•
State
City
2180-100 (999)
County
2190-100 (999)
Managers Reg
______-750 (999)
TOTAL
License Account Number
County
City
Industry Type
LIABILITY INFORMATION
Liability Date
FROM
DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY
ZIP Code
ZIP Code
4. Mailing Address (Number and Street)
State
State
City
Present Trade Name of Establishment (DBA)
Present Expiration Date
1.
Applicant is applying as a
2. Applicant If an LLC, name of LLC; if partnership, at least 2 partner's names; if corporation, name of corporation Fein Number
2a.Trade Name of Establishment (DBA)
3. Address of Premises (specify exact location of premises)
Present Class of License
County
City or Town
Present State License No.
Partnership (includes Limited Liability and Husband and Wife Partnerships)
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• ALL ANSWERS MUST BE PRINTED IN BLACK INK OR TYPEWRITTEN
• APPLICANT MUST CHECK THE APPROPRIATE BOX(ES)
• LOCAL LICENSE FEE $ __________________________
• APPLICANT SHOULD OBTAIN A COPY OF THE COLORADO LIQUOR AND BEER CODE (Call 303-370-2165)
Corporation
5. If the premises currently have a liquor or beer license, you MUST answer the following questions:
NEW LICENSE
TRANSFER OF OWNERSHIP
LICENSE RENEWAL
COLORADO LIQUOR
RETAIL LICENSE APPLICATION
DR 8404 (05/07/09) Page 1
COLORADO DEPARTMENT OF REVENUE
LIQUOR ENFORCEMENT DIVISION
DENVER CO 80261
2310-100
(999)
Cash Fund Transfer License
2300-100
(999)
Cash Fund New License
21
DEPARTMENT USE ONLY
State Sales Tax No.
Business Telephone
Individual
Association or Other
Limited Liability Company
License Issued Through
(Expiration Date)
TO
_____-750 (999)
LIAB
SECTION A
NONREFU