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Home My WebLink AboutMontana Department of Revenue (10) Ali Montana Department of Revenue ', • NAWANYWAROMP .40•WWWW. •41~00.011~fte NAMAIONAR WIEWOMOW Mike Kadas Steve Bullock Director Governor November 2, 2016 License Type: Montana Retail On-Premises Consumption Beer and Wine License License Number: 03-044-9569-301 Subject: Transfer of Ownership Applicant: High Plains Brewing LLC: Members: Dave Bequette Location Address: High Plains Brewing, 601 East Main Street, Laurel, Billings, Yellowstone County, Montana 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 December 2, 2016, if there is a compliance issue. 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, VA:Cti.ot,Atinoto Vickie Zincke lECEOVE Compliance Specialist Department of Revenue Liquor Licensing ft NOV 5 'n15 PO Box 1712 Helena MT 59604-1712 I Telephone (406) 444-0713 CITY OF LAUREL VZincke2mt.qov End. Floor Plan and Application Pages Certificate of Service revenue.mt.gov A Toll free 1-866-859-2254(in Helena,444-6900) • TDD (406)444-2830 CERTIFICATE OF SERVICE I certify that on this 2 day of November, 2016, 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 ishovar(a�laurel.mt.gov RIVERSTONE HEALTH 123 SOUTH 27TH STREET BILLINGS MT 59101 clark.sny@riverstonehealth.org YELLOWSTONE COUNTY SHERRY LONG TREASURERS OFFICE P 0 BOX 35010 BILLINGS MT 59107-5010 SLONG@CO.YELLOWSTONE.MT.GOV ADMINISTRATIVE ASSISTANT FIRE PREVENTION AND INVESTIGATION BUREAU 303 NORTH ROBERTS BOX 201415 HELENA MT 59620-1417 diswingley@mt.gov � • Jessica :arnes, Compliance Technician Section II GENERAL INFORMATION Name of Entity or Person Applying High Plains Brewing LLC (Sole Proprietor/Partnerships/Corp/LLC/LLP e.g.Swanny's Bar LLC) Business Name 601 East Main Street,Laurel, MT 59044 Physical Address of Premises to be Licensed 601 East Main Street Laurel 59044 Street,Suite No City Zip Mailing Address 601 East Main Street Laurel 59044 Street,Suite No City State Zip Business Cell Phone (406)633-4594 Phone Fax Email rockpile1@outiook.com FEIN _ 0 Check this box if you wish to receive annual ❑ N/A(f sole proprietor who will not require hired renewals electronically Liquor License Number (write"NEW"if new license application) I ' ATTORNEY INFORMATION Check this box and complete below information if you wish to have all correspondence sent to the attorney who submitted this application on your behalf Attorney Name Christopher Sweeney Business Phone (406)248-7731 Mailing Address 27 North 27th Street,Ste. 1900 Billings MT 59103 Street,Suite No City State Zip Email Address christopher.sweeney@moultonbeilingham.com The premises for licensing is located within: 0 the boundaries of an incorporated city/town a distance of five miles of an incorporated city/town an unincorporated city/town or outside the boundaries of,and more than five miles distance from any city/ town whether incorporated or unincorporated City of Laurel County of Yellowstone 2 Section III OWNERSHIP & MANAGEMENT INFORMATION The applicant is a:(See hybmiation checklist far documents required for each ownership type) Ownership Type: [� Individual(s)/Sole Proprietor(s) Are any individuals and/or partners • General Partnership Joint Tenants with Rights of Survivorship(JTROS)? 12 Limited Partnership 0 No )g Yes g Limited Liability Company • Limited Liability Partnership C Charitable or Non-Profit Organization qualified under 26 U.S.C.501(c)(3),(c)(4),(c)(8)or(c)(9) i Retirement home or nursing home(Gambling Only) • C Corporation [1 Subchapter S Corporation 17 Publicly Held Corporation - - List all owners,partners,members,officers and/or directors of entity applying. Please include SSN for individuals and FEIN for entities. Each individual listed below must submit two completed fingerprint cards, personal/ criminal history statements and fees. Use additional sheet of paper if necessary. For applicants that use a multiple entity structure,attach a diagram showing all entities and individuals. Name(First.nni Dave Bequette Title Owner/Member DOB - SSN or FEIN -- Number of Shares N/A Address 601 East Main Street,Laurel, MT 59044 Percentage of Ownership 100 Name(First,MI,Last) _ Title DOB SSN or.FEIN Number of Shares Address Percentage of Ownership Name(First,MI,Last) Title DOB SSN or FEIN Number of Shares Address Percentage of Ownership °(t Management Type: Entity C Individual (i$ Owner managed Not known at this time Provide the following information for each management employee. If applying as an entity,include the manager of the day-to-day operation for the business. Attach management agreement if applicable. Each individual listed below must submit two completed fingerprint cards,personal/criminal history statements and fees. ❑ Gambling 0 Alcoholic Beverages 0 Both IS N/A Name(First,MI,Last) DOB SSN/FEIN Address Salary ❑ Gambling 0 Alcoholic Beverages 0 Both 0 N/A Name(First,MI,Last) DOB SSN/FEIN Address Salary 3 Section V PREMISES INFORMATION A. Does the applicant's premises: 1. A No re Yes Have permanently installed walls extending from floor to ceiling? 