Art Gallery Permit Application Form. This is a Colorado form and can be use in Dept Of Revenue Statewide.
Tags: Art Gallery Permit Application, DR 8443, Colorado Statewide, Dept Of Revenue
DR 8443 (04/29/08) COLORADO DEPARTMENT OF REVENUE LIQUOR ENFORCEMENT DIVISION 1375 SHERMAN STREET DENVER, COLORADO 80261 (303) 205-2300 ART GALLERY PERMIT APPLICATION 2341 ART GALLERY PERMIT $71.25 NEW 1. Name of Applicant RENEWAL State Sales Tax Number 2. Trade Name of Establishment (DBA) 3. Address Phone Number City County State ZIP Code 4. Mailing Address (Number and Street) City or Town State ZIP Code • Attach a copy of a deed or lease in the exact name of the applicant only, reﬂecting possession of the permitted area for at least the minimum duration of this permit (1 year from date of issuance). • Attach a diagram of the premises which accurately reﬂects the area where alcohol beverages will be stored, served, possessed or consumed. Pursuant to 12-47-422, C.R.S., Applicant hereby states that it qualiﬁes for an Art Gallery Permit, in order to serve complimentary alcohol beverages, and certiﬁes to the State Licensing Authority and Local Licensing Authority: ________________ That it does not sell alcohol beverages by the drink. ________________ That it will not serve alcohol beverages for more than 4 hours in any one day, no more than 15 days per year as follows: Date: From: To: Date: From: To: Date: From: To: Date: From: To: Date: From: To: Date: From: To: Date: From: To: Date: From: To: Date: From: To: Date: From: To: Date: From: To: Date: From: To: Date: From: To: Date: From: To: Date: From: To: OATH OF APPLICANT I declare under penalty of perjury in the second degree that I have read the foregoing application and all attachments thereto, and that all information therein is true, correct, and complete to the best of my knowledge. Signature Title Date REPORT AND APPROVAL OF LOCAL LICENSING AUTHORITY (CITY/COUNTY) The foregoing application has been examined and the premises, business conducted and character of the applicant is satisfactory, and we do report that such permit, if granted, will comply with the applicable provisions of Title 12, Articles 46 and 47, C.R.S., as amended. THEREFORE, THIS APPLICATION IS APPROVED. Local Licensing Authority (City or County) Date ﬁled With Local Authority Signature Title Date REPORT OF STATE LICENSING AUTHORITY The foregoing has been examined and complies with the ﬁling requirements of Title 12, Article 47, C.R.S., as amended. Signature Title Date DO NOT WRITE IN THIS SPACE - FOR DEPARTMENT OF REVENUE USE ONLY Liability Information County City Industry Type License Account Number Liability Date FROM Cash Fund 2341-100 (999) City 2180-100 (999) License Issued Through (Expiration Date) TO County 2190-100 (999) TOTAL American LegalNet, Inc. www.FormsWorkflow.com