HomeMy WebLinkAboutMontana Dept. of RevenueDan Bucks
Director
September 26, 2005
Montana De
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27 2005 Brla~$oCvherWn~IZer
CITY OF LAUREL
RE:
Application for Transfer of Ownership of Montana Ali-Alcoholic Beverage With
Catering Endorsement License No. 03-044-9403-002, DJ STEAK PALACE BAR &
GRILL, 305 E. Main Street, Laurel, Yellowstone County, Montana
PREMISES IS BEING REMODELED
The above referenced application was received at the Depadment 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.
THIS IS AN APPLICATION FOR A PREMISE BEING REMODELED. BUILDINGT HEAL TH
AND FIRE APPROVALS WILL BE REQUIRED BEFORE DEPARTMENT APPROVAL WIII
BE CONSIDERED. If any agency determines deficiencies exist that should be considered in
the issuance of this license, please advise this office in writing by October 26, 2005. 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
pretest against the issuance of this license, a public hearing will be scheduled.
If you have any qu/e~ns, please call 444-0710.
Liquor Licensing
P O Box 1712
'Helena MT 59604-1712
C:
Annette Rinehart, Department of Labor & Industry
Deanna Uithof Food and Consumer Safety
Customer Service (406) 444z6900 · TDD 1406) 444-2830 · www.mt.gov/revenue
CERTIFICATE OF SERVICE
the foregoing has bee--'-~ee~ed by pl~cing 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
YELLOWSTONE COUNTY SANITARIAN
BOX 35033
BILLINGS MT 59107
YELLOWSTONE COUNTY
TREASURERS OFFICE
P O BOX 35010
BILLINGS MT 59107-5010
ADMINISTRATIVE ASSISTANT
303 NORTH ROBERTS BOX 201417
HELENA MT 59620-1417
Check The Appropriate Boxes To Designate The Purpose Of This Application
Alcoholic Beverage Designate The Type Of License Of Your Application:
[] NewAIcohol[c Beverage LicenseAppiication [] On-Premises Beer
~(Existing Alcoholic Beverage License; Transfer of OwnershipApplication [] On-Premises BeerAN[ne
'[]Existing Alcoholic Beverage License; Corporate Structure Change ,~AII-Beverage
[] ExistingAlcoholic Beverage License;Transfer Of LocationApplication [] Restaurant BeerANine
[] ExistingAIcoholic Beverage License; Death'of Licensee [] Resort License
Gambling
4¢~,N ew Gambling
(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 operation without submitting an amended 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
Partners or LLC/LLP Members
Print Or Type
Name of Applicant:
Business/Trade Name:
Mailing Address:
[] Existing Gambling License Deletion of Owner(s)
[] Existing Gambling Location ChangeApplication
[] Existing Gambling License Type ChangeApplication
~ Other - (Explain)
General Information
BLING CONe'
(Sole Pmprietor~a~nerships/Cor~./LLC/LL~)~
(Doing business as .....)
(Box or ~rae~)
(Street, Suite No., Buildin~ No.)
Business Cell
O Check if applied for but not yet received.
(N/A if not applicable)
Address of Premise to be Licensed:
City / State / Zip Code:
Business Phone / Cell Phone:
Fax:
Federal Tax I.D.: ~O - r,~,--'~ ~) 42/ z./
Alcohol Beverage License Number:
Are the premises for licensing located:
~[,Within the boundaries of an incorporated city/town (Gambling Licensing.)
~LWithin a distance of five miles of an incorporated city/town (Liquor Licensing.)
[] Within an unincorporated city/town or outside the boundaries of and more than five miles distance from any city/town whether
incorporated or unincorporated (Liquor Licensing.)
City Name County Name
2
RECEP' D BY
AUG 4 2005
Owners h,p Infor G C0NTROL D[VISI0 ,
A. The applicant is a: Check appropriate box ~ U~'
' ~U
[] Individual(s)/Sole Proprietor(s); List all owners in Section II, Subsection "~.~/Y]~//~
[] Partnership; List all general and Limited Partners in Section II, Subsection "C."
(Attach copy of Partnership Ag recreant: Newly Formed Partnerships-Copy of Application/Cer~ificate for Reg~¥f'~/~l~n 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 I1, 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/
directors and gambling managers in Section II, Subsection "C."
(Attach a copy of IRS Letter of Non-profit designation and an Authorization for Examination and Release of Information,
(Form 3), in th~ 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
Corporation; List all shareholders, officersidirector~} in Section II, Subsection "C,"
(Attach copy of Articles of Incorporation, By Laws, Certificate of Incorporation; Certificate of Existence orAuthority to do
Business 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.)
