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Home My WebLink AboutMTDOR - Liquor licenseCustomer Service Center Sam W, Mitchell Building Nell Paterson, Administrator Montana Department of REVENUE MAR 3 1 2003 CITY OE LAUREL P. C. D;x ~712 Helena, Montana 59604-1712 March 27, 2003 RE: Application for Transfer of Stock Ownership of Montana All- Alcoholic Beverage with Catering Endorsement License No. 03-044- 9403-002, PALACE BAR & LANES, 305 E Main St., Laurel, Yellowstone County The above referenced application was received at the Department of Revenue, Registration & 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 any agency determines deficiencies exist that should be considered in the issuance of this license, please advise this office in writing by April 27, 2003. If we receive a determination of a local deficiency, the license application process cannot be completed until the 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 no response is received, it will be assumed there are no problems that would affect the issuance of a license. If you have any questions, please call 444-0713.- Sincerely, Sharon Blunn Compliance Specialist cc: Howard Reid, Bureau Chief Food & Consumer Safety Customer Intake, Lee Baerlocher / Document & Information Processing, Reed Knudson Accounts Receivable & Collection, Rochelle Stewar~ Telephone (406) 444-6900 Fax (406) 444-0750 Internet Address http://www.state.mt.us/revenue/rev, htm CERTIFICATE OF SERVICF I certify that on this ~. ")¢~ay of --P/02./? ¢Jq ,2003, 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 MIKE ATKINSON PO BOX 10 LAUREL MT 59044 LAUREL CITY BUILDING INSPECTOR PO BOX 10 LAUREL MT 59044 CITy-COUNTY PLANNING PO BOX 1178 BILLINGS MT 59103 YELLOWSTONE COUNTY SANITARIAN BOX 35033 BILLINGS MT 59107 YELLOWSTONE COUNTY TREASURERS OFFICE P O BOX 3501O BILLINGS MT 59107-5010 ADMINISTRATIVE ASSISTANT : FIRE PREVENTION AND INVESTIGATION BUREAU 303 NORTH ROBERTS BOX 201417 HELENA MT 59620-1417 rCheck The Appropriate Boxes' ,.. Designate The Purpose Of This App.~ation Alcoholic Beverage 1TI New Alcoholic Beverage License Application [] On-Premises Boer [] Existing Alcoholic Beverage License; Transfer Of Ownership Application [] On-Premises BeerANine [] Existing Alcoholic Beverage License; Corporate structure Change [] Ali-Beverage [] Exist;, ,gAloohotic-Beveragg:--EiceF~-r-an, cfcr Of Losatien~li~t~n r-I R~.~tnumnt Re~ige Gambling [] Resort License ~ New Gambling Designate The Type Of License Of Your Application RECEIVED DEPT, OF JUSTICE GAI~BLIN800N~-RDL DIVBIOh (An owner of an interest in a licensed gambling operation may not transfer an interest 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.) [] New Gambling - No Alcoholic Beverage License is Required for Live Keno/Bingo. [] Amended Gambling License Application - (Note: No fee is required for this application) (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 opera[on without submitting an a~ended gambling license application to the department and obtaining department approval.) [] Existing Gambling License Change Among Existing Corporate Shareholder(s) [] Existing Gambling License Change Among Existing [] Existing Gambling License Deletion of Owner(s) [] Existing Gambling Location Change Application [] Existing Gambling License Type Change Application [] Other - (Explain) Partners or LLC/LLP Members Print Or Type General Information Name of Applicant: (Sole ProprietodPartnerahips/Corp.lLLCILLP) Business/Trade Name: (Doing business as _...) Mailing Address: (Box or Street) Address of Premise to be Licensed: (Street) Palace Bar and Lanes, Inc. Palace Bar and Lanes 305 East Main S'~reet 305 E. Main Street City / State / Zip Code: . LaurEl, / MI' /59044 Business Phone/Cell Phone: (~406) 628-8788 I' Business Cell Fax: (406) '628-8754 . Fed_F.F.F.F.F.F.F.~ .-.:/- _ ~"~ 81-030499~8 [] Check if applied for Alcohol Beverage License Number: '% _ _ . but not yet received. -"~. --- ~~ (N/Aifnotap_p_~ 03 044 9403 0-02_ ~~g located: ~ Within the boundaries of an incorporated city/town [] Within a distance of five miles of an incorporated city/town [] Within an unincorporated city/town or outside the boundaries of and more than five miles distance from any city/town whether incorporated or unincorporated ____LaurP] ....... In County of Y~=] 'l ~. City Name County Name 2 Ownership Information The applicant is a: Check appropriate box individual(s) / Sole Proprietor(s); List all owners in Section I~, Subsection "C." [] Partnership; List all genera! and Limited Partners in Section II, Subsection "C." (Attach copy of Partnership Agreement: Newly Formed Partnerships-Copy of Application/Certificate for Registration of the Partnership filed with Sec. of State's Office, Existing Partnerships - Copy of Renewal of Partnership filed with Sec. of State's Office and Release of Information, (Form 1), in the partnership name.) [] General [] Limited [] Limited Liability Company, List of members in Section II, Subsection "C." (Attach a copy