HomeMy WebLinkAboutMontana Department of Revenue (5) Montana Department of Revenue j ,
Mike Kadas ! ir4 Steve Bullock
Director I Governor
JAN 24 2014
January 21, 2014 ccount ID: 5027610 - 008 -ONP
CITY Y 0 E Eii' I) R E L icense Type: Montana Retail On- Premises
onsumption Beer and Wine License.
License Number: 03 -044- 9179 -301
Subject: Application for Transfer of Location
Applicant: HMII, LLC — Sole Member: — Hal. W. McCoy II
PIZZA HUT LIQUOR
Location Address: 211 Bernhardt Road, Laurel, Yellowstone County, Montana.
NEWLY LICENSED PREMISES
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 February 21, 2014, if there is a compliance
issue. If we do not hear from you conceming 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 (separate inspections and permits may be required — contact the local building department),
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.
Sincerely,
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
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) A TDD (406) 444-2830
CERTIFICATE OF SERVICE
I certify that on this .a day of )E„Nnt,,raNt , 2014, 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
PO BOX 10
LAUREL MT 59044
LAUREL CITY BUILDING INSPECTOR
PO BOX 10
LAUREL MT 59044
RIVERSTONE HEALTH
123 SOUTH 27 STREET
BILLINGS MT 59101
YELLOWSTONE COUNTY
TREASURERS OFFICE
P O BOX 35010
BILLINGS MT 59107 -5010
ADMINISTRATIVE ASSISTANT VIA EMAIL
FIRE PREVENTION AND INVESTIGATION BUREAU
303 NORTH ROBERTS BOX 201415
HELENA MT 59620 -1417
alorenz(mt.gov
smckennac mt.gov
i
V
72 - 27 - 13P(4)39 RCVD ;3
State of Montana .I-L- EIVED
Form 39 DEC ! 7 2013
Liquor and/or Gambling Short Form
1 11411 11111111
The use of No shoat application Is IMAM to charges In is tips of business @ Mt►, for example sole paoprlalo' b ootpqeal% or
an Insane a current omnerahip ponies from undo' 10% to over 10% interest, but no other changes to lei loansaa-or based
arc sat made and a banter of a licence from one baton to another, but no a0xsr dmgss to the lahwN or Insnsec
. made. NOTL An ownership taxlesd in a banned gambling safer liquor operation nay not be transbrrod to a oomplot
stranger to AMMO* lieveregefeanibling the Nemec (someone not already bled end approved as an owner In the Nosnsed operation/ lnlees a rim
Operator combined Lean.. Application nnaging Om proposed toaster Is song to and
approved by the divisions. Although this application b a short loon, the chums of entity gyps or the increase of oaetarslnfp needs
to be published once a week for two oo seculvs weeks and the public has the dght to protest. Bee the attached pease for a
SWAN of the documents and information Mat s% be required for each tranactIon type.
❑ En* Type Changs • ❑ morass of ausant ownership interest from less than 10% awmreh(s to over 10% ownership
ViTmeefor of LoosNon (QOA and/or ONP only; Oaminng Operators use Fo n 37)
Sepleb Melly
elly the mown lorrikis appNasllon:
(t
Xiata .∎ !1 fate r a.. 1 },
Nr floor ill SE 4 Streit LureI MT
Processing Fee. 300
Fbgerpdnh Per 0'27.26 per est (two) when required. (Sae bdlNdu i branseolon type.)
Amount N D SOL 11 — o l t l _ . tquor Manse No. O "' 4944 1111 4 " 30 t
Name ataoeneae . Ik M ZI L LC
•
Business/Trade None Ping &it Cr' 1t+gr
maangAddme /100 L . 9.1• Drive. ,, � W it i KS 612O - 3•eo
Address o Licensed Pardee lit fterh AGA
m sow no L 4u nl / MT 5 044
Business Phone 3li --td4 Mu Phone Email address 1 tty F r0 coon
•
San 1 em MAhohned to mats thle spplation for the applicant and that be snow= contained herein are hue and amplest. If
this @potation or auaoghnle oonteln false kibemalon, I understand I may be subject to be aknUhM penalties of Mont. Cods Ann,
46- 7-203, 46.7.206, 13-4-402 andlbr of any gambling andlor liquor licenses granted mow to e i.
