), or any other person with a 10% or greater nancial interest in the applicant failed to
pay any fees or surcharges imposed pursuant to section 44-3-503, C.R.S.?
Yes
No
4. 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 ofcers, 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), ofcers,
directors, managing members, or general partners are materially interested.
Yes
No
5. 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
6. 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
7. 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 any
licensee? If yes, attach a detailed explanation.
Yes
No
DR 8400 (07/24/19)
COLORADO DEPARTMENT OF REVENUE
Liquor Enforcement Division
Submit to Local Licensing Authority
3
DR 8400 (07/24/19)
COLORADO DEPARTMENT OF REVENUE
Liquor Enforcement Division
Afrmation & 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 44, Articles 4 and 3, C.R.S., and Liquor Rules.
Therefore this application is approved.
Local Licensing Authority For Date
Signature Title Attest
4
Tax Check Authorization, Waiver,
and Request to Release Information
I, am signing this Tax Check Authorization, Waiver and Request to Release
Information (hereinafter “Waiver”) on behalf of
(the “Applicant/Licensee”)
to permit the Colorado Department of Revenue and any other state or local taxing authority to release information and
documentation that may otherwise be con dential, as provided below. If I am signing this Waiver for someone other than
myself, including on behalf of a business entity, I certify that I have the authority to execute this Waiver on behalf of the
Applicant/Licensee.
The Executive Director of the Colorado Department of Revenue is the State Licensing Authority, and oversees the
Colorado Liquor Enforcement Division as his or her agents, clerks, and employees. The information and documentation
obtained pursuant to this Waiver may be used in connection with the Applicant/Licensee’s liquor license application
and ongoing licensure by the state and local licensing authorities. The Colorado Liquor Code, section 44-3-101. et seq.
(“Liquor Code”), and the Colorado Liquor Rules, 1 CCR 203-2 (“Liquor Rules”), require compliance with certain tax
obligations, and set forth the investigative, disciplinary and licensure actions the state and local licensing authorities may
take for violations of the Liquor Code and Liquor Rules, including failure to meet tax reporting and payment obligations.
The Waiver is made pursuant to section 39-21-113(4), C.R.S., and any other law, regulation, resolution or ordinance
concerning the con dentiality of tax information, or any document, report or return led in connection with state or local
taxes. This Waiver shall be valid until the expiration or revocation of a license, or until both the state and local licensing
authorities take nal action to approve or deny any application(s) for the renewal of the license, whichever is later.
Applicant/Licensee agrees to execute a new waiver for each subsequent licensing period in connection with the renewal
of any license, if requested.
By signing below, Applicant/Licensee requests that the Colorado Department of Revenue and any other state or local
taxing authority or agency in the possession of tax documents or information, release information and documentation to
the Colorado Liquor Enforcement Division, and is duly authorized employees, to act as the Applicant’s/Licensee’s duly
authorized representative under section 39-21-113(4), C.R.S., solely to allow the state and local licensing authorities, and
their duly authorized employees, to investigate compliance with the Liquor Code and Liquor Rules. Applicant/Licensee
authorizes the state and local licensing authorities, their duly authorized employees, and their legal representatives, to
use the information and documentation obtained using this Waiver in any administrative or judicial action regarding the
application or license.
Name (Individual/Business) Social Security Number/Tax Identi cation Number
Address
City State Zip
Home Phone Number Business/Work Phone Number
Printed name of person signing on behalf of the Applicant/Licensee
Applicant/Licensee’s Signature (Signature authorizing the disclosure of con dential tax information) Date signed
Privacy Act Statement
Providing your Social Security Number is voluntary and no right, bene t or privilege provided by law will be denied as a
result of refusal to disclose it. § 7 of Privacy Act, 5 USCS § 552a (note).
DR 8495 (07/23/19)
COLORADO DEPARTMENT OF REVENUE
Liquor Enforcement Division