CheckType of Corporation:
[] C Corporation
~'Subchapter S
[] Publicly Held (Registered with the Securities & Exchange Commission and Traded on a National Stock Exchange)
~ State in which Incorporated: JV~0/~I~-.T"J~V' ~. Date Incorporated:
.Is the corporation registered with the Montana Secretary of State to do business in Montana?
[] No [] N/A
~>Is the corporation in good standing w{th the Secretary of State?
~1~ Yes [] No If No, explain:
).Identify address where corporate organization records are maintained. /~.~ ~J~/-~/".J(',~
3
~ C~__.rovide the information requested below for each: Check appropriate box (Use additional paper if necessary)
Individual/Solo
Proprietor ~l:~'~'on(s) holding a~[he business or
r~ General or [] Limited Partnership _~ny ic¢;e~ h,:~u~s
· [] Limited Liability Company (Member of...) [] Other
~ Offi~er--c~La~.,.o.~ie~--- [] Check this box if ownership in the liquor license is also
~l Director of a Corporation ' held as Joint Tenants with Rights of Survivorship (JTROS))
or Tenants in Common (TEN COM) and make certain each
individual with dghts of survivorship or common are listed
~Shareholder of a Corporation
[] Shareholder owning 5% or more of the stock of a publicly below.
traded corporation JTROS [] or TEN COM []
[] Person(s) and/or committee managing the gambiing
activity under a 26 U.S.C. 501 (c)(3), (c)(4),)(8) or (c)(19)
organization
Note: Each individual listed above must submit with this application a personal history statement, (Form 10), Auihorization for Examination
and Release of Information, (Form 1.) and a completed Fingerprint Card. Use additional sheet of paper if necessary.
f'~lf applying for an Alcoholic Beverage License, answer the following question: /
! > Are all applicants, partners, members or 10% or more shareholders Montana Residents, qualified ~o vote in a state election?
L ~,Tes [] 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 indicaie: [] 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 Janua~j 1, 1949?
[] Yes [] No
~' Provide Address of National Headquarters:
(Street Address)
/
(Cit~) (State)
A copy of your organization or pest charter must accompany ~hts application.
Location of Gambling Premises:
(Zip)
(Street Add ross)
4 /
(Cit~) (State)
Howmany days, peryear, Is gambling conducted at this location? __ Days.
(Zip)
Premises InformatiOn
A. Does the applicant's premises: (Use additional paper if necessary)
1. Have permanently installed walls extending from floor to ceiling?
,,~es [] No
2. Haveadistinct address?
,~(.es [] No
3. Share an address with another business?
[] Yes ~..No
RECEIVED BY
GA BLING CONTROL DIVISION
4. Have a public external entrance that is not shared with another premises for which a gambling opera[or license has been
issued?
[] Yes '~lNo
5. Share a common internal wall with another premises to which a gambling operator license has bean issued?
[] Yes '~.~o If Yes, explain and submit copy of the floor plan.
B. Describe where the premises is located:
1. Are the entrance doors of the premises proposed for licensing on the same street and within 600 feet of the entrance doors
of a building occupied exclusively as a church, synagogue or other place of worship or school (except a commercially
operated or post secondary school)?
[] Yes I~o
2. Is the premises located within 150 feet of another premises licensed for on-premises alcoholic beverage consumption? (As
defined in 23-5-829 MCA)
[] Yes '~,lo If yes, answer all the following questions:
[] Yes
[] Yes
[] Yes
[] Yes
[] No Does the second premises already have a permit for placement of video gambling machines?
[] No Is there a structural walkway between the two premises?
[] No Is the second premises licensee affiliated with the applicant?
[] No Is there an immediate family member related to the applicant within the ownership structure of the second
premises licensee?
[] Yes [] No Do the two licensed premises share any common management personnel?
[] Yes [] No Would [he applicant be considered a parent or subsidiary business entity to the second licensee?
[] Yes [] No Does any person or entity within the ownership structure of the applicant share a commonality of business
interest with any other person or entity within the ownership structure of the second licensee?
[] Yes [] No Are there any contractual agreements or financing agreements between the applicant and the second
licensee?
[] Yes [] No Are there any investors common to the applicant and the second licensee?
Is the premises within any defined zones:
'1. Where the sale of alcoholic beverages is prohibited by city or county ordinance?
[] Yes
2. Where gambling is prohibited by city or county ordinance?
[] Yes ~o
D. Is the building ready for use for an alcoholic beverage business: ~Yes [] No
1. Fora new constructed premises?
[] Yes [] No If No, indicate an estimated date of occupancy
2. For remodel of existing building?
[] Yes [] No If Yes, indicate an estimated date of completion
E. Submit a copy of the floor plan area to be licensed, using approximate dimensional measurements, including
external dimensions and general layout - preferably on an 8-'~/2" x 'H" 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.