of the Articles of Organization as filed with the Montana Secretary of State's Office; organization minutes; a copy of the Certificate of Fact; and other member agreements and an Authorization for Examination and Release of Information, (Form 1), in the Company's name.) [] Charitable or Non-profit Organization qualified under 26 U.S.C 501 (c)(3), (c)(4), (c)(8) or (c)(19); List all officers/directora and gambling managers i& Secti6n II, Subsection "C.' (Attach a copy of [RS-Letter of Non-profit designation and an Authorization for Examination and Release of Information, (Form 3), in the non-profit organization name.) If applicant is a charitable, religious, veterans'or fraternal organization, when are new officers elected? Date: [] Retirement home or nursing home. List all officers/directors and gambling managers in Section II, Subsection "C." [] Corporation; List all shareholders, officers/directors) in Section II, Subsection "C.' (Attach copy of Articles of Incorporation, By Laws, Certificate of Incorporation; Certificate of Existence orAuthority to do Busines~ in Montana; all organizational minutes; share issuance records; copies of share certificates and an Authorization for Examination and Release of Information, (Form 1), in the corporate name.) > Check Type of Corporation: ~ C Corporation [] Subchapter S [] Publicly Held (Registered with the Securities & Exchange Commission and Traded on a National Stock Exchange) ~' Stateinwhichlncorporsted: MOn'~ZL,~ _ Datelncorporated: I~y iq: '[qRR __ > Is the corporation registered with the Montana Secretary of State to do business in Montana? bYes r~No [3N/A Is the corporation in good standing with the Secretary of State. bYes r~NO IfNo, explain: ~ .. Identify address where corporate organization recoYds are maintained. 3D.5_Y~__M~__iD__S_t~ LaLlr~ 59044 Management Information Provide the following information for each management employee. Attach management agreement if applicable: [] Gambling [] Alcoholic Beverage ]~] Both mN/A Note: Each individual listed above rnust su bmit with this application a personal history statement, Form 10 and Authorization and Release of Information (Form 1). Provide the information requested below for each: Check appropriate box (Use additional paper if' necessary) [] Individual/Sole Proprietor [] Shareholder owning 5% or more of the stock of a publicly traded corporation [] General or [] Limited Partner [] Person(s) and/or committee managing the gambling activity under a [] Limited Liability Company (Member of...) 26 U.S.C. 501 (c)(3), (c)(4),)(8) or (c)(19) organization [] Officer of a Corporation [] Person(s) hctding an option to pumhase the business or any interest in the busine~ [] Director of a Corporation [] Other [] Shareholder of a Corporation [] Check this box if ownership in the liquor 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__ Darrell L McGills 511 W. llth Presiden~ 7/]/1 qSRI 517-~-~qnn n n Linda McGillen 511 W. llth Sec/Tr~3~ ~[~7./1'q~ ~7-66-9621 ~ N Darrell L. McGill ,n 511 W, llth PPDPOSED ,aurel, F~ 59044SHAREHOLDER 7/1/1950 517-56-4900 100 1000 Note: (Each individual listed above must submit with this application a personal history ~tatement, (Form 10), and Authorization for · Examination and Release of Information, (Form 1.) Use additional sheet of paper if necessary. *"~f applying for an Alcoholic Beverage License, answer the following question: J > Are all applicants, partners, members or 10% or more shareholders Montana Residents, qualified to vote in a state election? ~ ::~]Yes []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: F~NIA 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~or a pertod of five years prior to January 1, 19497 F"lyes []No ~ Provide Address of National Headquarters: - (Street Address) /- X (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 Declaration and Affidavit declare under the penalties of false sweadng and/or the revocation of any licenses granted pursuant hereto, that I am the ~licant or duly authorized representative of the firm or corporation mailing this application and that I examined the application, including any accompanying information, and that the responses 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. STATE OF MONTANA } County of Y'RT ,T PA~7~ff~_. .......... } D.~:~r ,T, 'r.. _, be ng duly sworn, if for himself or herself, deposes and says, and that he/she is the applicant above named; or that he/she is i:~es J.c].ez3..b. of the above named corporation; that he/she has read the foregoing application and attachments and that he/she knows the content., thereof, and that all matters and things therein set forth ¢"~true and correct. Print Full Name Si--gnature -D~t-e Personally appeared.~.~;~.~¢_.~,. ]v~={ '~ '] ~,TI W P~bli%~the_$~te ~ Jv~31~-p,~,tl.~ "~*t~. _1 /~_ .~ I'~'~"~r'~l~- Notary Signature My-Commissior~Expires~(.~l~._~C.~Me~-~th, Day and Four Digit ,Year 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 MAt? 1. 0 DEPT. OF &/ST/CE RECEI~ DEPT. OF