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Home My WebLink AboutMontana Department of Revenue (11) Montana Department of Revenue Mike Kadas Steve Bullock Director Governor May 12, 2017 License Type: Montana Retail Off-Premises Consumption Beer and Wine License Number: 03-999-9171-303 Subject: Application for one original new Off Premises Consumption Beer and Wine License Applicant: Town and Country Supply Association, d/b/a Town and Country Supply West Main (see attached list of directors) Location Address: 817 West Main Street, Suite A, Laurel, Yellowston County, Montana NEW LICENSED PREMISE 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 June 12, 2017,if there is a compliance issue. If we do not hear from you concerning 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, 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, Vioeetk-Zi/i^‘*-0 gECEOVELO Vickie Zincke Compliance Specialist, Department of Revenue MAY 1 7 2017 Liquor Licensing PO Box 1712 Helena MT 59604-1712 CITY OF (406)444-0713 LAUREL VZincke2(a�mt.gov Encl. Floor Plan and Application Pages Certificate of Service revenue.mt.gov A Toll free 1-866-859-2254(in Helena,444-6900) A TDD(406)444-2830 i I I i i I I i �I i I� i I I i I it III i 1 CERTIFICATE OF SERVICE I certify that on this 12th day of May, 2017, 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 jshovarAlaurel.mt.gov RIVERSTONE HEALTH clark.snAriverstonehealth.org marilyn.tap(a�riverstonehealth.org YELLOWSTONE COUNTY SHERRY LONG SLONGa.CO.YELLOWSTONE.MT.GOV DICK SWINGLEY, STATE FIRE MARSHALL FIRE PREVENTION AND INVESTIGATION BUREAU diswinglevAmt.gov Moreen Swin,gl�1�ey / Compliance?gelinician • RECEIVED e/1TIP>j!IUSINESSLICEIISES MAY 01 2017 N ,,,------- eStop Master Application MT DOR Business Licenses is Check appropriate boxes and complete all applicablenow.mt.g box(es) pl information. •, eStor�.mf,gov Business Changes ' , ® Register a new business with eStop.See Section II for fees that apply. kl N. ❑ Update business information,such as mailing address or contact information,etc.No fee. ❑ Change business structure or entity type.A liquor processing fee may apply.See Section II. ❑ Add a new physical location to your eStop business.See Section ii for fees that apply. ❑ Purchase of an existing eStop location.Previous owner's Location Number Location Changes-Provide current Location Number for box(es)selected below Your Location Number is at the upper right-hand section of your eStop license and renewal. O Relocate to a new physical location.A license fee may apply.See Section II. ❑ Update location information,such as name/DBAltrade name,etc.No fee. ❑ Update license information,such as add,increase/decrease,change license type,etc.See Section II for fees that apply. Section I. Business information Company or Owner Name Town and Country Supply Association Federal Employer Identification Number or Social Security Numtx _ , P.O.Box 367 Laurel MT 59044 Business Mailing Address City State ZIP+4 Type of Business(please check one and provide additional information if needed): ❑ Sole proprietorship ❑ S corporation 0 Governmental V� ❑ Limited liability company 0 Association 0 Limited partnership c\ ® C corporation 0 Limited liability partnership ❑ Other ` ❑ Nonprofit C corporation O Partnership ` ' Location Information Assumed Business NamelDBAITrade Name,etc.Town and Country Supply West Main 817 West Main Street,Suite A Laurel Montana 59044 Physical Location Address City State ZIP+4 Yellowstone 406-628-6314 406-628-7895 County Location Phone Number Location Fax Number Contact information Name Wes Burley Phone Number 406-628-6314 Please Print Email address wburley@tandcsupply.com Important Complete Section II(other side of form),if applicable.In all situations,sign and date. All coordinating applications and affidavits must be completed and attached for processing. License fee and payment information is on the other side of this form. Signature(required) I declare under penalty of false swearing that I am the applicant or the duly authorized representative of the entity making this a tion, that the responses provided,including any accompanying information,are true,correct and complete. ,� General Manager Wo ?