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CHECKLIST FOR TRANSFER OF OWNERSHIP FOR 3.2 % BEER LICENSE APPLICATION   YOU MUST SUBMIT AN ORIGINAL PACKET AND ONE COPY OF THE PACKET.  All transfer of ownership applications must be submitted to the Front Desk in the Tax & Licensing Office. The applicant will be contacted by a Licensing Officer to set up an appointment for fingerprinting and to review items needed to complete the application.   Application forms provided in this packet:  1. Fee Schedule for City and State (all processes) Business/Sales Tax License Application and Affidavit. Please use the online business license application at www.auroragov.org/obl. Use the “pay in person” option and the city will waive these fees. 3.2% Beer/Fermented Malt Beverage License application DR 8403 (Note: State and City Beer licenses will not be issued until a State Sales Tax license is acquired.)  Affidavit of Transfer and Statement of Compliance form  Collection of Sales Tax form (if applicable)  Temporary Permit Application with application fee payable to the City of Aurora Individual History Record form DR 8404-I  Consent to Release Financial Information form – must be notarized.  Bank Credit References form. Include all bank accounts, bank debit cards and credit cards such as Visa, MasterCard, etc., (both business and personal) used in the financing of the business.   Additional items you must provide to complete the application packet: (items #2. - #10.) 2. Application fee payable to the Colorado Department of Revenue NON-REFUNDABLE application fee payable to the City of Aurora  If the license is approved, all fees are due. Licenses will not be issued until all fees are paid in full.  State license fee payable to the Colorado Dept. of Revenue  City License fee  Liquor Occupation Tax fee Amusement Device(s) application fee and per-machine fee   3. Lease, assignment of lease, or deed. This must be in the EXACT owner name of the applicant, (sole proprietor, corporation, partnership, LLC) and must include the business location street address, unit, city, state and zip code.  4. According to the applicant’s type of ownership, submit the following items. If a sole proprietorship, disregard this item.  CORPORATIONS  PARTNERSHIPS LIMITED LIABILITY COMPANIES Date-stamped Articles of Incorporation  Partnership Agreement Date-stamped Articles of Organization Current Certificate of Good Standing if corporation is over 2 years old   Current Certificate of Good Standing if LLC is over 2 years old  Certificate of Authority if a foreign corporation  Certificate of Authority if a foreign partnership  Certificate of Authority if a foreign company  Stock Certificates (front and back)   Copy of operating agreement Minutes showing elections, resignations, and actions taken   Minutes showing acceptance of new members, resignations and actions taken State master file letter (if applicable)  State master file letter (if applicable) State master file letter (if applicable)        Finance Department  Tax & Licensing Division  15151 E. Alameda Parkway, Ste. 1100  Aurora, Colorado 80012  Phone  303-739-7057  Fax  303-739-7071  

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Page 1: Tax & Licensing Division E. Alameda Parkway, Ste. 1100

CHECKLIST FOR TRANSFER OF OWNERSHIP FOR 3.2 % BEER LICENSE APPLICATION  

 YOU MUST SUBMIT AN ORIGINAL PACKET AND ONE COPY OF THE PACKET.  All transfer of ownership applications must be submitted to the Front Desk in the Tax & Licensing Office. The applicant will be contacted by a Licensing Officer to set up an appointment for fingerprinting and to review items needed to complete the application.    

Application forms provided in this packet:  1. Fee Schedule for City and State (all processes)

Business/Sales Tax License Application and Affidavit. Please use the online business license application at www.auroragov.org/obl. Use the “pay in person” option and the city will waive these fees.

3.2% Beer/Fermented Malt Beverage License application DR 8403 (Note: State and City Beer licenses will not be issued until a State Sales Tax license is acquired.)  

Affidavit of Transfer and Statement of Compliance form   Collection of Sales Tax form (if applicable)   Temporary Permit Application with application fee payable to the City of Aurora Individual History Record form DR 8404-I   Consent to Release Financial Information form – must be notarized.  

