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HomeMy WebLinkAboutAgenda - City Council - 04/05/2014 t southburlingto VERMONT AGENDA SOUTH BURLINGTON CITY COUNCIL City Hall Conference Room 575 Dorset Street SOUTH BURLINGTON, VERMONT S ecial Session 8:00 AM. Saturda Aril 5 2014 1. Agenda Review: Additions, deletions or changes in order of agenda items. 2. Hear reports from City Council Committees. 8:00 — 8:15 AM Bike and Pedestrian Committee 8:15 — 8:30 Board of Civil Authority 8:30 — 8:45 City Charter Committee 8:45 —9:00 Design Review Committee 9:00 —9:15 Development Review Board 9:15—9:30 Energy Committee 9:30—9:45 Form Based Code Committee 9:45 — 10:00 Library Board of Trustees 10:00 — 10:15 Natural Resources/Open Space Committee 10:15 — 10:30 Pension Advisory Committee 10:30 — 10:45 Recreation and Leisure Arts Committee 10:45— 11:00 Red Rocks Committee 3. Report on status of negotiations between CCTA and drivers. (Steve Magowan, South Burlington representative to the CCTABoard) ) 4. ***Convene as the Liquor Control Board to approve the following Liquor Licenses: : Champlain Farms, Skinny Pancake, KIin9 ead,O'sKO�t D�kbGreen Mtn.letree ISu Suites, Boururnene's, Cheese Traders, d Variety, Uno's,Vt National CC(2),Leisure World, Franny Kinney Drugs#55,Chicken Charlie's, Hannafords (Dorset St),Guild, Sheraton(2) Lakeview Bar&Grill, Aviation Deli,Jolley#107, U Save, Vermont Sportsgrill,Waterfront Catering,Shaw's,Hannafords(Hannaford dr),Gracey's,Venue,Pulcinellas Jiffy Mart,Applebee's,Gracey's Liquor Store,Short Stop#105,Kmart#7039,Simon's Store,Zen Garden,Van na, Phan hamPlain Farm LodEagles1CIuNb,Short Stop#04 Sugal Market deli3Osaka ars ap,Switchback Beerworks, Vermont plain School Apts,Magic Hat,Champlain Farms(2), g Spirits. 5. Comments and questions from the public not related to the agenda. 6. Other Business: 7. Adjourn Respectfully Submitted: KewLw Do-►rw Kevin Dorn, City Manager ***Attachments Included South Burlington City Council Meeting Participation Guidelines City Council meetings are the only time we have to discuss and decide on City matters. We want to be as open and informal as possible; but Council meetings are not town meetings. In an effort to conduct orderly and efficient meetings, we kindly request your cooperation and compliance with the following guidelines. 1. Please be respectful of each other(Council members, staff, and the public). 2. Please raise your hand to be recognized by the Chair. Once recognized please state your name and address. 3. Please address the Chair and not other members of the public, staff, or presenters. 4. Please abide by any time limits that have been set. Time limits will be used to insure everyone is heard and there is sufficient time for the Council to conduct all the business on the agenda. 5. The Chair will make a reasonable effort to allow everyone to speak once before speakers address the Council a second time. 6. The Chair may ask that discussion be limited to the Councilors once the public input has been heard. 7. Please do not interrupt when others are speaking. 8. Please do not repeat the points made by others, except to briefly say whether you agree or disagree with others views. 9. Please use the outside hallway for side conversations. It is difficult to hear speaker remarks when there are other conversations occurring. Public Sign- In April 5, 2014 Please Print Name Name Name 1 /14 sp-- Se, 18 35 2 4 /Idol , 19 36 3 (G• 7/ )30 L 1`, 9ef- 20 37 4 IMF' ✓1 7—us/f y 21 38 5 EMi, ()/ 7S 22 39 6S EA-ta L)4- 23 40 7 %-'4taill- 'larorit 24 41 g ew 6aQ (,eAkcv- 25 42 9 26 43 10 27 44 11 28 45 12 29 46 13 30 47 14 31 48 15 32 49 16 33 50 City Charter Committee Summary April 5, 2014 As defined by the City website: The South Burlington City Charter Committee receives referrals from City Council regarding potential changes to the City Charter. Upon review and study the Charter Committee will make recommendations to City Council addressing the matters which have been referred to it. The Charter Committee is appointed by City Council and the members of the Charter Committee select their own Chair and Vice-Chair. The current members are: Member Telephone Term Agnes Clift, 34 Victory Dr., 658-0690 2014 Paul Engels, 15 Orchard Road 2014 Dan Fleming, 339 Golf Course Road 864-6460 2014 Vice Chair Donna Kinville, 82 Fieldstone Dr. 862-5238 2016 Peter Taylor, 4 Mayfair St. 862-9455 2015 Chair (note: appointments are 3 year staggered terms, expiring in the year listed) Status: • The Charter Committee exists at the Council's pleasure;it is not required by the City Charter or State statute. • Three seats are opening on the City Charter Committee. • The Charter Committee meets as needed to respond to "referrals from City Council regarding potential changes to the City Charter". • The Charter Committee's role is to examine and consider the pros, cons, and alternatives to issues or proposed Charter changes and to make recommendations and propose language to the City Council for its consideration and possible action. • Last referral was 2011-2012 re: City Clerk. o Q: Should the City Clerk position be elected or appointed? o Charter Committee report can be found on the City website ■ http://southburlingtonvt.govoffice2.com/vertical/sites/%7BD1A8A 14E-F9A2-40BE-A701- 417111F9426B%7D/uploads/City Charter Final Report Recom mendations Feb. 21.2012.pdf • Since then the Council has dealt with Charter related issues /questions without involving the Charter Committee o Examples: the role of the Library Committee (2013) and the City Clerk's term (2014). THE RECREATION AND LEISURE ARTS COMMITTEE (R&LA): SOME BASIC INFORMATION Revised 3/6/14 Q1: Who are the current members of R&LA? A: Glenn Sproul, Chair; term expires 2014; 658-5769(H), 881-8096(C) Jennifer Kochman,Vice-Chair; term expires 2016; 862-8281(H) Laura DeMaroney, Clerk; term expires 2014; 863-3234(H), 238-6906(C) Liz Robitaille; term expires 2016; 658-6695(H), 324-0881(C) Edie Robenstein; term expires 2016; 862-8917(H) Linda Janes; term expires 2015; 658-8988(H), 598 7(C) Susan DuCharme; has resigned, term expires 201,23 B203(C) tea: • Q2: With whom does the committee work with and to whom d&we report? A: R&LA works closely with the Director of Recreation and Parks, Todd Goodwin. It is the only committee with a broad advisory role to the Recreation and Parks Department and to Cil*,Council on matters related to recreation. It reports important resolutions and