HomeMy WebLinkAboutMontana Dept of RevenueDan Bucks
Director
September 24, 2007
Montana Department of Revenue
!i~]: SEP 26 2007
cFrY OF
Brian $chweitzer
Governor
RE:
Application for Transfer of Ownership of Montana Ali-Alcoholic
Beverage with Catering Endorsement License No. 03-044-9201-002,
THE LOCOMOTIVE CASINO, 216 S 1st Avenue, Laurel, Yellowstone
County, Montana
The above referenced application was received at the Department 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.
If any aftency determines deficiencies exist that should be considered in the
issuance of this license, please advise this office in writing by October 24, 2007.
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 you have any questions, please call (406) 444-0713.
Department of Revenue
Liquor Licensing
P O Box 1712
Helena MT 59624-1712
c: Annette Rinehart, Department of Labor & Industry
Customer Service {406) 444-6900 · TDD [406) 444-2830 · www.mt.gov/revenue
CERTIFICATE OF SERVICE
I certify that on this 24th day of September, 2007, 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
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 201417
HELENA MT 59620-1417
Check The Appropriate Boxes To Designate The Purple Of This Application . . .
Alcoholic Beverage Designer-, The Type Of License Of Your Application.
n NewAIcoholie Beverage Licence Aaplicetion n On-Promises Beer
sting Alcoholic Beverage license; Transfer Of OwnershlpAaplice~on.Q On-Premises Bnsr/~Nlne
I~ng Alceholic Beverage Ucen.: Corporate Structure Change /l$~,Ali-Baverag, RECEIVED
BY
n Exl~ng Alceholin Beverage License; Transfer Of LocetionAppllcetien []Resteumnt BesrANine
[] ExistingAl~oholicBeverage Ucense; Dseth of Ucensee [] Resort License AU~ ~ 4 20D7
Gambling G/~N~ GOi~
~J~New Gambling ~ ~81C~
(A' n owner of an I-~mat n a Insnced gambling operation may not tmnafer an infereet ~n the operatlofl to a etTanger to the license
until a new gambling license applicetion mtie~ng the pmpoced transfer IS subrnlffed to the daparlment and the department
approves ~ b'an~er.}
[] New ~unblMg - No Aleoholte Beverage Ucense is Required for Live Keno/Bingo.
[] Amended ~mbllng Lleenns Application- (Nm: No fee Is required for this application)
(An ownsrahip intemet in a licensedgam~lin~peret~n may not be.'~mafen~H= anet~f' ovme~ o r gro~p ~f~Nnem of an Interest
or intemm In the 8ama licensed gambling operation w'~hout eubmi~ng an amended gambling license applice~on to the depanYnent
and obtaining departmant approval.)
[] Exl~ng Gambling Ucense ChangaAmong Exl~ng
Co.orate ~hersholde~a)
[] Exis~ng Gambling Lice~ce ChangeAmong Existing
Partners or LLC/LLP Members
[] Existing Gambling Ucense Deletion of Owner(s)
[] E)deflng Gambling Location Change Application
~[] Existing Gambling Ucense Type ChangeApplicetion
[] Other - (Explain)
General Information
Print Or Type
NameofApplicent: ~,,~.,~,~._,~,,.,Z~ ~/_ ~
/ ~ (So~ Pm~a~emh~l~C~P)
Busln~mdeName: ~ ~~1 ~ ~J~
(D~ng ~Ine~ es....~su~d b~l~ ~ mu~ be tiled
(~ 5u~ No., Bui~ing No.)
ci~ / ~ / =p Cede: ~~
Busine~
Federal Tax I.D.: , [] Check if applied for but not yet received.
AlceholBeverageLJcenseNumb,r: '~"~'--- ' ~:~ '/'"/'~(¢~//Alfnot;ap~'~ -- ~
Are the premises for licensing located:
:~i~'V~thin the boundaries of an Incorporated city/town (G~mbling Licensing.)
~1~ Wd~in a distance of~ve aline of an innorpomted oityAown (Liquor Licensing.)
[] Within an uninceq)oreted city/town or outside the boundaries of and mom than five miles distence from any city/town whaler
incorporated or unincorporated (Liquor Licensing.)