Bank Credit References form. Include all bank accounts, bank debit cards and credit cards such as Visa, MasterCard, etc., (both business and personal) used in the financing of the business.  

 

Additional items you must provide to complete the application packet: (items #2. - #10.) 2. Application fee payable to the Colorado Department of Revenue 

NON-REFUNDABLE application fee payable to the City of Aurora   If the license is approved, all fees are due. Licenses will not be issued until all fees are paid in full.   State license fee payable to the Colorado Dept. of Revenue   City License fee   Liquor Occupation Tax fee

Amusement Device(s) application fee and per-machine fee   

3. Lease, assignment of lease, or deed. This must be in the EXACT owner name of the applicant, (sole proprietor, corporation, partnership, LLC) and must include the business location street address, unit, city, state and zip code.  

4. According to the applicant’s type of ownership, submit the following items. If a sole proprietorship,  disregard this item.  

CORPORATIONS   PARTNERSHIPS LIMITED LIABILITY COMPANIES

Date-stamped Articles of Incorporation   Partnership Agreement Date-stamped Articles of Organization

Current Certificate of Good Standing if corporation is over 2 years old  

  Current Certificate of Good Standing if LLC is over 2 years old  

Certificate of Authority if a foreign corporation  

Certificate of Authority if a foreign partnership  

Certificate of Authority if a foreign company  

Stock Certificates (front and back)     Copy of operating agreement

Minutes showing elections, resignations, and actions taken  

  Minutes showing acceptance of new members, resignations and actions taken

State master file letter (if applicable)   State master file letter (if applicable) State master file letter (if applicable)

 

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Finance Department  

Tax & Licensing Division  15151  E. Alameda Parkway, Ste. 1100  Aurora, Colorado 80012  Phone  303-739-7057   Fax  303-739-7071   

Page 2: Tax & Licensing Division E. Alameda Parkway, Ste. 1100

5. Purchase agreement. An executed Bill of Sale must be furnished by the date of hearing.    

6. For EACH individual, partner, officer, director, member, stockholder with 10% or greater financial interest, any person who can access/sign on the business accounts, or any private party who lends money to the applicant:  

Most recent 6 months bank and credit card statements from the accounts listed on the Bank Credit References form and the Individual History Record (both business and personal) used in the financing of the business. If the applicant does not reside in Colorado, provide the name, residence address and date of birth of the authorized agent in Colorado upon whom service of process can be made in any proceedings against the applicant pursuant to any statute, ordinance or regulation applicable to the conduct of said business.  

All individuals submitting the application, as well as the registered manager, must be fingerprinted. The Licensing Office will contact you regarding completion of this requirement after we have reviewed your application. You may be fingerprinted by the Aurora Police Department, the Colorado Bureau of Investigation, or by a police department of your choice.  

 7. A Manager registration (If the registered manager has 10% or greater financial interest in the business,

disregard this item):   Individual History Record form DR 8404-I (print from Item #1) Fee payable to Colorado Department of Revenue (hotel-restaurants, taverns and L&E ONLY).   Fee payable to City of Aurora (hotel-restaurants, taverns and L&E ONLY).    8. Financial documents:  Copies of all promissory notes and/or loans   Gift letters, if applicable   

9. Legible interior floor plan – 8½” X 11”. The entire licensed premises MUST be outlined in BOLD black lines on both copies and include the perimeter dimensions and the location of all permanent fixtures such as the cooler, kitchen, restrooms, office, and doors. If there is a patio that you intend to use as part of your premises, make sure this is included in your lease and your floor plan.  