recommendations to the South Burlington City Council and City Manager Kevin Dorn, and/or to other committees and staff as appropriate. Q3: What is the role or mission of this c 'mittee? A: There is no clear mandate from City Council for R&LA at this time. The Bylaws we inherited from previous years are outdated, and the duties they describe are actually duties.,ofthe Recreation &Parks Department. City Mana .er Kevin Dorn and the Staff Review Committee are planning to make reco ,--_ ations to clarify the roles of all city committees. the fall of 2013 the R&LA Committee wrote and approved a set of revised Bows. These were then submitted to City Council,which has ultimate authority over Rr.LA and all other city committees. Though City Council has not yet acted on our proposed By-laws,the Committee has been proceeding in accordance with them. The proposed By-laws describe the general mission of the Committee as follows: Duties and Purpose of the Committee A. The Committee shall consult with and advise the Director of Recreation and Parks in matters affecting recreation programs. These matters shall include: 1. Review of park/facility related projects 2. Review of program offerings 3. Review of department policies 4. Review of finances and proposed budgets 5. Assisting in the development of long-range planning, including needs assessment and setting priorities 6. Providing interface and collaboration with other city committees 7. Other matters as they arise B. The Committee will be involved in the selection of a new Director of Recreation and Parks. C.The Committee will provide support to the Director's annual presentation to the City Council of budget and other matters. D. The Committee will serve as 1. Representatives of the community 2. Advocates of the department and its mission 3. Citizen advisory committee to City Council Q4: What kinds of issues does the Committee address? A: The range of issues we address is quite Inroad,ranging from the review of ongoing recreation programming and other dia-to-day operations of the Recreation & Parks Department to participation in long-range planning for parks and recreation facilities. Q5: What have been some accomplishments o - &LA during the past three years? A: On December 1, 2011 we passed a.Resolution on Outdoor Recreation Space, which we presented to City Council and the Planning Commission. In 201243 we designed a survey of recreation interests and needs in South Burlington and prepared a,summary of the results for City Council and for publication in.The Other Paper. In-20-1,3 we devised a "Site Evaluation Matrix" to assist city staff in evaluating the potential of parcel of land for development for active recreation. In 2013 we developed the R&LA By-Laws mentioned earlier and presented them to the City Council. In 2013 at the request of the City Center Public Facilities Task Force,we drafted a wish list of recreation facilities we would like to see in a new City Center facility, and we met with an architect retained as a consultant to the Task Force. In 2014 we have continued to refine our wish list. In 2014 in response to the Open Space and Planning Commission requests for specifics on City Center Open Space,we drafted a wish list of green spaces within City Center,which was sent to the Open Space Committee and the Planning Commission. In 2014 we began the process of designing an Orientation presentation for new members. Q6: What issues is the Committee addressing this year? • The City Council created the IZ Open Space Committee and included on it a representative from the R&LA Committeeus committing us to an active role in determining open space regulates. Jennifer Kochman has been our representative to the n Space Committee. • A major ongoing task for the Committee this year supporting and promoting the building of an indooreci ation facility in the proposed new City Center,with an accompanying"town green". The lack of an indoor facility is the latest limiting factor to expanding and further diversifying recreationprograms, especially programs for seniors and families with pre-school children. • The Committee has requested of City Count that it be assigned a leading role in planning'for thefuture uses ofthe former Underwood property located East of Spear Streetand,South of Nowland Farm Road. The request was madointly With the Natural Resources Committer • The'Committee collaborates with the developer of any proposed new housing dewloptnenttp plan appropriate neighborhood parks or ., bier green ;r es in the development. �iL �► City of th urlington it ® City Clerk' Office YOIP Donna Kinville, City Clerk April 5,2014 The following first,second class and tobacco licenses were approved by the South Burlington Liquor Control Board after being reviewed by the City Tax, Fire and Police departments. Name Description Champlain Farms(1041 Shel Rd) second class/tobacco Skinny Pancake first class Klinger's Bread Company second class Koto Restaurant first class Doubletree Hotel first class Shelburne Road Variety second class/tobacco SL Uno's Burlington Inc first class Vermont National Country Club first class(2)outside consumption Leisure World second class Franny O's first class/outside consumption Outback Steakhouse first class Green Mountain Suites Hotel first class/outside consumption Bourne's Service Center second class/tobacco Kinney Drugs#55 second class/tobacco Chicken Charlie's first class Hannaford (Dorset St) second class/tobacco Guild&Co steakhouse first class Sheraton Vermont Corp first class(2) Cheese Traders second class Switchback beerworks Inc taste testing/4/24/2014 Higher Ground Vermont Spirits taste testing 4/24/2014 Higher Ground Lake View Bar&Grill first class/outside consumption Aviation Deli second class/tobacco Jolley#107 second class/tobacco U Save beverage second class/tobacco Vermont Sportsgrill first class Waterfront Catering first class Shaw's second class/tobacco Hannaford(Hannaford Dr) second class/tobacco Gracey's Store second class/tobacco M&K Enterprises/Venue first class Pulcinella's first class/outside consumption Jiffy Mart second class/tobacco Applebee's first class Gracey's Liquor Store second class/tobacco 575 Dorset Street South Burlington,VT 05403 802-846-4105 dkinville@sburi.com Short Stop#105 second class/tobacco K Mart second class Name Description Simon's Store(974 Shel Rd) second class/tobacco Zen Garden first class Van Phan Billiards first class Moose Lodge#1618 first class Mill Market& Deli second class Osaka Hana Inc first class Magic Hat second class Champlain Farms(1800 Will Rd) second class/tobacco Champlain Farms(1118 Will Rd) second class/tobacco Eagles order#793 first class/(outside consump x2) Sugarsnap first class Champlain School apts first class/outside consumption Short Stop#104 second class/tobacco Pam Mackenzie Chair Pat Nowak Vice Chair Chris Shaw Meaghan Emery Clerk Helen Riehle L t „ �/ City of South Burlington ►I• . City Clerk's Office ;rip Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME d,r4cT8,---,-iilar--- . ADDRESS 1/0 YI '', FIRST CLASS - SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE D/I SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date . SO. BURLINGTON FIRE DEPT R Chief Douglas).1...