•
Speer 01 LianseelAidtiorlzed Agent tea. Idol 4113
Pdnt Ful Name of taomse&Aulnorlaed Agent 1
• Ram s0Rata 01'2013
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amain. and liquor moth* may oonlnus pending appmvml vita business.ntigaaype change. TMb tons sign only a meg lI
there will be no mew persons added to the new snap If them am new persons end a nerrr.nt %a new Aloslp�
Gambling Opener Combined License Application (Form 5) must be completed. PMese send Ih.following dooumi and
r� p
aplomb* b iso1U len
ih. and approval ortme transfer. •
1. Copy Or current floor plan (Including name, liquor Iosnse number, physlal addkass din oro, s.ednp, "noon bar,
2. Manioc flor I vin Iliastery of Stab for new entity.
3. FEIN vedlicel on from the IR&
4. sachets ur etc for any new funds used forth. thongs, or infused in to the new entity (e g.
5. Corporals andbr business statement (pease use stashed form If neceseaay).
5. Other hnformaflon as applicable to help early the alarms.
T. Bank signets* cards shoeing the new business entity ton
a You wM be pealed dim °proteIIon of the audi and at that time you wM be able to schedule the dosing. Upon doebng,
pleas supply dxemrards memorialising the Menge of entily4yrpes from the ou ant type to the newton Depending en
to change this oomud include corporate doounsnts, perbme hip agreements, LLC agreements, Nor
• Documents vsrlfyhm the end of the current entily4oe, hd ;d ig atidlo
noun of �,
caporatelLLCALP/PartnereNp end of Wawa • Documents vmdlying the new entity-ape, Including minutes, ammo* of
ooporet.ILLC/U PIPert nsta creation documents.
Gambling and liquor aaMy may aananus pis appeal of to knew of oaaarshp from under 10%b OW 10%. lithe parson
Incensing tie ownership wee not prevbusiy qual sd the tome will not wok. This form may only be used If them MI be no odor
clangs* made to the or lts entombs, i.e. leasehold, oenoeeelone, manmgere, losalloue, sls. Miheam are sddldenal
obepse, a nenpAleobo/oo and Gambling Opeaater Combined Lames Appllealion (Form 5) must be oompleled
1. Copy of cuum,* loon plan (including name, liquor license number, phyelal addles.. dimension. seating, $Subs bar,
Piquet storage orb.).
2. Doomed. wilting the source of finding, co radbutsd sapid, equity or for any new funds used for to change, or Infused
Info the way (..p. bon downed* ssoully agreements etc.). •
3. Corporate an w business statement (please use attached form V neoeessry).
4. Other Inbrmelbn as spoilable to help verily the knoleise in ownership or
5. You will be notified of the completion of the audit and at tang* you wan be ebb to schedule to dosing. Upon dosing,
please supply documents msmodelbinm the masses of shereholdermemberberber ownisshlp to the Wily.
• Narrative and aka eMly doc.mets, i.e. mattes, shereeNtersebOannerships issuance agree ts,
• 8hamehnhembsr interests aatiwates.
lies.atadad page 3 for required Information.
You need to sad one original signed application to to 'ambling Control Division. If you would rather n out the applodon on
Your passe computer the tong M meals on the Gambling Cordrd Division wmbelte (www.doi.eat.gov/ gams tgamna.eap) or
from the Depamne t of Revenue webbbo (www.revonae.mt.sov). AI eloohole bsveags and gambling related Was end nubs ale
also avelsbb stases wafts. You cannot *moil or slecbonloaly sand to competed am: you rant cenrplete the form and
send N along wlh the required documents and fees toc
lionises Dsped mment of Juaioe
Goal m Catrol Melon
2550 Prospect Pon - P.O. Box 20t424
• Helene, Montane 005204434
The Dhrleloe(aa) may make la applaud'. aeedadrrlbaal dCoaamS* or NlbnnsM.n. Mb aippleed°. mar
wadded dasumeal. and Inlbnnalroe ad be maimed ender an ameadnd Haan probes and Oval syryraevel$MN
a(4.
at .10 proaedass »7'l "you new any ga sdona plum the Gaefb ag Cannel Obl fe n, unneing
Faaa su Wend 01r2013
2
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The use offs short _ppbdlon k breed b a transfer ale lice se from one boalbn b another, but ho other flanges to he IIou. or *mew •
edgers mate.
Address of Proposed Premises: 2 Etpatarit /acrd r Lsrrei •tf Sri 0 4
(Skeet Address, City, Sate Zlp code)
b the prwrhbes for Nosnsing located:
G✓
Within the boundaries of an boorporated al yltown.
O WNW • dbtenoa of five mess of an incorporated ciyriown.
