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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