10. Cabaret License Application for a dance floor is a separate packet on this web page.

 Reviewed 11-18-2016  

 

‘            

Finance Department  

Tax & Licensing Division  15151  E. Alameda Parkway, Ste. 1100  Aurora, Colorado 80012  Phone  303-739-7057   Fax  303-739-7071   

Page 3: Tax & Licensing Division E. Alameda Parkway, Ste. 1100

Finance Department

Tax & Licensing Division 15151 E. Alameda Parkway, Ste. 1100 Aurora, Colorado 80012 303.739.7057

22LIQUOR LICENSE FEE SCHEDULE

Type of License

Aurora License

Fee New Apps

ONLY

State License

Fee

Aurora Annual Liquor

Occupation Tax Fee

Aurora Renewal

Fee

Temporary Permit Fee

3.2% Beer On Premises $3.75 $96.25 $500.00 $103.75

$100.00

No Fee for 60 day extension

3.2% Beer Off Premises $3.75 $96.25 $275.00 $103.75 3.2% Beer On & Off Prem. $3.75 $96.25 $800.00 $103.75 Arts $41.25 $308.75 $275.00 $141.25 Beer & Wine $48.75 $351.25 $450.00 $148.75 Brew Pubs $75.00 $750.00 $650.00 $175.00 Club $41.25 $308.75 $275.00 $141.25 Hotel-Restaurant $75.00 $500.00 $650.00 $175.00 Liquor Licensed Drug Store $22.50 $227.50 $300.00 $122.50 Liquor Store $22.50 $227.50 $400.00 $122.50 Racetrack $75.00 $500.00 $650.00 $175.00 Tavern $75.00 $500.00 $650.00 $175.00 New Application Fees $1,000.00 $920.00 Concurrent Review Fee No Fee $100.00 Transfer Ownership Application Fee

$750.00 $920.00

Late Renewal Application Fee

$500.00 No Fee

Bed & Breakfast Permit $25.00 $25.00 Cabaret – application fee Class A – license fee Class B – license fee

$30.00 $269.00 $178.00

N/A

Change Location of Liquor License

$750.00 $150.00

Change of Trade Name or Corporate Name

No Fee $50.00

Change Corporate Structure

$100.00/ person No

fee if Master

File Letter

$100.00 /person

on Master

File Letter only

Duplicate License No Fee $50.00 Manager Registration H-R & Tavern only

$75.00 $75.00

Manager Registration (All others except 3.2%)

$75.00 No Fee Manager Registration not required on 3.2% licenses

Modification of Premises No Fee $150.00 Optional Premises (H-R licenses only)

No Fee $500.00

Page 4: Tax & Licensing Division E. Alameda Parkway, Ste. 1100

Finance Department

Tax & Licensing Division 15151 E. Alameda Parkway, Ste. 1100 Aurora, Colorado 80012 303.739.7057

Type of License

Aurora License

Fee New Apps

ONLY

State License

Fee

Aurora Annual Liquor

Occupation Tax Fee

Aurora Renewal

Fee

Temporary Permit Fee

Additional Optional Premises / per premises

No Fee $100.00

Special Event Permit (Liquor) (per application)

$100.00 No Fee Special Event Permits are processed at the local level only; notification to State

Special Event Permit (3.2% Beer) (per application)

$100.00 No Fee Special Event Permits are processed at the local level only; notification to State

Tastings License Tastings Permit

$130.00 No Fee

N/A

Reissued License Fee $25.00 / day past 90 day expiration Business License Paper Application Processing Fee

$10.00 for paper business license application / $39.25 fee waived (no fee for online business license application)

Revised 6-2016

Page 5: Tax & Licensing Division E. Alameda Parkway, Ste. 1100

City of Aurora

Finance Department 15151 East Alameda Parkway, Suite 5700 Aurora, Colorado 80012-1555 Phone: 303-739-7800 www.auroragov.org

March 3, 2016

Dear License Applicant:

You are applying for a special business license, a liquor license, or a marijuana-related business license that requires the City of Aurora, Colorado, to submit your fingerprints to the Colorado Bureau of Investigation to conduct a check of your Colorado and FBI criminal history record. This background check is required for the type of license you are seeking. The City will use the results of this background check according to the requirements specified in the City Code to determine if you are suitable for obtaining the license you seek.

As an applicant for a license to be issued by the City of Aurora, Colorado, you will have the opportunity to view the information in your criminal history results. As an applicant you will also have the opportunity to submit any information necessary to complete or challenge the information listed in the criminal history results the City receives from the FBI and the CBI.

