Liquor Licence Application Form - Colorado
NoYes
Landlord Tenant Expires
DR 8404 (05/07/09) Page 3
NoYes
16. Brew-Pub License or Vintner Restaurant Applicants answer the following:
(a) Has the applicant received or applied for a Federal Permit?
(Copy of permit or application must be attached)
NoYes
14. Liquor Licensed Drug Store applicants, answer the following:
(a) Does the applicant for a Liquor Licensed Drug Store have a license issued by the Colorado Board of
Pharmacy? COPY MUST BE ATTACHED.
15. Club Liquor License applicants answer the following and attach:
(a) Is the applicant organization operated solely for a national, social, fraternal, patriotic, political or athletic purpose and
not for pecuniary gain?
(b) Is the applicant organization a regularly chartered branch, lodge or chapter of a national organization which is
operated solely for the object of a patriotic or fraternal organization or society, but not for pecuniary gain?
(c) How long has the club been incorporated? (d) Has applicant occupied an establishment for three years
(Three years required) __________ that was operated solely for the reasons stated above?
17a. Name of Manager (for all on-premises applicants) ________________________________________ (If this is an
application for a Hotel,
Restaurant or Tavern License, the manager must also submit an Individual History Record (DR 8404-I).
17b. Does this manager act as the manager of, or have a financial interest in, any other liquor
licensed establishment in the State of Colorado? If yes, provide name, type of license and account number.
18. Tax Distraint Information. Does the applicant or any other person listed on this application and including its partners, officers,
directors, stockholders, members (LLC) or managing members (LLC) and any other persons with a 10% or greater financial interest
in the applicant currently have an outstanding tax distraint issued to them by the Colorado Department of Revenue?
If yes, provide an explanation and include copies of any payment agreements.
NoYes
NoYes
6. Is the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or officers, stock-
holders or directors if a corporation) or manager under the age of twenty-one years?
7. Has the applicant (including any of the partners, if a partnership; members or manager if a limited liability company; or officers,
stockholders or directors if a corporation) or manager ever (in Colorado or any other state);
(a) been denied an alcohol beverage license?
(b) had an alcohol beverage license suspended or revoked?
(c) had interest in another entity that had an alcohol beverage license suspended or revoked?
If you answered yes to 7a, b or c, explain in detail on a separate sheet.
8. Has a liquor license application (same license class), that was located within 500 feet of the proposed premises, been denied within the
preceding two years? If "yes," explain in detail.
9. Are the premises to be licensed 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?
10. Has a liquor or beer license ever been issued to the applicant (including any of the partners, if a partnership; members or manager if a
limited liability company; or officers, stockholders or directors if a corporation)? If yes, identify the name of the business and list any
current or former financial interest in said business including any loans to or from a licensee.
11. Does the Applicant, as listed on line 2 of this application, have legal possession of the premises by virtue of ownership, lease or other
arrangement?
Ownership Lease Other (Explain in Detail)
a. If leased, list name of landlord and tenant, and date of expiration, EXACTLY as they appear on the lease:
Attach a diagram and outline or designate the area to be licensed (including dimensions) which shows the bars, brewery, walls, partitions,
entrances, exits and what each room shall be utilized for in this business. This diagram should be no larger than 8 1/2" X 11". (Doesn't have
to be to scale)
12. Who, besides the owners listed in this application (including persons, firms, partnerships, corporations, limited liability companies),
will loan or give money, inventory, furniture or equipment to or for use in this business; or who will receive money from this business.
Attach a separate sheet if necessary.
Attach copies of all notes and security instruments, and any written agreement, or details of any oral agreement, by which
any person (including partnerships, corporations, limited liability companies, etc.) will share in the profit or gross proceeds of
this establishment, and any agreement relating to the business which is contingent or conditional in any way by volume,
profit, sales, giving of advice or consultation.
13. Optional Premises or Hotel and Restaurant Licenses with Optional Premises
Has a local ordinance or resolution authorizing optional premises been adopted?
Number of separate Optional Premises areas requested. (See License Fee Chart)
Date of Birth
INTEREST
NAME
FEIN OR SSNDATE OF BIRTH
No
Yes
No
Yes
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