— rent ft(1(1 o SO. BURLINGTO TAX DEPT il — 7/9 "LI _,, /(:)-- -1(illy . Martha Lyons, Deput Tax Collector Date sent to Montpelier: ii.' Obl-'61bD __:r1"____________________,----- 575 Dorset Street South Burlington,VT 05403 802-846-4105 dkinville©sburl.com • 2014 LIQUOR LICENSE RENEWAL APPLICATION 316-015-SECN-001 SECOND CLASS LICENSE TO SFT.T MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. • Applicant: Coco Mart, Inc. Licensee # 316- 15 Doing Business As: Jiffy Mart Mailing Address: 110 Kennedy Drive PO Box 229 South Burlington VT 05403 Perkinsville VT 05151 Telephone: (802) 865-0143 PLEASE INCLUDE EMAIL ADDRESS: ► qACQ2 0,, r- D k.C,C)rr.% Description of Premises: Lessor: Store located in a wood and brick building approx. 1500 sq. feet in C.D. Cairns Trust size. Located at 110 Kennedy Drive in the City of South Burlington, PO Box 2126 Vermont. So. Burlington VT 05403 Last Enforcement Seminar: 10/17/2013 Fed. ID Number: 03-0323725 Incorporation Date: 03/01/1990 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Cairns, Charles Box 2307, Lake Rd. Charlotte VT 05445 Director 2. Cairns, Lynn Box 2307, Lake Rd. Charlotte VT 05445 Director 3. Cairns, Bryan Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 4. Cairns, Bryan Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 5. Cairns, Charles Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 6. Cairns, Lynn Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 7. Cairns, Michael Box 2307, Lake Rd. Charlotte VT 05445 Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes ./No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any electi` or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following information: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 316-015—SECN-001 SECOND CLASS LICENSE TO SETJ MALT AND VINOUS BEVERAGES Page 2 I/We herebyy7 certify that the information in this application is true and complete.J Dated this r day of( ✓ , az,y Signature of authorij,Ir.gent Signature of individual or partners of c. at'on, canpano` r association 4111F7 -Iketir —, . Al Got.2. cori-\Q. PO\ (Ti e) / Are you making this application for the benefit of any other party? Yes V No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information.of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of City of , v I) Total Membership 5 , members p tr wn Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 2014 TOBACCO LICENSE RENEWAL APPLICATION 316-015-TOBC-001 TOBACCO LICENSE TO SFTh TOBACCO Page 1 License Year Beginning May1, 2014 endingApril 30, 2015 Optional Fee: $1$0.0 0 of which g g $0.00 is paid to town/city $100.00 is paid to DLC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Coco Mart, Inc. Licensee # 316- 15 Doing Business As: Jiffy Mart Mailing Address: 110 Kennedy Drive PO Box 229 South Burlington VT 05403 Perkinsville VT 05151 Telephone: (802) 865-0143 PLEASE INCLUDE EMAIL ADDRESS: itNcvai 4i Q r)Ci\ `C r\C)1\.ci)4Y\ Description of Premises: Lessor: Store located in a wood and brick building approx. 1500 sq. feet in C.D. Cairns Trust size. Located at 110 Kennedy Drive in the City of South Burlington, PO Box 2126 Vermont. So. Burlington VT 05403 Last Enforcement Seminar: 10/17/2013 Fed. ID Number: 03-0323725 Incorporation Date: 03/01/1990 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Cairns, Charles Box 2307, Lake Rd. Charlotte VT 05445 Director 2. Cairns, Lynn Box 2307, Lake Rd. Charlotte VT 05445 Director 3. Cairns, Bryan Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 4. Cairns, Bryan Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 5. Cairns, Charles Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 6. Cairns, Lynn Box 2307, Lake Rd. Charlotte VT 05445 Stockholder 7. Cairns, Michael Box 2307, Lake Rd. Charlotte VT 05445 Has any director or stockholder been convicted or pleaded guilty to any crimipal or motor vehicle offense in any court- of law (including traffic tickets by mail) during the last year? Yes If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any electivylor appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes t No If yes, please attach the following information: Individual's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. • I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 TOBACCO LICENSE RENEWAL APPLICATION 316-015-TOBC-001 TOBACCO LICENSE TO SFLT TOBACCO Page 2 I/We hereby certify that the information in this application is true and complete. A-^ Dated this St, day of ,...14. 1/ , - .00.-1 Signature of authori = -gen Signature of individual or partners of c.--= at'...n, c /or _ _ . __ AZ l..` s I m ...oar PoC\ (Ti e) Are you making this application for the benefit of any other party? Yes y/No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual cavcnissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED i Approved by Board of Control Commissioners of e City or-fa o U I�v,�'iik iii Total Membership 6 , members present -i �iAW!'Siown Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 eats City South Burlington VI®®Q City Clerk's Office VOTEDonna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME ADDRESS /6S _(DDKge,-)- (5)' FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE . , ,al-k, z9D/Lfr So. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEP a \ - Z.S 1.5‘ik.ty Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT -71: "(4 ,) Z�=f l { MartTia Lyons, Deput Tax Collector Date sent to Montpelier: 575 Dorset Street South Burlington,VT 05403 802-846-4105 dkinville@sburl.com 2014 LIQUOR LICENSE RENEWAL APPLICATION 7695-002-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFr,T MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Apple New England LLC Licensee # 7695- 2 Doing Business As: Applebee's Mailing Address: 155 Dorset Street Attn: Cheryl Mills South Burlington VT 05403 P.O. Box 507 Telephone: (802) 862-2818 ��u West Linn OR 97068 PLEASE INCLUDE EMAIL ADDRESS: CAI !Ls ea�) --a4'1let't M.earl- Description of Premises: ' r Lessor: Restaurant in the center entrance to a single story shopping mall Finard & CO knon as "University Mall" consisting of a dining roan with bar, Attn William Finard kitchen & storage. Located on the west side of Dorset Street. 155 Dorset Street Designated as #155 in the city of South Burlington VT S Burlington VT 05403 Last Enforcement Seminar: 02/26/2013 Filed Articles of Organization: Yes Date Filed: 06/08/2011 Federal ID Number: 45-2596142 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Company Name Address Town/City State Zip Cola Member 1. Krebsbach, Daniel Victor 7304 259th Place Northeast St. Cloud MN 98053 Member 2. Flynn, Gregory Grant 3821 Jackson Street San Fransisco CA 94118 Member 3. Shigeru, Ronald Igarashi 920 Eastlake Drive Eastlake OH 44095 Member 4. Cortina, Lorin Michael 2110 Redington Road Hillsborough CA 94010 Has Any person been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any elec>-ive or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes 1,01No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 10780 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Roans Cert./Acct. No.: 440-912115263F-03 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Pnard may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) • I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of acployment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 7695-002-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SELT. MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this app 'cation is true and complete. Dated this /( day of J4, L/ f, / Signature of authoriz_. agent Signature of individual or partners of corpo ation, company, cl1 o °=ssociation J ir CyC (Tit ) Are you making this application for the benefit of any other party? Yes �o Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each • individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED • Approved by Board of Control Commissioners ofagar of ,JI)..1/�L Total Membership e5 , members present 1own Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 60 City of South Burlington 0"40 4 City Clerk's Office ; ' Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENA E , J, Grzz6 '� L oofDram. ADDRESS 1 /Mnc bor ri , 4 ) FIRST CLASS f SECOND CLASS-I:I:22) CABARET DATE RECEIVED BY CLERK'S OFFICE SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date = SO. BURLINGTON FIRE DEPT Acizkv..-- -, ,3"....cliy Chief DouglasDcl....„— rent Date S0. BURLINGTON TAX DEPT4-'5'n ,jitft A:y1;9,4,0 ;_ 4 /1;23711-V Mart a Lyons, Deputy Tax Collector Date sent to Montpelier: X ADb Onn O/C A1nC 2014 LIQUOR LICENSE RENEWAL APPLICATION 3601-001—SECN-001 SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Sisters & Brothers Investment Group Licensee # 3601- 1 Doing Business As: Gracey's Liquor Store Mailing Address: 26 Hinesburg Road, Unit 1 75 South Winooski Avenue South Burlington VT 05403 Burlington VT 05401 Telephone: (802) 862-9543 PLEASE INCLUDE EMAIL ADDRESS: )0C4 pnd�l6UZAOn(�y I 6," Description of Premises: r( Premises: KX Dened Leased A store and liquor agency located in a one story brick and metal building approximately 3,000 square feet in size and located at 1333 Williston Road in the city of South Burlington, Venmjnt. Last Enforcement Seminar: 06/12/2013 ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Partnership Name Address Town/City State Zip Code Partner 1. Handy, Joseph 200 Hidden Oaks Drive Colchester VT 05446 Partner 2. Handy, Charles 18 Ridgewood Drive Burlington VT 05401 Partner 3. Handy, Anthony 4327 Harbor Rd Shelburne VT 05482 Partner 4. Handy, Joan 109 Field Green Drive Colchester VT 05446 Partner 5. Handy, Laura 486 Country Lane Colchester VT 05446 Has any person been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during.;the oast year? Yes No _Lf yep'.ease.attach the following information: Individuals name, court/traffic bureau, offense;and date :• In the'past year has any person heldYany elective or appointive state, county, city, village or town office in Vermont • (See VSA; T.7, Ch.9, Sec.` 223j? , 'Yes XXNo If yes, please attach the following inforn�tion: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or ace in full compliance with a plan to pay any and all child support payable under a supx rt order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of • contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this application is true and complete. (Dated this ' day of J t.4 pry , -7b h4( S. ture authorized agent Signature of individual or partners (1);oiiirp�n crmp y, club_ association Q1 eJ1/� { 8,c tt y ( GCt/t + ((Title) Are you making this application for the benefit of any other party? Yes )(No Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 3601-001-SECN-001 SECOND CLASS LICENSE TO SFT,T. MALT AND VINOUS BEVERAGES Page 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Rnard for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of ity or of q f Total Membership —members presen Ati + . ,� 40i Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town hcerd of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 2014 TOBACCO LICENSE RENEWAL APPLICATION 3601-001-TOBC-001 TOBACCO LICENSE TO SFTT TOBACCO Page 1 Optional Fee: $100.