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HomeMy WebLinkAboutMT Department of Revenue (5)F Montana Dep e ° Y D Dan Bucks Brian Schweitzer Director OCT 16 2009 Governor October 15, 2009 CITY OF LAUREL RE: Application for Transfer of Ownership of All-Alcoholic Beverages with Catering Endorsement License No. 03-044-9403-002, PALACE BAR OF LAUREL, 303 East Main Street, Laurel, Yellowstone County, Montana The labove referenced application was received at the Department of Revenue, Liquor Licensing. Notice is being provided to you to give you an opportunity to advise if the applicant and premises meet all the laws and ordinances your office is responsible for regulating. We will be happy to provide any additional information that is needed. Local laws are not enforced through the alcoholic beverage licensing process; however, if there are local laws affected by this application, compliance with those laws may influence the final determination to issue the license. If an agency determines deficiencies exist that should be considered in the issuance of this license, please advise this office in writing by November 16, 2009. If we receive a determination of a local deficiency, the license application process cannot be completed untilithe issue is cleared up at the local level. In addition, if we receive a written protest against the issuance of this license, a public hearing will be scheduled. If you have any questions, please call (406) 444-0713. Singerely, 7K` Tanya Stelzer Compliance Specialist Dep rtment of Revenue Liquor Licensing P O Box 1712 Helena MT 59624-1712 cc: Department of Labor & Industry Customer Service (406) 444-6900 A TDD (406) 444-28;30 A www.mt.gov/revenue CERTIFICATE OF SERVICE 1 certify that on this 15th day of October , 2009, a true and correct copy of the foregoing has been served by placing same in the United States mail, postage prepaid, and addressed as follows: LAUREL CITY COUNCIL PO BOX 10 LAUREL MT 59044 LAUREL CITY ATTORNEY PO POX 10 LAUREL MT 59044 LAUREL POLICE CHIEF MIKE ATKINSON PO BOX 10 LAUREL MT 59044 LAUREL CITY BUILDING INSPECTOR PO BOX 10 LAUREL MT 59044 YELLOWSTONE COUNTY SANITARIAN BOX 35033 BILLINGS MT 59107 YELLOWSTONE COUNTY TREASURERS OFFICE P O IBOX 35010 BILLINGS MT 59107-5010 ADMINISTRATIVE ASSISTANT FIR PREVENTION AND INVESTIGATION BUREAU 303 NORTH ROBERTS BOX 201415 HEIJENA MT 59620-1417 18-Sep-2009 11:50 AM SAYE J, pllc 406-294-6650 J 49 2/3 Chuck the Appropriate Boxes to Designate the Purpose of this Application Alaohcllal Beverage Designate the Type of License ©NowAlcoholic Beverage License Applicatlon of Your Application- BY xisting'AAlcohollo Beverage License; Transfer of Ownership Application [3 on-Promises Beer RECEIVED xlsting A}lochot(c Beverage License; Corporate Structure Change 1] Ona.Premises SeeMMns . $ EP 1 7 A09 0 Existing Alcoholic Beverage License: Transfer of Location Application ?Il-severage © Existing Alcoholic sewerage License: Death of Licensee © Restaurant Beer Wlne oFJYfi iSw1110N 0 Resort Licenas Gambling An ownersh p Interest In a licensed gambling operation may not transfer an inWrest In the operation to a stranger to the license until a I bfing license application reflecting the proposed transfer is submltted to the department and the department approves transfer: An ownership Interest in a lloensed gambling operation may not be transferred to another owner or group of owners of an Interest or il*rests In the same licensed gambling operation without submitting an emended gambling license application to the department and obtaining department approval. © New Gambling © New Gambling - No Alcoholic Beverage License Is Required for Live KenolBingo. tnendsO Gambling License Application (Note. No foe Is required for this application) xisting 0ambling License Change Among 5deting E3 Existing Gambling License Deletion of Owner(s) Oorporat¢ Shareholder(s) Q Existing Gambling License Change Among Sklaling Partners for LLCILLP Members © Existing Gambling Location Change Application El Existing Gambling License Type Change Application El Other (Explain) General Information Print or Type Name of Applicant Weis Guy Investments, Inc. (Owning entity such as Bole propftior/f'erbwmhipgMorp,/LLCILLP) Bueinesslt)rade Name Palace Bar of Laurel (An assumed brute name must be fled with the secretary of State and verillcallon provided.) Mailing Address 2105 SWWWmck Drive (P.O. Sax or Street) Address of Premises to be Weenead303 E Main Street (Street, Suits No., Building No.) City Laurel g? MT Z1080044 Business hone ( 408 )828"8788 Cell Phone ( 408 )865-2126 Fax ( ...?_ ) Federal I.D. Tb? Number Aloohol 8,6-rage 7License Number Are the pMm'rses for licensing located: (NIA If not applicable) ® Within a boundaries of an incorporated oity/town (Gambling Licensing.) 