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HomeMy WebLinkAboutMontana Department of Revenue - Pitts Pizza A Ilk Montana Department of Revenue Dan Bucks ± Brian Schweitzer Director ; i' kln'� 1 - ' l I Governor i tw c012 i i.�s October 4, 2012 ( T \ ' v'- ( ` i � - L Account ID: 5916867 - 004 -ONP License Type: Restaurant Beer and Wine License Number: 03- 044-NEW -401 Subject: Application for Issuance of One Original (NEW) Montana Retail On- Premises Consumption Restaurant Beer and Wine License Applicant: Pittstop, LLC — Members with 10% or more: Travis L. Pitts and Lori J. Pitts Location Address: Pitts Pizza Company, 305 South 1 Avenue, Laurel, Yellowstone County, Montana ISSUANCE OF A NEW LICENSE We need your help to determine if the above applicant and location comply with all laws and ordinances administered by your office. We ask that you please advise us by November 29, 2012, if there is a compliance issue. If we do not hear from you concerning a compliance issue, we will assume the laws and ordinances have been met. We would be happy to provide you with any additional information to determine compliance. This is an application for a new premises; a premises not currently licensed for the consumption of alcohol. Building, health and fire approval will be required before department approval will be considered. It is important for you to understand that local laws are not enforced through the alcoholic beverage licensing process but several factors can influence the issuance of a license or prevent processing of the application: • Compliance with local laws may influence our final decision; and • Notification of a local deficiency I will be happy to assist you if you have questions. Please contact me at the address, telephone number or e- mail below. Tanya Stelzer Compliance Specialist Department of Revenue Liquor Licensing PO Box 1712 Helena MT 59604 -1713 Telephone (406) 444-0712 tstelzer mt.gov Encl. Floor Plan and Application Pages 2, 4, 13 & 18 Certificate of Service c: Department of Labor & Industry Montana Beer and Wine Distributors Association revenue.mt.gov • Toll free 1- 866 -859 -2254 (in Helena, 444 -6900) • TDD (406) 444 -2830 CERTIFICATE OF SERVICE I certify that on this 7 day of November, 2012, 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 BOX 10 LAUREL MT 59044 LAUREL POLICE CHIEF RICK MUSSON 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 BOX 35010 BILLINGS MT 59107 -5010 ADMINISTRATIVE ASSISTANT FIRE PREVENTION AND INVESTIGATION BUREAU 303 NORTH ROBERTS BOX 201415 HELENA MT 59620 -1417 alorenz Check the Appropriate Boxes to Designate the Purpose of this Application Alcoholic Beverage Designate the Type of License 0 New Alcoholic Beverage License Application of Your Application: Q Existing Alcoholic Beverage License; Transfer of Ownership Application 0 On- Premises Beer Q Existing Alcoholic Beverage License; Corporate ; ,, e n BY © On- Premises Boerne Q Existing Alcoholic Beverage License; Transfer o Lj - • .. 4' iar B T 0 All- Beverage Q Existing Alcoholic Beverage License; Death of Licen q Restaurant Beer/Wine a ' LU IL 0 Resort License Gambling An ownership interest in a licensed gambling operati erect in the operation to a stranger to the license until a new gambling license application reflecting the proposed transfer is submitted to the department and the department approves the transfer. An ownership interest in a licensed gambling operation may not be transferred to another owner or group of owners of an interest or interests in the same licensed gambling operation without submitting an amended gambling license application to the department and obtaining department approval. 0 New Gambling 08 R C V D Q New Gambling - No Alcoholic Beverage License is Required for Live Keno/Bingo. Q Amended Gambling License Application (Note: No fee is required for this application) Q Existing Gambling License Change Among Existing Q Existing Gambling License Deletion of Owner(s) Corporate Shareholder(s) 0 Existing Gambling Location Change Application Q Existing Gambling License Change Among Existing 0 Existing Gambling License Type Change Application Partners or LLC/LLP Members El Other (Explain) Section 1 General Information Print or Type Name of Applicant Pittstop LLC (Owning entity such as Sole Proprietor /Partnerships/Corp. /LLC /LLP) Business/Trade Name Pitts Pizza Company (An assumed business name must be filed with the Secretary of State and verification provided.) Mailing Address 1 901 Pinyon Drive, Laurel, MT 59044 (P.O. Box or Street) Address of Premises to be Licensed 305 S. 1 st Avenue (Street, Suite No., Building No.) City Laurel State MT zi Business Phone ( 406 )628 4838 Cell Phone ( 406 )861 -7893 Fax ( Federal Tax I.D. Number 0 Check if applied for but not yet received. Alcohol Beverage License Number N/A - - - (N/A if not applicable) Are the premises for licensing located: Q Within the boundaries of an incorporated city/town (Gambling Licensing.) Q Within a distance of five miles of an incorporated city/town (Alcoholic Beverage Licensing.) Q Within an unincorporated city/town or outside the boundaries of and more than five miles distance from any