CO Liquor Licensing Questionnaire

INSTRUCTIONS
We have prepared this Questionnaire to obtain information and documents we will need to prepare your federal, state and/or local applications for liquor licensing.

Where a question requires a narrative response, please simply answer the question as accurately and completely as possible, but do not worry about your wording. Wording everything appropriately is part of our job. If you have questions about the substantive information or documentation you should provide, please do not hesitate to let us know or make a note in your response to the question.
1. CONTACT INFO:
Full name*
First Name Middle Name Last Name
Cell phone*
Home phone (if different)
Personal address*
Street Address Address Line 2 City State ZIP Code
Email address*
2. BUSINESS ENTITY INFO:
Entity type*
- Corporation
- LLC
- Partnership
Entity name*
State and date of formation*
Business address (if different than premises)
Street Address Address Line 2 City State ZIP Code
Business phone number*
EIN number*
State sales tax number*
3. OWNERS :
Who owns the applicant entity?
- Owner #1:
- 1. Name*
  First Last
- 2. Alias (include nicknames, maiden names)
- 3. Home address*
  Street Address Address Line 2 City State ZIP Code
- 4. Home phone*
- 5. Cell phone*
- 6. Email*
- 7. Date of birth*
  MM slash DD slash YYYY
- 8. Place of birth (city/state)*
- 9. Social security no.*
- 10. Driver’s license no. (state)*
- 11. US citizen?*
  - Yes
  - No
- 12. Veteran status?*
  - Yes
  - No
- 13. Officer of applicant entity? If so, list title
- 14. % owned
- 15. Physical info
- a. Height*
- b. Weight*
- c. Eye color*
- d. Hair color*
- e. Gender*
- f. Race*
- 16. Spouse name*
  First Last
Would you like to add owner #2?
- Yes
- No
- Owner #2:
- 1. Name
  First Last
- 2. Alias (include nicknames, maiden names)
- 3. Home address
  Street Address Address Line 2 City State ZIP Code
- 4. Home phone
- 5. Cell phone
- 6. Email
- 7. Date of birth
  MM slash DD slash YYYY
- 8. Place of birth (city/state)
- 9. Social security no.
- 10. Driver’s license no. (state)
- 11. US citizen?
  - Yes
  - No
- 12. Veteran status?
  - Yes
  - No
- 13. Officer of applicant entity? If so, list title
- 14. % owned
- 15. Physical info
- a. Height
- b. Weight
- c. Eye color
- d. Hair color
- e. Gender
- f. Race
- 16. Spouse name
  First Last
Would you like to add owner #3?
- Yes
- No
- Owner #3:
- 1. Name
  First Last
- 2. Alias (include nicknames, maiden names)
- 3. Home address
  Street Address Address Line 2 City State ZIP Code
- 4. Home phone
- 5. Cell phone
- 6. Email
- 7. Date of birth
  MM slash DD slash YYYY
- 8. Place of birth (city/state)
- 9. Social security no.
- 10. Driver’s license no. (state)
- 11. US citizen?
  - Yes
  - No
- 12. Veteran status?
  - Yes
  - No
- 13. Officer of applicant entity? If so, list title
- 14. % owned
- 15. Physical info
- a. Height
- b. Weight
- c. Eye color
- d. Hair color
- e. Gender
- f. Race
- 16. Spouse name
  First Last
Would you like to add owner #4?
- Yes
- No
- Owner #4:
- 1. Name
  First Last
- 2. Alias (include nicknames, maiden names)
- 3. Home address
  Street Address Address Line 2 City State ZIP Code
- 4. Home phone
- 5. Cell phone
- 6. Email
- 7. Date of birth
  MM slash DD slash YYYY
- 8. Place of birth (city/state)
- 9. Social security no.
- 10. Driver’s license no. (state)
- 11. US citizen?
  - Yes
  - No
- 12. Veteran status?
  - Yes
  - No
- 13. Officer of applicant entity? If so, list title
- 14. % owned
- 15. Physical info
- a. Height
- b. Weight
- c. Eye color
- d. Hair color
- e. Gender
- f. Race
- 16. Spouse name
  First Last
Would you like to add another owner?
- Yes
- No
If you want to add some more owners then please contact us directly through email.
4. RESIDENCES:
In this table, you will list ALL residences for each owner listed above for the last 5 years.
- Owner #1 Name*
  First Last
- All residences for owner #1*
  Full Address Dates lived there
- Owner #2 Name
  First Last
- All residences for owner #2
  Full Address Dates lived there
- Owner #3 Name
  First Last
- All residences for owner #3
  Full Address Dates lived there
- Owner #4 Name
  First Last
- All residences for owner #4
  Full Address Dates lived there
5. EMPLOYMENT HISTORY:
In this table, you will list ALL prior employment for each owner listed above for the last 5 years. Please include periods of self-employment or unemployment. There should be no gaps.
- Owner #1 Name*
  First Last
- All prior employment for Owner #1*
  Name of employer Full Address Position Dates of employment
- Owner #2 Name
  First Last
- All prior employment for Owner #2
  Name of employer Full Address Position Dates of employment
- Owner #3 Name
  First Last
- All prior employment for Owner #3
  Name of employer Full Address Position Dates of employment
- Owner #4 Name
  First Last
- All prior employment for Owner #4
  Name of employer Full Address Position Dates of employment
6. MANAGEMENT:
In this table, you will list your officers, board of directors (if a corporation), managers (if an LLC) AND any individual who has “management responsibility.” [NOTE: if not already listed above as an owner, then provide same list of info as owners]
Management*
Name Title
7. PREMISES INFO:
Address of brewery/brewpub location*
Street Address Address Line 2 City State ZIP Code