If you determine there is incorrect or inaccurate information in your FBI or CBI criminal history record you may follow the procedures set forth in Title 28, C.F.R., Section 16.34 to change, correct or update the incorrect or inaccurate information.

Please inform the Licensing Division if you intend to contest or supplement the information in your criminal history record. Failure on your part to inform the Licensing Division that you will supply additional information or you will contest the information in your criminal history information will be deemed a waiver on your part by the Licensing Division to complete or contest the criminal history record received by the City of Aurora, Colorado.

Sincerely, Tax and Licensing Division City of Aurora, Colorado  

Page 6: Tax & Licensing Division E. Alameda Parkway, Ste. 1100

1

New License New-Concurrent Transfer of Ownership

• 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: www.colorado.gov/enforcement/liquor1. Applicant is applying as a/an

Corporation Partnership (includes Limited Liability and Husband and Wife Partnerships)

Individual Limited Liability Company Association or Other

2. Applicant(s) If an LLC, name of LLC; if partnership, at least 2 partners' names; if corporation, name of corporation FEIN

2a. Trade Name of Establishment (DBA) State Sales Tax No. Business Telephone

3. Address of Premises (specify exact location of premises)

City County State ZIP Code

4. Mailing Address (Number and Street) City or Town State ZIP Code

5. Email Address

6. If the premises currently has a liquor or beer license, you MUST answer the following questionsPresent Trade Name of Establishment (DBA) Present State License No. Present Class of License Present Expiration Date

Section A Nonrefundable Application Fees Section B 3.2% Beer License Fees

Application Fee for New License $920.00

Application Fee for New License - w/Concurrent Review $1020.00

Application Fee for Transfer $920.00

Retail 3.2% Beer On-Premises (City) $96.25

Retail 3.2% Beer On-Premises (County) $117.50

Retail 3.2% Beer Off-Premises (City) $96.25

Retail 3.2% Beer Off-Premises (County) $117.50

Retail 3.2% Beer On/Off Premises (City) $96.25

Retail 3.2% Beer On/Off Premises (County) $117.50

Master File Location Fee ............... $25.00 x _________ To _________

Master File Background ............... $250.00 x ________ Total ________

Questions? Visit www.colorado.gov/enforcement/liquor for more informationDo Not Write In This Space - For Department Of Revenue Use Only

Liability InformationLicense Account Number Liability Date: License Issued Through: (Expiration Date) Total

$

DR 8403 (06/28/16) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division (303) 205-2300

Colorado Fermented Malt Beverage (3.2% Beer) License Application

Page 7: Tax & Licensing Division E. Alameda Parkway, Ste. 1100

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7. Is 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 under the age of twenty-one years?

Yes No

8. 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 8a, b or c, explain in detail on a separate sheet

9. Has a 3.2 beer license for the premises to be licensed been denied within the preceding one year? If "yes," explain in detail.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:Landlord Tenant Expires

b. Is a percentage of alcohol sales included as compensation to the landlord? If yes complete question 12.

c. 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".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.Last Name First Name Date of Birth FEIN or SSN Interest

Last Name First Name Date of Birth FEIN or SSN Interest

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. Name of Manager for all on and on/off applicants.Last Name First Name Date of Birth

14. 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.15. 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.

Page 8: Tax & Licensing Division E. Alameda Parkway, Ste. 1100

4

16. If applicant is a corporation, partnership, association or limited liability company, applicant must list all Officers, Directors, General Partners, and Managing Members. In addition, applicant must list any stockholders, partners, or members with ownership of 10% or more in the Applicant. All persons listed below must also attach form DR 8404-I (Individual History Record), and submit fingerprint cards to the local licensing authority.Name Home Address, City & State Date of Birth Position % Owned

Name Home Address, City & State Date of Birth Position % Owned

Name Home Address, City & State Date of Birth Position % Owned

Name Home Address, City & State Date of Birth Position % Owned

** Limited Liability Companies and Partnerships - 100% of ownership must be accounted for on question #16 ** Corporations - The President, Vice-President, Secretary and Treasurer must be accounted for on question #16 (Include ownership percentage if applicable)

Oath of ApplicantI 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. I also acknowledge that it is my responsibility and the responsibility of my agents and employees to comply with the provisions of the Colorado Liquor or Beer Code which affect my license.Authorized Signature Printed Name and Title Date

Report and Approval of Local Licensing Authority (City/County)Date application filed with local authority Date of local authority hearing (for new license applicants cannot be less

than 30 days from date of application 12-47-311 (1) C.R.S.)