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $0.0 0 is paid to town/city $100.00 is paid to DLC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON • MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Sisters & Brothers Investment Group Licensee # 3601- 1 Doing Business As: Gracey's Liquor Store Mailing Address: 26 Hinesburg Road, Unit 1 75 South Winooski Avenue South Burlington VT 05403 Burlington VT 05401 Telhone:PLEASE�INCLUDE )EMAIL 86 4ADDRESS: ,/d eJ 43 h tl( I h col d Y(1 (..ko, Description of Premises: ! Premises: XX Owned Leased A store and liquor agency located in a one story brick and metal building approximately 3,000 square feet in size and located at 1333 Williston Road in the city of South Burlington, Vermmont. Last Enforcement Seminar: 06/12/2013 ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. ' Partnership Name Address Town/City State Zip Code Partner 1. Handy, Joseph 200 Hidden Oaks Drive Colchester VT 05446 Partner 2. Handy, Charles 18 Ridgewood Drive Burlington VT 05401 • Partner 3. Handy, Anthony 4327 Harbor Rd Shelburne VT 05482 Partner ., _ 4. Handy, Joan 109 Field Green Drive Colchester VT 05446 Partner 5: Handy,-Laura 486 Country Lane Colchester VT 05446 Has any person been convicted or pleaded guilty to any criminal or for vehicle offense in any court of law (including traffic tickets by mail) during'the last year's ` Yes No If yes, please attach the following information. Individual's name, ourt/traffic bureau, offense and date `' In the past year has any person held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes ,No If yes, please attach the following info ion: Individual's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this application is true and complete. Dated this day of )ry„Lo t,i. , Signet e of authorized agentSignature of individual or partners o rporatio , y, ub or association Are you making this application for the benefit of any other party? Yes A No Continued on next page 2014 TOBACCO LICENSE RENEWAL APPLICATION 3601-001-TOBC-001 TOBACCO LICENSE TO SFT,T, TOBACCO Pace 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual camnissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of 'r of . Total Membership 4E5 members presentsTown Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 .► City of South Burlington ,s®,*i City Clerk's Office Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME • ADDRESS 6T7if A-516vrei FIRST CLASS > SECOND CLASS CABARET (:: DATE RECEIVED BY CLERK'S OFFICE , _&91 0/ 2/- SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT Chief Douglas S. Brent Da e SO. BURLINGTON TAX DEPT.) —77/70615atk- Martha Lyons, Deputy Tax Collector Date sent to Montpelier: 575 flnrsPt StrPPt Cnuth Riirlinntnn VT flRdfl; Rfl9-RaR__n_1f1 rllrinuillanchnrl rnn 2014 LIQUOR LICENSE RENEWAL APPLICATION 4312-003-SECN-001 SECOND CLASS LICENSE TO SFTJ MALT AND VINOUS BEVERAGES Fee: $1 4 0.0 0 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION FOR SUSPENSION OR REVOCATIONCOFT OTHEE LICENSE,N PITY LICENSE APPLICATION SHALL BE GROUNDS AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Slimain Handy's Convenience Stores, Inc. Licensee # 4312- 3 Doing Business As: Shmon's Store & Deli Mailing Address: 974 Shelburne Road 75 South Winooski Avenue South Burlington VT 05403 Burlington VT 05401 Telephone: (080) 862-8011 ,.j// 1 �tJ V PLEASE INCLUDE EMAIL ADDRESS: %rp YA cy 11 1 ((Y 4'v,�l Vt./n Description of Premises: Lessor: Grocery store located in a one story cement and woodframe building Mountaha Handy situated on the east side of Shelburne Road and designated as 974 Burlington Vt Shelburne Road in the city of South Burlington, Vermont. Last Enforcement Seminar: 11/23/2013 Fed. ID Nimiber: 33-1234567 Incorporation Date: 04/06/2000 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes • ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Name Address Town/City State Zip Code Corporation VT 05446 Director 1. Handy, Joseph 200 Hidden Oaks Drive Colchester 05401 Director 2. Handy, Charles 18 Ridgewood Drive Burlington i 4327 Harbor Rd Shelburne VT 05482 Director 3. Handy, Anthony VT 05446 Director 4. Handy, Laura 486 Country Lane Colchester VT 05446 Director 5. Handy, Joan 109 Field Green Drive Colchester 200 HidriPn Oaks Drive Colchester VT 05446 Stockholder 6. Handy, Joseph Burlington VT 05401 Stockholder 7. Handy, Charles 18 Ridgewood Drive VT 05401 Stockholder.... 8 Handy, 327 Harbor Rd Shelburne Anthonyy Colchester VT,v05446 Stockholder'.'` F.=9. `Handy, Laura 486 Country�.Lane •�VT 05446' Stockholder • 10.•'Handy, Joan 109 Field Green Drive Colchester Has any director or stockholder been convicted or pleaded"gtfilty to'any criminal or-motor vehicle-offense in any court . -. of law (including traffic tickets by mail) during the last year? Yes l(No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? _Yes No If yes, please attach the following information: Individual's nave, office and juri diction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board ray obtain crirdna' history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are ine oo des a t di g t respect to child support or are in full compliance with a plan to pay any and all child support pay support order. (VSA, Title 15, Section 795) of perjury, that I/We are in good In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 4312-003-SECN-001 SECOND CLASS LICENSE TO SFTJ MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and conplete. Dated this 1 '2 day of )( 4u V 7 , rJ2d/i Signatur authorized agent Signature of individual or partners of corporatio , %c y, c association 4/1 JL"s'C 145/.1 )1,/X-10,� r(Ti le) Are you making this application for the benefit of any other party? Yes }(No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the :Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED • ior Approved by Rnard of Control Commissioners of .wn of •' � _. t � a G / own Clerk Total Membership ✓ members present estt{ t���j _ } TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 • 2014 TOBACCO LICENSE RENEWAL APPLICATION 4312-003-TOBC-001 TOBACCO LICENSE TO SFaT TOBACCO Page 1 • Optional Fee: $100.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $0.0 0 is paid to town/city $100.00 is paid to DLC Fee due only if licensee dnes not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. • Applicant: Slimain Handy's Convenience Stores, Inc. Licensee # 4312- 3 Doing Business As: Simon's Store & Deli Mailing Address: 974 Shelburne Road 75 South Winooski Avenue South Burlington VT 05403 Burlington VT 05401 Telephone: (080) 862-8011 ff PLEASE INCLUDE EMAIL ADDRESS: rYlle/i SAC1y& ,)ay b"' :Co,n Description of Premises: Lessor: Grocery store located in a one story cement and woodframe building Mountaha Handy situated on the east side of Shelburne Road and designated as 974 Burlington Vt Shelburne Road in the city of South Burlington, Vermont. Tagt Enforcement Seminar: 11/23/2013 Fed. ID Number: 33-1234567 Incorporation Date: 04/06/2000 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Handy, Joseph 200 Hidden Oaks Drive Colchester VT 05446 Director 2. Handy, Charles 18 Ridgewood Drive Burlington VT 05401 Director 3. Handy, Anthony 4327 Harbor Rd Shelburne VT 05482 Director 4. Handy, Laura 486 Country Lane Colchester VT 05446 Director 5. Handy, Joan 109 Field Green Drive Colchester VT 05446 Stockholder 