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HomeMy WebLinkAbout08/19/2013 Item 005Arizona Department of Liquor;Llcenses and Control R E C E I V E D OW est Washin-qton; 5th Floor Phoenix, Arizona 85007 JUL 11 2013 www azliquor g'ov 602 542 514k CLERK OF THE BOARD APPLICATION FOR LIQUOR LICENSE a„ TYPE OR,P , 1NT�WITH BLAGKINK° lw Notice: Effective Nov. 1, 1997, "All Owners Agents Partners Strickholders..Officers, or Managers actively involved In the day to day operations of the business must attend a Department;approved Iiquor'law training course or provide proof of attendance;virithintha last five years. See page 5 of the Liquor Licensing requiremerds SECTION 1 This application is for a: E SECTION`2 Type of ownership; ❑ MORE THAN ONE LICENSE b r> • INTERIM PERMIT Complete Section 5 e J.T W RO.S. Complete Section 6 • NEW LICENSE Complete Sections 2;, 3, 4, 13, 14; 15, 16 ❑ INDIVIDUAL Complete Section 6 ❑ PERSON TRANSFER (Bars & Liqudt Stores,ONLY) _ ❑PARTNERSHIP Complete Section 6 Complete Sections 2, 3, 4, 11;`43,4, 15,x16 ❑ CORPORATION Complete Section 7 ❑ LOCATION TRANSFER (Bars and Liquor Stores ONLY) . s ❑ LIMITED;LIABILITY CO. Complete Section 7 Complete Sections 2, 3,;f4, 12; 13,15, 16 "= ❑.CLUB Complete Section 8 ❑ PROBATE/WILL ASSIGNMENT/DIVORCE DECREE ❑GOVERNMENT Complete Section 10 Complete Sections 2, 3; 4, 9, 13, 16 '(fed notiequlred) El TRUST Complete Section 6 _ ❑ GOVERNMENT Complete Sections 2, 3, 4, 10, 13,;15, t. ® OTHER (Explain) 7 — — — SECTION 3 Type of license and fees LICENSE #{s) 1. Type of License(s): 50-p1etc 1Z Department Use Only 2. Total fees attached: $ �> APPLICATION FEE AND INTERIM PERMIT FEES (IF APPLICABLE) ARE NOT REFUNDABL The fees allowed under A R.S 44 -6852 will be charged for all dishonored checks. F SECTION 4 Applicant 1. Owner /Agent's Name: E] Ms. (Insert one name ONLY to appear on license) Last First Middle 2. Corp./Partnership/L.L.C.: "ft- M6 i a, -i- —r' K4 i a.w (rt% "t. (Exactly as it appears on Arti s of Inc. or Articles of Org.) 3. Business Name: H VV ka% t a i TO: Tom Sheahan, Mohave County Sheriff FROM: The Clerk of the Board' s Office Mohave County Board of Supervisors DATE: July 11, 2013 I have reviewed the attached Liquor License application: (7) Interim Permit (X-) New License ( ) Person Transfer ( ) Location Transfer ( ) Special Event ( ) Extension of Premises/Patio Permit ( ) Agent Change ( ) Acquisition of Control Series No: 12 - Restaurant For the following applicant: I Do Not Oppose ( ) IOppose Huukan Golf Club By: Shan Lee Lewis 5835 Desert Lakes Drive Fort Mohave, AZ 86426 Tom Sheahan, Mohave County Sheriff /it li 3 Date ARIZONA D_EPARTWN*TOF LIQUOI CENSES AND CONTROL Date of Posting: Lewis Applicant Name:.. Last_ 5835 Desert Lakes Drive Business Address: Street First Fort Mohave ay - Lee Middle 86426 zip License #: 12083492 [hereby certify that,pursuant to AIRS. 4201, I posted notice in a conspicuous place on the premises proposed to be licensed by the.above applicant and said notice was posted for at least twenty(20) days. L. of elty/county official Title 99tum. this affidavit -with documents. .7 _a ?-S Telephone M Date signed recommendation (i.e.; Minutes of Meeting, Verbatim, etc.) or any other related If you have any questions please call (602) 542 -5141 and ask for the Licensing Division. Individuals requiring special accommodations please call (602) 542 -9027 Li19119 V2M