Business phone number (if you have one yet)
Name and contact for Landlord*
Expiration date of lease*
MM slash DD slash YYYY
Amount of monthly rent*
Other payments to Landlord?
Share the premises with any other business? If so, please explain
Own or lease equipment? If lease, then please provide equipment lease info
List of all brewery equipment you plan to have on location*
List all security measures you will use on location*
Explain how production area will be separated from taproom/customers*
Explain where/how tax-paid beer will be stored*
Will you have serving tanks? If so, what is the capacity of serving tank(s)*
Explain how you plan to serve beer in the tasting room?*
Will you serve food? Please explain.*
Do you intend to serve beer or liquor that you do not make yourself? Please explain.*
Have you confirmed that the premises is zoned for the intended use*
8. SOURCES OF INVESTMENT:
Please identify all sources of investment/loans for brewery in the box below.
In your response, please include:
- Total amount of financial investment broken down by owner.
- Any loans? Provide copy of loan, as well as bank statement showing receipt of such money.
- If source of funds is from checking, savings, or other bank account, then provide copy of three most recent statements showing the balance.
[NOTE: Regarding your financial investment, we need to give our best estimate of the amount and the source of those funds for your investment in the new location. This would be the amount that you are investing in the location for things like new equipment, furniture, signage, initial deposits, etc. Ideally, whatever amount you are estimating should be easily verified in the records. So, for example, if $100K is coming from your 401k Plan, we would want to be able to show a financial statement for the 401k Plan with a balance of at least $100K, and then a bank statement that shows it was withdrawn/transferred and deposited into your business checking account.]
Sources of Investment*
9. CRIMINAL / REGULATORY BACKGROUND:
In this table, you will list ALL CRIMINAL OR REGULATORY matters against you or any other owners. Although you need to fully disclose everything, be aware that you may not be automatically excluded on the basis any one criminal offense in your background, even for example a prior DWI. Federal and state agencies tend to be most concerned with fraud, embezzlement, sales to minors and other offenses that could reflect unfavorably upon your suitability to hold a liquor license and pay taxes when due.
Has there been any adverse action ever taken against you or any of your officers, directors, or owners by federal or state liquor licensing authority, etc.? Please explain.*
Have you or any of your owners ever been convicted of any felony or misdemeanor under federal or state law (other than minor traffic violations)? Please explain.*
Ever been arrested or charged with felony or misdemeanor (other than minor traffic violation)? Please explain.*
Do you or any officers, directors, or owners hold any other interests in any other alcohol related business? Please explain.*
Have you have ever been employed by a company with a federal permit to manufacture, bottle, sell alcohol or tobacco (besides applicant)? Please explain.*
10. LIST OF SUPPORTING DOCUMENTS:
Instructions: Please provide copies of the following supporting documents for your applications.
- Copy of lease agreement (if applicable)
- Annotated 8 ½” x 11” diagram of brewery
  - Include scale and measurements in feet/inches for all areas (public and non-public) of the premises; in particular, show separation of the tasting room from the brewing area
  - Show where the windows, exterior and interior doors are located
  - Show security measures (e.g., commercial locks, alarm, beer storage, etc.)
  - If there is an outdoor patio or other outdoor area, you will also need to add measurements for the patio seating area. Please indicate what separates the patio area. For example, is it a fence, a partial wall, etc.? How tall is the fence/wall?
  - Indicate/annotate on your diagram where the brewing equipment and tax-determination tanks are located.
  - If alternating premises with winery, please provide annotations regarding location of production areas to be alternated, as well as wine-specific areas of premises
- Copy of articles of organization/incorporation
- Copy of operating agreement or by-laws (if you have)
- Copy of any loans, notes, security instruments, etc. (if applicable)
- Copy of last three months’ bank statements showing source of funds for any lease or other investment
- Copy of retail sales tax permit
* Please make sure you submit all of your answers by clicking the Submit button below.
Name
This field is for validation purposes and should be left unchanged.

Full Address	Dates lived there

Full Address	Dates lived there

Full Address	Dates lived there

Full Address	Dates lived there

CO Liquor Licensing Questionnaire

INSTRUCTIONS

1. CONTACT INFO:

2. BUSINESS ENTITY INFO:

3. OWNERS :

Owner #1:

Owner #2:

Owner #3:

Owner #4:

4. RESIDENCES:

5. EMPLOYMENT HISTORY:

6. MANAGEMENT:

7. PREMISES INFO:

8. SOURCES OF INVESTMENT:

9. CRIMINAL / REGULATORY BACKGROUND:

10. LIST OF SUPPORTING DOCUMENTS:

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