city/town whether incorporated or unincorporated (Alcoholic Beverage Licensing.) Laurel in County of Yellowstone City Name County Name 2 C. Provide the information requested below for each: Check appropriate box (Use additional paper if necessary) o Individual/Sole Proprietor Q Person(s) holding an option to purchase the business o General or 0 Limited Partnership or any interest in the business ® Limited Liability Company (Member of...) 0 Other 0 Officer of a Corporation 0 Check this box if ownership in the alcoholic beverage 0 Director of a Corporation license is also held as Joint Tenants with Rights of Survivorship (JTROS) or Tenants in Common (TEN © Shareholder of a Corporation COM) and make certain each individual with rights of O Shareholder owning 5% or more of the stock of a survivorship or common are listed below. O publicly traded corporation 0 JTROS or 0 TEN COM © Person(s) and/or committee managing the gambling activity under a 26 U.S.C. 501 (c)(3), (c)(4),)(8) or (c) (19) organization Name (First, M.I., Last1Travis L. Pitts T -owner Date of Birth Social Security No. Number of Shares Address 1901 Pinyon Drive, Laurel, MT 59044 Percentage of Ownership 50% Name (First, M.I., Last) Lori J. Pitts Title co -owner Date of Birth Social Security No. , Number of Shares Add 1901 Pinyon Drive, Laurel, MT 59044 Percentage of Ownership 50°i6 Name (First, M.I., Last) Title Date of Birth Social Security No. Number of Shares Address Percentage of Ownership Note: Each 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. I 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 fratemal organization, complete the following information. If not applicable indicate: El N/A Date qualified for exemption under 26 U.S.C. 501 (c)(3), (c)(4), (c)(8) or (c)(19): Month Day Year Date local charter issued or post organized: Month Day Year Has national organization been in existence for a period of five years prior to January 1, 1949? CI Yes 0 No Provide Address of National Headquarters: Street Address City State Zip A copy of your organization or post charter must accompany this application. Location of Gambling Premises: Street Address City State Zip How many days, per year, is gambling conducted at this location? Days 4 Section V Restaurant BeerlWine License 1. Do you agree to serve beer and wine only between the hours of 11:00 a.m. and 11:00 p.m. and only to a patron who orders food? El Yes 0 No 0 NA 2. Do you understand that under a restaurant beer and wine license beer and wine may not be sold for off - premises consumption? ® Yes 0 No D NA 3. Do you understand and acknowledge that issuance of a restaurant beer and wine license prohibits issuance of a license to conduct any gambling activity on the licensed premises? Fa Yes 0 No O NA 4. Do you understand and agree to maintain a service bar? A service bar means an area where alcoholic beverages are stored and prepared for table service delivery to patrons for on- premises consumption. Consumption of alcoholic beverages by patrons or any other person is not permitted at the service bar. Yes 0 No Wine Amendment for On- Premises Beer License 1. Do you operate a restaurant or prepared food business? El Yes 0 No ON/A If Yes, explain and submit a menu J o 2. Do you have a minimum of 12 seats at tables or booths? E3 Yes 0 No 0 N/A If No, explain present arrangement ( "Restaurant" means a public eating establishment allowing for seated service for a minimum of 12 persons at tables or booths where the sale of food is served and prepared on site. A Prepared Food Business" means a restaurant, except the food need not be prepared on site.) Catering Endorsement 1. Do you wish to add a catering endorsement to the All- Beverages License? DYes No ❑ Existing ® NA 2. Do you wish to add a catering endorsement to an On- Premises Consumption Beer/Wine License? OYes ® No 0 Existing 0 NA 15 Section VII Declaration and Authorization APPLICANT'S FORMAL DECLARATION AND AUTHORIZATION FOR EXAMINATION AND RELEASE OF INFORMATION Lori J. Pitts I, , hereby declare under the penalty of law and/or the revocation of any licenses granted pursuant hereto, that I am the applicant or duly authorized representative of the firm or corporation making this application and that I have examined the application, including any accompanying information, and that the responses provided herein 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 45-7 -202, 45-7 -203 and 45-7 -208, Montana Code Annotated, and /or revocation of any alcoholic beverage or gambling licenses granted pursuant to this application. 1 further authorize a full review, disclosure and release to any duly authorized 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 properly determines relate to my qualifications for gambling and /or liquor licensure, whether the records are of a public, private, or confidential nature. SIGNATURE ,�I /i /1i • 0 PRINT FULL NAME Travis L. Pitts Lori J. Pi TITLE /POSITION co -owner co -owner DATE This application must be completed in full, and all requested attachments must accompany it. Delay, denial or the retum of the application will result if incomplete. 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