6. Handy, Joseph 200 Hidden Oaks Drive Colchester VT 05446 Stockholder 7. Handy, Charles 18 Ridgewood Drive Burlington VT 05401 Stockholder 8. Handy, Anthony 4327 Harbor Rd Shelburne VT 05482 Stockholder 9. Handy, Laura 486 Country Lane Colchester VT 05446 Stockholder 10. Handy, Joan 109 Field Green Drive Colchester VT 05446 Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes 100 If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following information: Individual's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant�y�,� understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. • I/We hereby certify, under the pains and penalties of perj`n-y, that 7/We are in good standing with respect to or in full. compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) perjury, that I/We are in good In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 TOBACCO LICENSE RENEWAL APPLICATION 4312-003—TOBC-001 TOBACCO LICENSE TO SFT.T TOBACCO ?age 2 I/We hereby certify that the information in this application is true and complete. Dat this 17 day of :5-,7 vi&.ry A AY ture o author' agent Signature of individual or partners of co y, or association 444 / Tfe.l` k@nd lvf)�r l (Title) Are you making this application for the benefit of any other party? Yes }(No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of , 1111 - own of ib / } Total Membership members present ?+ L Town Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 • If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town heard of selectmen or city board of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 � o ® City of South Burlington tit*** 1 City Clerk's Office VOT fr Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENANE ADDRESS 6';'et4le- AV/ FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE i ( . �/, e5014. SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE D Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT ---7 Jam -' } 1 Martha Lyons, Deputy Tax Collector Date sent to Montpelier: Cla 1 S Ck_ S 6` 3 ck 0 G'-iy v.)✓� (IA P «/r tCAA i iiJV 15 Ae t4v' '(Ai (,'n/1 ;319 --(t ; F7F Ilnrcot Ctroot Cnuth Rnrlinntnn VT nr,in2 an)_szaa_ninF iLln illo ohii.l i t_ 2014 LIQUOR LICENSE RENEWAL APPLICATION 6172-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFLT, MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $1 1 5.0 0 is paid to town/city �1 5.0 0 's �aid to DLC) Town: 04O6 - St5TJTE BURL"1'TGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the info ion presented on this form, indicating any changes in the spaces provided. Applicant: Panda Dynasty, Inc. Licensee # 6172- 1 Doing Business As: Zen Garden Mailing Address: 7 Fayette Drive 7 Fayette Drive South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 522-3095 PLEASE INCLUDE EMAIL ADDRESS: �flgr c e.c\P\\'V C)3n°nci 1.Crrr% Description of Premises: �1 J Lessor: A Restaurant located in a brick single story building being J & J Vermont Properties LLC approximately 7,000 square feet in size and located at 7 Fayette Drive 22 Country Club Est. in the City of South Burlington, Vermont. Swanton VT 05488 Last Enforcement Saninar: 09/21/2011 Fed. ID Number; 20-5871153 Incorporation Date: 11/03/2006 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Hsu, Sunnie 38 Chelsea Place Williston VT 05495 Director 2. Hsu, Tai Lin 38 Chelsea Place Williston VT 05495 Stockholder 3. Hsu, Sunnie 38 Chelsea Place Williston VT 05495 Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes J No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any electiv or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 10818 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Roans Cert./Acct. No.: 440-205871153E01 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Bird may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes d.a the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 Liquor License Renewal Application: Date: January 21, 2014 To: Department of Liquor Control The existing issue regarding Ch Partners LLC my landlord for the last couple of years has not provides me an updated lease with their information; they are still following the old lease that was from my previous landlord J3&J Vermont Properties LLC. For the last couple of years Ch Partners LLC is the one that I been paying the rent to. Ch Partners LLC at 514 Farrell Drive,South Burlington VT 05403. The contact person would be Tom Carroll 802-881-7733. If you have any questions, please feel free to contact Elaine Hsu, as she is still serving as the registered agent for the corporation. Elaine Hsu can be reach at 802-522-3095. 71 will be submitting the certificat ' formation once I completed the seminar on 02/12/2014. Thank you, ae IaGhEZ) vSunnie Hsu -Dc as. ) I r) Lodz- 0° 3 VERMONT Michael J.Hogan,Commissioner State of Vermont Department of Liquor Control 13 Green Mountain Drive,Drawer 20 [phone] 802-828-2339 Montpelier,VT o562o-45ot [fax] 802-828-1031 liquorcontrol.vermont.gov Please double check the following information on your renewal when received,'for accuracy. 2 i L it 9. Seminar Date Corporation/ LLC/Partnership Changes (corp.name change,director changes,etc.) Trade Name Info /Changes Lease Info/ Changes Other Info / Changes (Federal ID Number,Outside Consumption Area,Payment of Fee,etc.) SEMINARS: Please check the seminar date on your renewal. If it has been 2 years since your last seminar,an owner,director or manager needs to attend a seminar. CORPORATION / LLC/ PARTNERSHIPS: If you have had any changes to your Corporation,Partnership or LLC,please note on the renewal application and include documentation of the change (i.e. copies of changes filed with Secretary of State's office showing new information.) If you have added or removed a director, partner or member,please include minutes of the meeting where the change took place. We will also need info on any new directors (legal name,address,date of birth and place of birth) TRADE NAME: If you have changed your Trade name (d/b/a),we need a copy of the approved trade name from the Secretary of State's office,if you include a copy with your renewal application,this will speed up the renewal process. LEASE: If you have any changes in your lease, (either a new landlord or you purchased the property) we will need a copy of the new lease or title. OTHER INFO: Also just make sure to double check the renewal application for things like your Federal ID number,health number,outside consumption area,etc. and