Each person required to file DR 8404-I has

Been fingerprinted

Been subject to background investigation, including NCIC/CCIC check for outstanding warrants

That the local authority has conducted, or intends to conduct, an inspection of the proposed premises to ensure that the applicant is in compliance with, and aware of, liquor code provisions affecting their class of license.(Check One) Date of Inspection or Anticipated Date _____________________________________

Upon approval of state licensing authority

The foregoing application has been examined; and the premises, business to be conducted, and character of the applicant are satisfactory. We do report that such license, if granted, will meet the reasonable requirements of the neighborhood and the desires of the adult inhabitants, and will comply with the provisions of Title 12, Article 46 or 47, C.R.S. Therefore, this application is approved.Local Licensing Authority for Telephone Number Town, City

CountySignature Printed Name Title Date

Signature (attest) Printed Name Title Date

Page 9: Tax & Licensing Division E. Alameda Parkway, Ste. 1100
Page 10: Tax & Licensing Division E. Alameda Parkway, Ste. 1100

Finance Department

Tax & Licensing Division 15151 E. Alameda Parkway, Ste. 1100 Aurora, Colorado 80012 Phone 303-739-7057 Fax 303-739-7071

COLLECTION OF SALES TAX ON MALT, VINOUS AND SPIRITUOUS LIQUORS SOLD BY THE DRINK Section 130-163 of the Aurora City Code reads:

(a) "Unlawful to assume or absorb tax: It shall be unlawful for any retailer to advertise or hold

out or state to the public or to any customer, directly or indirectly, that the tax or any part thereof imposed by this division shall be assumed or absorbed by the retailer, or that it will not be added to the purchase price of the property sold, or, if added, that it or any part thereof shall be refunded."

(b) "Nothing in this section shall be deemed to prohibit any retailer selling malt, vinous or spirituous

liquors by the drink from electing to include in the purchase price of such liquor any tax levied by this division. Once having made the election and having reported his or her decision to the city on such forms as are prescribed by the Finance Director, he or she must continue to impose and collect the tax in the manner elected unless granted authorization to change by the Finance Director. Any excess taxes collected are to be remitted to the city in accordance with Section 130-167."

In accordance with this Section of the Aurora City Code, you are hereby requested to elect one of the following methods of imposing and collecting sales tax on malt, vinous or spirituous liquors sold by the drink. Once having made the election, you must continue to impose and collect the tax in the manner elected unless granted authorization to change by the Finance Director. I wish to include the sales tax in the price of all drinks sold. Example: Drink will sell for

$2.00 and this price will include the sales tax. ($1.85 plus $.15 tax)* I wish to add the sales tax to the purchase price of all drinks and show it as a separate

and distinct item. Example: Drink will sell for $2.00 plus $.16 tax for a total of $2.16.* *The above calculations assumes an 8% tax rate. _________________________________ _________________________________________________ Trade Name or DBA Location Address _________________________________ _______________________________ __________________ Signature of Applicant Title Date Reviewed 11-16-15

Page 11: Tax & Licensing Division E. Alameda Parkway, Ste. 1100

Revised 2-9-16

Finance Department

Tax & Licensing Division 15151 E. Alameda Parkway, Ste. 1100 Aurora, Colorado 80012 Phone 303-739-7057 Fax 303-739-7071

TEMPORARY PERMIT APPLICATION

APPLICANT NAME: ______________________________________________________________________

TRADE NAME OR DBA: ___________________________________________________________________

LOCATION ADDRESS: ____________________________________________________________________

The above named (Individual, Corporation, Partnership, Limited Liability Company) has applied for a Transfer

of Ownership of:___________________________________________________________________________ (Type of Liquor License)