Note: On the floor plan you will need to ciearty mark the areas where alcohol will be served, stored and
consumed. The floor plan must contain outside dimensions, the name of the establishment, physical address,
liquor license number (if applicable) and date of submittal
Declaration and Affidavit
I declare under the penalties of false swearing and/or the revocation of any licenses granted pursuant hereto, that I am the
applicant 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 th is application.
RECEIVED BY
AUG o 2005
STATE OF MONTANA )
) IBLING CONTROL DIVISION
County of~, )
/~'~¥") ~--'~' ~ ~J~)~ ,being duly sworn, if for himself or herself, deposes and
says, and that he/she is the applicant above named; or that he/she is .~¢-,~ ~ of the above
named corporation; that he/she has read the foregoing application and attachments and that he/she knows the
contents thereof, and that all matters and things therein ~t forth are~tru, e ~)nd correct.
Print F.ull Name / ~ ' S'igna~"r~' I
JODY B. LANDSVERK
Notarial Seal State of Montana
Notary Pubiic for the State of Montana
Residing in L~urel
My Commission Expires w~.-I ;L- ~
Notary Seal
'On this ~ "~-- dayof
Personally appeared ~q~(,On~-.
~e a Nota~ Public for the S~te of
~,~ ~' ~~ ' ' (No~ Signature)
L ) ~0~' ~. ~Cr~ (Print Name of Nota~)
' ~ Expires
My C.emmms~on (Month, Day & Four Digit Year)
This applicat oq must be completed in full, and all requested attachments must
accompany it. Delay, denial ortho return ortho application will result if incomplete.
Additional Information May Be Required During the
Investigation of Your License Application
IUE
MONTANA
Survey-02
Rev, 3-02
Certified Survey Affidav ECEIvE )"
GAMBLI!',G COt fTF OL
Legal description and/or street address of proposed premise
City
County Yellows bone
305 East Main Street
I ~U~- ~/O~ r-lCounty Surveyor, r'lcitySurveyor, ElPrivate
Licensed Land Surveyor ~ ocal Government Official (check ane) have the knowledge and the
authority to attest to the location of the premise known as ~q ~ Pa,* .~.,~a T.~¢,
(trade or business name). ·
The location of this premise is; (check one)
E] within the incorporated boundaries of ~au=e2_ (city),
[] within five miles of the incorporated boundaries of -(city),
[] more than five miles from the incorporated city of (city).
The distance was measured by radial survey method from the nearest corporate city boundary to
the nearest entrance of the proposed premise. Plat(s)/map(s) verifying the location that indicate
the points between which the measurement was made and the distance can be provided upon
.request '
I declare under penalty of false swearing that the information in this document is true, correct and
complete.
tz,/'¢/
Subscribed and Sworn before me
This
Notary Public for the State of Montana
Residing at ~.o~,z-~/__ , Montana.
My Commission Expires /-,2¢ - (p ¢
507
(' ]2Z '-'-~
RECEIVED' BY
AUG 0 1 ~005
~BLING CONTROL DIVISION
I I
M~ I. 0 ~00~ .
DEPT, OF JUSTicE
AUG O 1 2005
~A~IBLiNG CONTROL DIVISION
\
t
/
1
I
/
NEW ENCLOSED CASSI.NO AREA.
Palace Remodel
-~I$oQ.~e: NO SCALE
6/28,'~00~
//DEL:
., JJ Clark Johnson
IL Re&id~.tlal Design Servic~
Revision:
Sheet
1
Existing Floor Plan
Palace Remodel
Clark Johnson
Rasidential Design servioe~ L
Reviszon:
RECEIVED BY
AUG o 12005
¢¢~IBLIN6 CONTROL DIVISION
NEW WINDOWS
RS
S TO
NEW WALL AND OPEN
WALL TO FLOOR
WHERE WINDOWS
WERE
CASSINO
13'0 ~ 11'4
Sheet
2
July 29, 2005
Montana Department of Justice
Gambling & Liquor Control Division
2550 Prospect Avenue
Helena, MT 59620-1424
AU~ o 1 2005
~AMBLING CONTROL 9,~VISiON
To Whom It May Concern:
I have enclosed our current floor plans. Due to the new Smoking Law we will be
remodeling our casino to comply with the new law, therefore I also enclosed a copy of
the new construction. The construction is nofih p~:bgress yet, bfit will be completed by
October 1, 2005 to comply ~with the new regulations.
Sincerely,
Shawna K. Gradwohl