make any changes necessary,Also make sure your company check is attached for payment of your renewal fee. If you double check the renewal applications and attach copies or documentation for any changes,this can help to expedite the renewal process. Thank you , Liquor Control Board: Walter E.Freed,Chairman;John P.Cassarino,Member;Stephanie O'Brien,Member 2014 LIQUOR LICENSE RENEWAL APPLICATION 6172-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFTJ MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. Dated this D 1 day of Jnr,_x+ce4 , :?4-3 4 Signature of authorized agent Signature of individual or partners of corporation, company, club or association (Title) Are you making this application for the benefit of any other party? Yes /No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each i d vio l caemissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED G i t Approved by Board of Control Commissioners of - City o •f v , rTowrn Clerk Total Membership 5 _ members present , TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 i4R"=14Y BF, a► City of South Burlington 0 **° City Clerk's Office °o Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME ADDRESS 65 .. 11-) Pri'D r FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE 7g15). l a aD)/-)= SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date - SO. BURLINGTON FIRE DEP 4I-:-- -) Chief Douglas S. Brent Date SO. BURLINGTO TAX DEPT �.-� � J. /7/C-1 _, -MO /tir)/(/) Martha Lyons, Deputy T Collector Date sent to Montpelier: 575 Dorset Street Smith Rurlinntnn VT nRnns R117-R4R-4.111 r11(invillPC¢7chiirl rum 2014 LIQUOR LICENSE RENEWAL APPLICATION 5511-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFTJ MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Van Phan rts, Inc. ,/ (s � 7)Licens # 5511- 1�G Doing Business As:l VG.n P h A n Z 1 C I t ' Mailing Address: \\ '55 San Remo Drive 55 San Reno Drive South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 651-0111 •! i PLEASE INCLUDE EMAIL ADDRESS: _1.-: r(D91 a y) L j�(A C-0 - \� ' ' ' Description of Premises: / Lessor: 1st class located in a single story metal & wood constructed building Besaw rar with an approximate size of 5,000 square feet located at 55 San Remo South Burlington VT 05403 Drive in the City of South Burlington, Vermont. Last Enforcement Seminar: 01/16/2013 Fed. ID Number: 76-0762207 Incorporation Date: 04/27/2004 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Phan, Van 14 Cabot Court South Burlington VT 05403 Director 2. Bostock, Morton 480 North Avenue Burlington VT 05401 Stockholder 3. Phan, Van 14 Cabot Court South Burlington VT 05403 Has any director or stockholder been convicted or pleaded guilty to any crimipal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? _Yes If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes /No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 10551 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Roans Cert./Acct. No.: 440-760762207F-01 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Fnard may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page fun r r; 1j I r 1 , STATE OF VERMONT , i OFFICE OF SECRETARY OF STATE I Certificate of Trade Name Registration ff,' S .. I,James C. Condos,Vermont Secretary of State hereby certify that ;_ F VAN PHAN BILLIARDS & BAR r y ':11,;: -- was registered on September 17,2013 per copy attached. w�. i_ September 23, 2013 i. E. Given under my hand and the seal of the State of Vermont,at F= Montpelier, the State Capital z ,v da„, C. James C.Condos % Secretary of State i This trade name expires 5 years from the date of registration/renewal t .- 7 Y2 f I I FORM: TRADENAME REGISTRATION Page 1 of 2 • TRADENAME REGISTRATION(11 vSA,Ch.15) Vermont Secretary of State, 128 State Street,Montpelier,VT 05633-1104 (802-828-2386) BUSINESS NAME: (corporate indicators such as incorporation,limited,company,LLC cannot be used in a trade name) Note:anyone intending to operate a postsecondary school must first apply to the state board of education. Alternate name: (If first choke is not available) Name of the town where business is located: `� U t Z.-I—ft1 .13 1 r( i a'?G44' G Date business began: L _' Business purpose-,(be specific- "restaurant"/"beauty beauty shop„!„auto sales„) a r I 5 G W 4J List below the individual(s) or the entity names & address that are doing business under this trade name. Name of owner(list person or company name) street& po box ci state& zi code (4 .. f V- "0sVic, j f Name and address of process agent(non-residents only): ___ .._._________..-___"_.-�__.__._._____._.._. Vermont One of the individuals listed or an officer of the corporation/LLC must sign in front of a notary public. Applicant'sg signature: G� ���✓�'� Title Pit';*/eie..4 ,� Subscribed and sworn to be his /o� day of :� i" Notary Public signature/ commission expiration date Zw iI $50.00 FEE: File in duplicate with self-addressed envelope. Once filed name is valid for 5 years and is public information. Trade name registration is not a guarantee that you are entitled to the name, a person or entity may have, or claim to have, a pre-existing right to exclusive use of the name. You must notify this office if the business name, address or ownership is changed. Resources to help you start and grow your business can be found through Community Business Connections at: www.StartaBusinessinVermout http://www.see.state.vt.us/corps/forms/tradeapp.htm . 9/12/2013 FORM: TRADENAME CESSATION CERTIFICATE Page I of I TRADENAME CESSATION APPLICATION (T.1 1 ch 15) Vermont Secretary of State Office, 128 State Street Montpelier,VT 05633-1104(802-828-2386) NAME of Business: i V E� �. 3 ;n I ., 1 There are a few reasons why a cessation is.frled-(1)the business has closed(2)the business is sold(3)the business name or structure is changing(4)a new owner is added(5)an existing owner departs.In the case of a departing owner only a partial'cessation is required. When a partial cessation is filed the "remaining owner"is the one who files and signs the cessation-the business continues without interruption. PARTIAL CESSATION is being filed to remove the name of an existing owner. The name of the owner being removed is:I _ �~~ COMPLETE CESSATION is being filed: (check one) Business has closed or been sold 43usiness name is changing; i 0 Business structure is changing ..I Adding a new owner r i. Date of this cessation: (j / 2 Ze d COMPLETE cessation must include the names and address of ALL owners as set forth on the original registration. (name/address f 4 -S g ,5 t k 103 .1 �.