C~ Name / County Name
,
2
T
Provide the Information requested below for each: Che~ appropflste box (Use additional paper if necoasap/)
O Individual/Sole Proprietor O Person(a) holding an option to pumhase the business or
0 General or 0 Limited Partnership any interest In the business
[] Limited Liability Company (Member of...) [] Other
X Officer of a Corporation [] Check this box if ownership in the ]~luor Ilcorme is also
held es Joint Tenants with Rights of Survivomhip (JTROS))
'~ Dire~or of · Corporation or Tenants in Common (TEN COM) and make codein each
~ Shareholder of a Corporation individual with rights of survivorship or common am listed
O Shareholder owning 5% or more of the atcok of a publicly below.
traded corporotion J'rROS orTEN COM
D PotaSh(S) and/or committee managing the gambling
a~vtty under a 26 U.g.C. 501 (o)(3), (o)(4),)(8) or (o)(19)
organization
· .~'?d;;.Le~ame;:;' ::: , ' -... r.' ' ':' :~'=' ' :'~i_~_'~of :'i'':'-ab;iai. Pementage' 'Number
d'M~l
efOwne~!blp
'::' IPimt. M'l'~: : ....,~., ~1.~.., .,!, :."" ~: :"?';'.,:', ,!::,::![a~ .":' ~:,~ ,_e~t~au.mlmi' ~ghares
Note: Each indhdduallisted above must submit with this abpil~atico a personal history statement, (Form 10),Authorlz~on for Examination
and Release of information, (Form 1.) and a complate~ Fingerprtn! Ca~. Use additional sheet of paper if neneesa~/.
hereby request smoYJng exception and affirm that 60% of the revenue generated by this b~miness will be from the sate of liquor ]
end/orgembling, ~ Ye~
Idenotrsquestemoklngexcepflon. [] No
Charitable, Religious, Veterans' or Frateroal Organization
If the applkmnt is a charitable, religious, vatererm' or fraternal organization, complete the following information.
If not applinable indicate: .~ N/A
~ OatequallfledforexempUsnunder26U.$.C. 801~'' (c)($),(c)(4),(c)(8)or(o)(19):
Month Day Year
), Date Ionat cberter hransd or pnst organized:
Month Day Year
)~ Hac national organization been In exiathnce for · period of gve years pdor to January 1, 1949?
D Yes [] No
) Provide Addraes of National Headquarb~ra:
(S'o'eat Address)
I
, (clb,) (state)
A copy of your organlzatien er post charter must accompany thl~ application,
I.o~Uon of Gambling Premises:
(Zip)
(Street Address)
(C~)
How many days, peryear, te gambling conducted atthle location?
/
(S~te) ~ip)
Days.
·
C. is the premises within Bny defined zones:
1. Where the sale of alcoholic beverages is restricted by ci~ or coun~ zoning ordinanca?
[] Yes ~j~No
2. Where gambling ia restricted by city or county zoning ordlnanco?
[] Yes ~'No
D. Is the building reedy for uae for an aJcoholis beverage busluses: ~Yes [] No
1. is this a newly constructed promises?
[] Yes ~No If No, indicate an estimated date of occupancy
2. Is this a remodel ~f an existing premises?
[] Yes ~No If Yes, Indicate an estimated date of completion
E. Submit a gopy of the floor plan area fo be licensed, using approximate dimensional measurements, including
external dimensions end general layout- on an 8-1/2" x 1t" ehust~of..paper:an~-numbe;m~-tables and chairs
indicated. If you are applying for a restaurant beer and wine license, be sure the floor plan has the service bar ama clearly
de,=lgnaisd thereon.
Note: On the floor plan you will need to clearly mark the areas where alcohol will be sewed, 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.
13
DecMration ,nd Affidavit C UNG DM;ION
I declare under the pertaltle8 of f"lse wearing and/or the revoc~lon of shy liconses granted pumuant hereto, thM I am the
spplle, ant or duly authorized mpmsen~tive of the tirm or COlT)Oration mallir~l this application and that I ex,mined the applica~on,
in~uding any ~coomp~nying infurm~licn, ~nd that the reepon~e~ ara tree, COn'eM and COmplete. I under6t=nd If this application
or attachment(s) COntoln$ f~16e Infurm~lon. I am Subjec~to the chminal penalties of Section 45-7-202, 45-7-205 and 4~-7-208.
Montana Code Annotated, and/or revocation of any alCOholic beverage or gambling licenses granted pursuant to this application.
STATE OF MONTANA )
)
oount~ of ~:~:/~/.~ 4/~ )
~'~ .~?~J:~./~".~V'.) ~A/~'. , bsl~ duly ~m, if ~ hlmsew °r hemelf, depos~ and
s~, ~at he/she Is ~ applica~ ab~e ~; or ~at h~s~ is ~/~ of the ab ove
n~ed ~omUon; ~t h~she has ~d ~e ~mgolng appll~tion and a~chme~ and ~at ~she kn~ ~
~n~n~ theme, and ~t a~ maim and ~1~ ~eMn set ~ am true and ~L
This application must he COmpleted in full, and all requested attachments must
accompany it. Delay, denial orthe return ofthe application will result If InCOmplete.
Additional Infonnstton May Be Required During the
Investigation of Your Ucense Application
CONTROL
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