//7 Signature Title Date j Mail completed form to:eStop Business Licenses,PO Box 8003,Helena,MT 59604-8003 Questions?Call us toll free(866)859-2254(In Helena,444-6900),FAX:(406)444-7723 Rev 1215 • Town and Country Supply Association 18 8th Avenue - P.O. Box367 Laurel, MT 59044 Directors Robert L.Williams President Home 962-3688 4072 HWY 310 Cell 208-6221 Joliet, MT 59041 Current Term 2018 William T. Mohr Vice-President Home 633-2974 2100 Hwy 10 West Cell 855-3009 Park City,MT 59063 Current Term 2017 Robert J. Michael Secretary/Treasurer Home 373-6102 3731 Pioneer Road Cell 670-7964 Billings,MT 59105 - - - Current Term 2018 Marvin S. Bauwens Director Home 668-7425 30 Musegades Rd Cell 425-0849 Bridger, MT 59014 - - - Current Term 2017 Ron Benzel Director Home 665-3831 RR 1 Box 1055 Cell 679-0000 Hardin, MT 59034 - Current Term 2018 Shawn Nedens Director Home 665-1072 1496 Peritsa Creek Rd Cell 665-5134 Hardin, MT 59034-9713 Current Term 2016 Randy Reiter Director Home 628-6480 3236 Yard Office Road Cell 690-0951 Laurel,MT 59044 Current Term 2016 Mark Richards Director Home 662-3783 47 Rushwater Rd Cell 591-2985 Bridger,MT 59014 Current Term 2016 Randy Ut}elman Director Home 665-3037 812 1st Street South Cell 679-0710 Hardin,MT 59034-2204 - ' Current Term 2017 MONTHLY MEE'T'1NUS-LAST THURSDAY 01' EACH MONTH ANNUAL MEETING-2ND TUESDAY OF APRIL . , Section 2. Premises 1. Please indicate the location of the physical address. City Limits 0 County Area 2. Is the building complete and ready for use? O Yes 03. No. The expected completion date is ickS<? The delay is due to: 0 remodel 0 new construction 3. Is the location to be licensed within a zone or area where the sale of alcoholic beverages is not allowed by city, county or tribal ordinances? O Yes EL No 4. Do you, as the individual or entity on the eStop Master Application, own or are you purchasing the real property, building or building area proposed for licensing? O Yes. Please provide a warranty deed, purchase agreement or current property tax statement O No. Please provide a lease agreement. Section 3. Type of Off-Premises Business Please check the license type under which the premises proposed for licensing will operate. 11- Grocery store (include a copy of the Grocery Inventory form) O Pharmacy (include a copy of your current pharmaceutical license) El Stand Alone If applying for a Stand Alone license type, do you agree to maintain a business gross income of 95% or more from the sale of beer and wine, and that the business gross income of other retail products will not exceed 5%? 0 Yes 0 No Section 4. Temporary Operating Authority Has this premises been licensed within the last year and no building, health or fire deficiencies exist? 0 Yes. Please enter the expected date that Temporary Operating Authority will begin VI No. Temporary Operating Authority cannot be granted. Note: Temporary Operating Authority is granted for the use of the Beer and Wine license only during the time period that your application is being processed. The department will issue Temporary Operating Authority when we receive verification that the tax information of the current recorded licensee or seller is current. The current recorded licensee(seller) must provide the Liquor Division Authorization to Disclose Tax Information form to the department.This form is available on our website at http://revenue.mtgov/home/liquor/forms.aspx. Please be aware that we will revoke Temporary Operating Authority if you or your employees violate any provisions of Montana Code Annotated or Administrative Rules of Montana. r b i 0 I I____ „ ,In It-' IF 11 .�1 1\ i i:IF 1411.1 I L' IF ,44, \ . i i i G I L •i«J \+ 4 DE a I11.1 111,ii l i O ! I! u I n In 4 I —u Ili I , --r ,I DI aF 111 E__ 1 �� • • 0 • 4 V o 4 4 4 !I 0 • 4 I $ -” OE I 4 4 4 IT a fir - ' I R AAA &A. 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