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HomeMy WebLinkAboutapp for alc beverage licDepartment of Alcoholic Beverage Control State of California APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE{S) ABC 2l 1 (6194) TO: Department of Alcoholic Beverage Control File Number: 5153$2 1900 CHURN CREEK R.D Receipt Number: 2077789 STE 215 Geographical Code: 0400 BEDDING, CA 96002 Copies Mailed Date: September 27, 2011 (530) 224-4830 Issued Date: DISTRICT SERVING LOCATION: BEDDING First Owner: KELSO, STACY LAUREN Name of Business: BUTTE MEADOWS MERCANTILE & RESORT Location of Business: County: Is Premise inside city ]imits? Mailing Address: (If different from premises address} Type of license(s): 41 7473 HUMBOLDT RD BUTTE MEADOWS, CA 95942-9718 BUTTE No PO BUX 1003 DURHAM, CA 95938-1003 Transferor's licenselname: 466535 1 DORMAN, PERRY LEE License Type Transaction Type 91 - On-Sale Heer And wine DROPPING PARTNER Census Tract 0016.00 Dropping Partner: Yes No_ Fee Type Master Duv Date NA Y 0 09/271I1 Total FEE $so.4a $5D.44 Have you ever been convicted of a felony? No Have you ever violated any provisions of the Alcoholic Beverage Control Act, or regulations of the Department pertaining to the Act? No Explain any "'Yes" answer to the above questions on an attachment which shall 68 deemed part of this application. Applicant agrees (a}that any manager employed in an on-sale licensed premises will have all the qualifications of a licensee, and (b) that he will not violate ar cause or permit to be violated any of the provisions of the Alcoholic Beverage Control Act. STATE OF CALIFOIZNIA County of BUTTE Date: September 27, 20 i 1 Under penalty of perjury, each person whose signature appears below, certifies and says: (1) He is an applicant, or one of the applicants, or an executive officer of the applicant corporation, named in the foregoing application, duly authorized to make this application on its behalf; (2) that he has read the foregoing and knows the contents thereof and that each of the above statements therein made are true; (3) that no persoar other than the applicant or applicants lras any direct or indirect interest in the applicant or applicant's business to he conducted under the license(s) far which this application is made; (4} chat the transfer application or proposed transfer is not made to satisfy the payment of a loan or to fulfill an agreement entered into mare than ninety (9D) days preceding the day on which the transfer application is filed with the Department or to gain or establish a preference to or for any creditor or transferor or to defraud or injure any creditor of transferor; (5) that the transfer application may be withdrawn by either the applicant or the licensee with no resulting liability to the Department. Applicant Name(s) Applicant Signature(s) See 211 Signature Page KELSO, STACY LAUREN KELSO, WII.,LIAM GARRISON 80AlZD QF S[IPBRVISORS SEP Z 8 ~~~~ oROVI~~I=, c~a«~©lzlv~a ~~ r ~~