2. a No ®Yes Have a unique,clearly definedaddress that is not shared with another business(i.e.,suite or unit designated) 3. J No El Yes Have another business operating out of the same premises? (If yes,name of the business) LE,LLC(not on,the licensed premises,but in the same building) 4. ®No (3 Yes Have a public external entrance that is shared with another premises for which a gambling operator license has been issued? (If yes,name of business): 5. ENo (g Yes Share a common internal wall with another premises to which a gambling operator license has been issued?If yes,explain and submit copy of the floor plan and also name of operator's/owners: 6. allo MIYes Have a bar and at least twelve (12) seats at the bar, tables or booths independent of gambling machines? B. Describe where the premises is located: 1. ®No ®'Yes Are the entrance doors of the premises proposed for licensing,on the same street as, 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) 2. h No laYes Is the premises located within 150 feet of another premises licensed for on-premises „. : alcoholic beverage consumption?(as defined in 23-5-629 MCA) Name of second location: LE.LLC 3. Il No ®Yes Does the second premises already have a permit for placement of video gambling machines? 4. ®No DYes Is there a structural walkway between the two premises? 5. No ®Yes Is the second premises licensee affiliated with the applicant?(If yes,please explain) 6. ®No ®Yes Is there an immediate family member related to the applicant within the ownership structure of the second premises licensee? r. 7. No Yes Do the two licensed premises share any common management personnel? 8. ISNo ®Yes Would the applicant be considered a parent or subsidiary business entity to the second licensee? 9. Oho DYes 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? 10. pjNo CBYes Are there any contractual agreements or financing agreements between the applicant and the second licensee? 11. In No D Yes Are there any investors common to the applicant and the second licensee? C. Is the premises within any of the following defined zones where: 1. t No ®Yes Sale of alcoholic beverages is restricted by city or county zoning ordinance? 2. pp No CIYes Gambling Is restricted by city of county zoning ordinance? D. Is the premises: 1. 0 No 14 Yes Ready for use 2. -. No 0.Yes Newly constructed premises?(If yes,indicate an estimated date of completion) 3: RP No a Yes Remodel of an existing premises?(If yes,Indicate an estimated date of completion) 4. In No a Yes Operated under a concession agreement?(If yes,attach a copy of the concession agreement. Note:ARM 42.12.133 requires certain signage fora premises operated under a concession agreement) 9 Section Viii MG DECLARATION AND AUTHORIZATION wan coonM 1, David Murphy Bequette , declare under the penalty of false swearing that I am the applicant or duly authorized representative of the entity 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 Montana Code Annotated 45-7-202. 45-7-203 and 45-7-208, and/or revocation of any alcoholic beverages or gambling licenses granted pursuant to this application. I 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 V;I Print Full Name David Murphy Bequette Title/Position Owner/Member of High Plains Brewing LLC Date August 17,2016 • 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 review of your license application. 12 n II plains Bream e1,M't 590 44 usiness name'KVM Stxeet'fur 56g-301 B 601 Fast 0-044-9569-301 Address: urnber. 03' Ave. yexage License N washi iit ' Be , `J i \\: to \\:\.\\ ♦, N {, . , ... ... ,„, ... .., , .„, , ,,, -\\ , .„. „ , ,, s. . „ -,„ -,,, ,,, „ „ \\\ -\\,\:\\\\ , --, , „.. ,„,,,,,N:\ -.. \ ‘ i 1 I .....;4 I, 0 \ ;100, a , ...,. -7 N„, ` a�4�r +rl' __444111 _r›-3 y" E. ( �� r o. 'sem "'.,� �`. , ,\,,, ., ... `°' yr! ,• .:l�y - , , d A ,„. .„, ,,. ‘ - 1 , Nt-tt, '''' ---,„:NNN'''N's Yom , ,jc.- my, .o CI. . _ et cp V. .4 +', r; �► .i• V IP ,,n ikt . r',-- • „41:-.191/1 411 Ns\:�`�.. `'`�,,` `. fir, y. a.: \, `,• _ N,`,,, NNy_ , % SEP 0 9 2016 r ,,N. i