O Min an unhworporated dgIbwn or outside the baadsAes of and mon than the mess diatoms from airy olyftwen wlhdShehr
Incorporated or unincorporated.
t v
ath In County of 1�e KatiIStarte.
pit► tvsrrhe County Name
Liquor Manes* SuIsbIUIy ChoNrtidt
1) &N Is the type of alcoholic beverages business easy determined, due to indoor and outdoor adrertisinp, steeps eedex
genes) byart and atmosphere of the premises b be homed.
2)bit b premises open on regular bade?
3)6* Does be floor plan and dimensions aoourahhly represent the physical layout of the premiers?
4)6N Does your premises meat building, health, and ere cods Mullion?
5 ) * Wit yaw premises be suparasd by bur pemwnent walls from any other business oondudsd in the bulking,
which Is not directly to tine manufacture, sae or distribution of alcoholic baseness, and with Inside soars only
through a doorway no larger than 6' which an be dosed and looked when not In we.
1 46)N Do you adarowle ge that automatic tic atoohoI dispensing or vending modems am not In use on the mows?
7) YM NIA If you have a deck or patio, sit Immediately adposnt to the licensed premises?
5) &N Doss the layout of your premises aloes for Noensse anchor employee only control over the sale and servos of alcoholic
t) YiNSI Does your estebilehment have • bar and at beet 12 sest at to bet, tables or booths kaspsndaht of gaming readers.
apps)?
egttmite�
• Doounnunle wilting the Nansee has possessory interest in the building where the business is operated. T documents wall be
desrmkhed by dAnthsr you own te new location or if you will be basing It.
o Copies of all pwdhw documents and related g reareMM. mortgages, and sourly egreernnte aadooleled with the new
iamb , and Oldie dale, deeds anchor other documents reteoing no yonder of swab puroh eset
o copes of all bass and related ascurly agreements associated with the new location:
o
Ceded survey elided ;
• Copy ofthe Ioor plan of the area to be licensed, wing approodnnts dimensional measurements, including adarhel dimensions
and general layout — on an 542' x 11' sheet of paper. fic13: On to floor plan you will need to dusty maths ones whore
alcohol steed and served. The tcor pen must contain outside dimmable, the nuns of to eebblishment, pI *si address,
liquor Nolan number and dab.
Farm es Raised O1/2Q13
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RECE1 /ED 8Y
ANA
?�a _., OV4 2019
was°
Certified Survey Affidavit •
Sleet Address of Proposed Premises . ,
/ A
City —. County ,�J ► ... /L_
In the caw of a location outside the corporate boundary, - , the following:
1 , am a D County Surveyor 13 City Surveyor 0 Private Uoeesd Land Surveyor
and law the knoWedge and do authority to attest fiat the distance was measured by radish survey method from the
•
nearest corporate oky boundary to the mufti entrance of the proposed premiss* Moroi as
(Doing Business As). Ptst(s)Ihep(s) verifying the location that Indicate the points between whloh the -
i mpawrm.nt was made and the ribbons can be provided upon request.
• In the case of a location Inside tile corporate boundary, Include the following:
I, n : e t ht f fi n V, can a El County Surveyor a City Surveyor IYI Private Marred Land Surveyor
and have the lowwtsdde and the authority to attest to the looatlon of the premises known as h
• .1d08a]G__ (Doing Business As) was determined by examination of corporate plats or other oebIal records.
• Location of Premiss (check ore) t (�
V Within the Incorporated bounded s of Lcw.rGx (Nana of Clly)
El Leas then We miles from the newest corporate boundary of ()flame of City)
0 Moe than live miles from any incorporated dty within (Name of County)
lithe premises is outside an Inoorporatsd city, please provide the exact Marco (In hwndmdws of a mile) from the nearest
corpowte boon .y to the nearest enhance of the promises. I � � I . m
By signing Ii form, I recognize Este law rsqukes the distanos to measured in a straight Ire from the nearest entrance
, / � /�!�.�.�.,
of the premises proposed for Maiming m est corporate boundary b 'hemmed of the oily or town. ,0i.,..,
Slpraturs •
Surveyor Lanes or Rpktratlon Number /tO2S 4 S
Subscribed and swam to before me this 1 6 of .�.ter�.n ix. 2Q,,. 1..
On this 16 say of JD�,fl & . 20 l 3
r r hit Person *y appeared 112, n I 4 -t -Moys4A —_
; , , _ • „_ , . • brew BOI me a Notary Puubli (,* tire Mats of W inetik4 1A`
• ORAL :. r r uarta 441444+4. (CS N Notary Signature
- Sreq..tti']ci 5 rt PM Name of Notary
My Commission Expkes04/0 h/ 7 Month, Day and Fourth digit of Year
1 ) -)