PRESENT NAME OF LICENSEE: ____________________________________________________________

PRESENT TRADE NAME OR DBA: __________________________________________________________

PRESENT STATE LICENSE NUMBER: _____________________________

PRESENT EXPIRATION DATE: ___________________________________

If this Permit is granted, it will be valid for one hundred twenty (120) days from date of issuance or until the application to transfer ownership has been granted or denied, whichever comes first. If the license has not been granted within 120 days, an extension may be approved for an additional period not to exceed sixty (60) days.

SIGNATURE: ______________________________________TITLE: _________________DATE: _________

NOTE: A TEMPORARY PERMIT CANNOT BE ISSUED UNTIL A COMPLETE APPLICATION PACKET IS RECEIVED AND THIS FORM IS SIGNED AND DATED BY THE LICENSING ADMINISTRATOR OR DESIGNEE.

OFFICE USE ONLY – DO NOT WRITE BELOW

Approved by: _____________________________________________________ Date: __________________ Licensing Administrator or Designee

Reason for Extension: _____________________________________________________________________

Extension approved by: ____________________________________________ Date: ___________________

Page 12: Tax & Licensing Division E. Alameda Parkway, Ste. 1100

Finance Department

Tax & Licensing Division 15151 E. Alameda Parkway, Ste. 1100 Aurora, Colorado 80012 Phone 303-739-7057 Fax 303-739-7071

CONSENT TO RELEASE FINANCIAL INFORMATION

A Liquor License Application which requires a financial background investigation has been submitted by: __________________________________________________________________________________

(Corporation/Partnership/LLC/Sole Proprietor) dba_______________________________________________________________________________

(Trade name) and I,_____________________________________________________________________________

(Applicant’s Name) am associated with said applicant in the capacity of _______________________________________, (Title) and fully understand that an investigation of my credit standing and business reputation is necessary for the approval of said license. NOW, THEREFORE, I hereby consent to, and authorize the release of any and all business books, records, check books, bank statements and records, financial data, balance sheets, income accounts, forms, and all other applicable data and information relative to my credit standing and business reputation by any person or entity having possession or control thereof to any person presenting a signed copy thereof, upon the express condition, however, that said release is limited to an investigation conducted pursuant to the aforesaid licensing and operation, but this consent shall continue to operate so long as the above-named licensee shall hold said license, if granted, and for the term or terms of any renewals or extension thereof. __________________________________________________ ______________________________ Signature and Title of Applicant Date of Signature State of ___________________________) § County of __________________________) Subscribed and sworn to before me this _______ day of ________________________, 20______, by ______________________________________________. ______________________________________________ Notary Public S E A L ______________________________________________ Address My Commission Expires:__________________________ Reviewed 9-21-2015

Page 13: Tax & Licensing Division E. Alameda Parkway, Ste. 1100

Finance Department

Tax & Licensing Division 15151 E. Alameda Parkway, Ste. 1100 Aurora, Colorado 80012 Phone 303-739-7057 Fax 303-739-7071

BANK CREDIT REFERENCES Applicant Name: ____________________________________________________________ Trade Name or DBA: _________________________________________________________ Location Address: ___________________________________________________________ Name of Individual: _____________________________________Phone: _______________

Financial Institution Name: ___________________________________________ Address: __________________________________________________________ Phone: _____________________ Account #:_____________________________ Checking Savings Other: _____________

Financial Institution Name: ___________________________________________ Address: __________________________________________________________ Phone: _____________________ Account #:_____________________________ Checking Savings Other: ______________

Financial Institution Name: ___________________________________________ Address: __________________________________________________________ Phone: _____________________ Account #:_____________________________ Checking Savings Other: ______________ This attachment must be completed by each sole proprietor, officer, director, stockholder with 10% or greater interest, general partner, limited partner, limited liability company managing member or member with 10% or greater interest, and any others having financial interest in this liquor license application. Reviewed 9-18-2015