0 Within distance of five miles of an incorporated oltyhown (Alcoholic Bavorage Licensing.) © Within n unincorporated olty/town or outside the boundaries of and more then fire miles distance from any city/town wheth Incorporated or unincorporated (Alcoholic Beverage Licensing.) Laurel Cigr Name ® Check if applied for but not yet received, 03 .04 '48 403-002 In County of Yellowstone County Name C. Provide the information requested below for each: Check appropriate box (Use additional paper If necessary) ® Indi4l ideal/Sole Proprietor 13 Person(s) holding an option to purchase the business ® General or ® Limited Partnership ® Limited Liability Company (Member of... ) ® Officer of a Corporation ® Director of a Corporation ® Shareholder of a Corporation © Sharreholder owning 5% or more of the stock of a ® publicly traded corporation © Pe or(s) and/or committee managing the gambling under a 26 U.S.C. 601 (c)(3), (c)(4),)(8) or (c) (19 organization Name (First, M.1 r. .*.. Bryan S. Weis Date 0 Birth Social Security No. Addresa2105 Saddleback Drive, Laurel, MT 59044 Titlepresident/shareholder Number of Shares 50,000 Percentage of Ownership 100 Name (First, M.I., Last) Title Date of Birth Social Security No. Address Percentage of Ownership Name (f=irst, M.I., Last) Date of Birth Social Security No. Title Number of Shares Address Percentage of Ownership Note: EwM Individual listed above must submit with this application a Personal/Criminal History Statement (Form 10) and a completed Fingerprint Card and fee. Use additional sheet of paper if necessary. 1 hereby request smoking exception and affirm that 60% of the revenue generated by this business will be from the sale of alcoholic beverages and/or gambling. ®Yes I do not request smoking exception. ® No D. Charitable, Religious, Veterans' or Fraternal Organization If the applicant is a charitable, religious, veterans' or fraternal organization, complete the following information. If not applicable indicate: ® N/A Date qualified for exemption under 26 U.S.C. 501 (c)(3), (c)(4), (c)(8) or (c)(19): Month'I Day Year Date I¢cal charter issued or post organized: Month Day Year Has n tional organization been in existence for a period of five years prior to January 1, 19497 ® Yes ®Nc Provide Address of National Headquarters: Street City _ A oop? of your organization or post charter must accompany this application. of Gambling Premises: Zip St" Address City State zip How Many days, per year, is gambling conducted at this location? Days or any interest in the business © Other © Check this box if ownership In the alcoholic beverage license is also held as Joint Tenants with Rights of Survivorship (JTROS) or Tenants in Common (TEN COM) and make certain each individual with rights of survivorship or common are listed below. ® JTROS or ® TEN COM Number of Shares 4 C. Is the premises within any defined zones: 1. Where the sale of alcoholic beverages is restricted by city or county zoning ordinance? 13l es ®No 2. Where gambling is restricted by city or county zoning ordinance? M*es 0No D. Is the building ready for use for an alcoholic beverage business: ®Yes® No 1. Is this a newly constructed premises? Byes ®No If Yes, indicate an estimated date of occupancy 2. Is this a remodel of an existing premises? 13 Yes ® No If Yes, indicate an estimated date of completion 8. Submit a copy of the floor plan area to be licensed, using approximate dimensional measurements. Including external dimensions and general layout - on an 8-112" x 11" sheet of paper and number of tables and chairs indicated. If you are applying for a restaurant beer and wine license, be sure the floor plan has the service bar area clearly designated thereon. Note4or n the floor plan you will need to. clearly mark the areas where alcohol will be served, stored and consumed. The plan must contain outside dimensions, the name of the establishment, physical address, alcoholic beverage license number (if applicable) and date of submittal. 13 SEP r 8 2009 Declaration and Authorization W"WfoLal APPLICANTS FORMAL DECLARATION AND AUTHORIZATION FOR EXAMINATION AND RELEASE OF INFORMATION I, E. R PR LSLS hereby declare under the penalty of law and/or the revocation of any licenses g nted pursuant hereto, that I am the applicant or duly authorized representative of the firm or corporation making this app' ion and that I have examined the application, Including any accompanying information, and that the responses provided h rein are true, correct and complete. I understand if this application or attachment(s) contains false information, I am subject to the criminal penalties of Section 46-7-202,45-7-203 and 4r).-7 2ta, Montana Code Annotated, and/or revocation of any al olio beverage or gambling licenses granted pursuant to this application. I further acrthortze a full review, disclosure and release to any duly authored officer, agent or employee of the Montana Department of Justice, Gambling Control Division, of any and all records concerning me that the Montana Department of Justice p perly determines relate to my qualifications for gambling and/or liquor licensure, whether the records are of a public, private, or confidential nature. SIGNATURE PRINT FULL &j UJE 15 TITLEIPOSITION _ 90 le ;:s h a re ho lder DATE r This application must be completed in full, and all requested attachments must accompany it. Delay, denial or the return of the application will result if incomplete. Additional Information May Be Required During the Investigation of Your License Application. 18