DR 8057 (10/06/09) COLORADO DEPARTMENT OF REVENUE Liquor Enforcement Division 1881 Pierce St., Ste. 108 Lakewood, CO 80214 Fax (303) 205-2341 Phone (303) 205-2300 APPLICATION FOR COLORADO VINOUS OR SPIRITUOUS LIQUOR MANUFACTURER SALES ROOM Reg 47-428 1. Name of Applicant exactly as it appears on your current Colorado Winery or Distillery License. 2. Trade Name of Applicant 3. State Sales Tax No. Applicant License No. 4. Business Address of Applicant (Number and Street) City State ZIP 5. Mailing Address (Number and Street City State ZIP 6. Tasting Location 7. Dates of Events: From Date: To Date: Time: Time: AM AM PM PM 8. Rights to Premises Granted by: (attach a copy Premises Use Authorization letter or lease) 9. During this tasting event wines or spirits will be sold (check all the apply) In open containers for on-premises consumption In sealed containers for off-premises consumption 10. Diagram and control of TASTING PREMISES Attach a diagram of proposed premises Attach a copy of premises control plan outlining how premises will be controlled to insure compliance with liquor code provisions including restricting sales to minors and intoxicated persons and insuring that participants cannot leave the premises with open containers of alcohol beverages. NOTIFICATION TO LOCAL LICENSING AUTHORITY 11. Local Licensing Authority Name Date Application copy provided to local Licensing Authority NOTICE TO LOCAL LICENSING AUTHORITY This application for a Tasting Permit will be granted to the above name applicant unless any of the below listed conditions apply. If any of these conditions apply please contact the State Licensing Authority immediately. For events lasting three consecutive days or less, the applicant has not provided you with at least 10 business days notice of the proposed tasting event. For events lasting four or more consecutive days, the applicant has not provided you with at least 30 days notice of the proposed tasting event. The proposed premises is not in keeping with the reasonable requirements of the neighborhood and the desire of the adult inhabitants pursuant to section 12-47-301(2)(a) C.R.S. Past wine tasting events have had a history of violation of the Colorado liquor code. If granted this permit would result in violations of the Colorado liquor code or the laws of the local government. (specify) Issuance of this permit would violate local zoning laws. Authorized Signature Title Date American LegalNet, Inc. www.FormsWorkFlow.com