�.,,..u.., �" 7�.% 1 ��w, irc:� DO Lk� a v�c� ^'l �f �'� !name/address . roams/address Cessation shall be sworn to and filed by a surviving partner, member of the organization, officer of the corporation, or person so doing business, his executor or administrator in front of a notary public. Printed name: Signature and Title } (U PHA f,` j '�`�_ __ ✓� SicC�L Subscribed and sworn to t is /2 day of r,�� 20/f Notary Public Signature commission expiration date: 2// //5 -77 $20.00 FEE payable to Vermont Secretary of State must be attached. File in duplicate with a self-addressed envelope. CA.? r‘qn lwT / CJ1�� - / ' L. http://www.sec.state.vt.us/corpsiforrns`tncess.htm 9/12/2013 • 2014 LIQUOR LICENSE RENEWAL APPLICATION 5511-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFT,T MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. Dated this / 7- day of 7:42, , QW fq Signature of authorized agent Signature of individual or partners of rporatio , company, club or association (Title) Are you making this application for the benefit of any other party? Yes No • Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title most be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of . /. I �,415110r/ 444440. Total Membership I , members present At V Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 ,► City of South Burlington ,t• ! City Clerk's Office ;fit Donna KinviNe, City Clerk `eft FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME 5i toed i ,(ig ADDRESS l610 )I/L v, t_.- rOGt FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE glaYl! LS/ /4 SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE -.(71;) SVSAiti- Chief Douglas S. Brent Date SO. BURLINGTON T DEPT 1/0 / ' -1 (1( Mart a Lyons, Deputy Tax Collector Date sent to Montpelier: ;7c fnrcot Ctroot Cnnth Rurlinntnn \/T nFnn2 Qn?_QtF_11nc rllrinAtillonehurl rn.n L 2014 LIQUOR LICENSE RENEWAL APPLICATION 565-002-1CLB-001 FIRST CLASS LICENSE FOR CLUB TO SETT MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Moose, Loyal Order of, Lodge #1618, Inc. Licensee # 565- 2 Doing Business As: Moose Lodge #1618, Burlington Mailing Address: 1636 Williston Road 1636 Williston Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 655-5192 jj PLEASE INCLUDE EMAIL ADDRESS: ��G � tQ 1dGG` h, r Description of Premises: JJJJ Lessor: Club in a single story wood structure situated on the northerly side Irene Hinsdale of Williston Road, designated as #1636 consisting of 3000 sq ft Burlington VT of kitchen, bar and dining/banquet hall in the city of South Burlington, VT Tast Enforcement Seminar: 08/12/2013 Fed. ID Number: 03-0187885 Incorporation Date: 09/01/1952 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR, Corporation Name Address Town/City State Zip Code Director 1. Shaw, Normand 63 Bernard Street Winooski VT 05404 Director 2. Bowen, Raymond RR3 Box 4899 Milton VT 05468 Director 3. Toutant, Keith 2 Heald Lane St. Albans , y VT 05478 Director 4. Shaw, Theodore mean '4'4 ADO 5 ti r(a+1 ck .Geiahootex- ."t‘ F1 VT 05116 c�S�f yS Director 5. Brown, Leon 15 Ruth St. S. Burlington VT 05403 Director 6. Gaulin, Randy 400 Hinesburg Rd. S. Burlington VT 05403 Director 7. Little, Gary 3 Gilbert St. S. Burlington VT 05403 Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes If yes, please attach the following information: Individ9ual's name, couXE/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective;�or^ appointive state, county, city, village or town office in Vesuunt (See VSA, T.7, Ch.9, Sec. 223)? Yes of If yes, please attach the following information: Individual's name, office and j isdiction Vt. Dept. of Health Food License No.: 12075 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Rooms Cert./Acct. No.: 440-030187885F-01 • Disclosure of Non-profit Organization?: Yes rim No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands that he/she must maintain a list of the names and residences of paid up members, a list of club officers, and a list of employees of the club and their annual salaries. These lists must remain on the licensed premises and be available for inspection upon request. The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. • I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any'and all taxes due the State of Vermont as of the date • of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page • • 2014 LIQUOR LICENSE RENEWAL APPLICATION 565-002-1CLB-001 FIRST CLASS LICENSE FOR CLUB TO SFTT MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. Dated this /0 day of i, , , 1/i/ Signature of authorized agent Signature of individual or partners of corporation, conpan lub or association ini (Title) Are you making this application for the benefit of any other party? Yes o Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of .e City o, Town of, V r ) Total Membership 45 , members present A "` , t eltkri Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 !lei City of South Burlington kit*• 0 City Clerk's Office VOTES Donna Kinville, City Clerk `oram FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENANE rniii VnaitliV&.' Lj611 ADDRESS / 5O %Tar. ,-F ° , FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE % .. ! J 1 CRC)/ 2Y' SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT l - IS( 1 Chief Douglas S. Brent D to SO. BURLINGTON TAX DEPT ---.=-"z-iiatiLf artha yons, Deputy Tac Collector Date sent to Montpelier: P_..+t (1..-1:--+— St, ncnnn nnfl n n r, nnnc 2014 LIQUOR LICENSE RENEWAL APPLICATION 7161-001-SECN-001 SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: BW Enterprises LIC Licensee # 7161- 1 Doing Business As: • BW Enterprises LLC Mailing Address: 1580 Dorset Street 20 Lewis Creek Road • South Burlington VT 05403 Hinesburg VT 05461 Telephone: (802) 862-4602 ) PLEASE INCLUDE EMAIL ADDRESS: - Q 1(N�1��41•c ts. Description of Premises: Lessor: Store in the front section of a two story wood structure consisting Robert & Royal Chittenden of approx 2500 sq ft of space to include retail space and a back South Burlington storage room and office located on the east side of Dorset St, 1 mile south of City Hall in the city of South Burlington, VT 'Last Enforcement Seminar: 01/26/2012 Filed Articles of Organization: Yes Date Filed: 02/20/2009 Federal ID Number: 26-4418717 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. Busier, Brian L. 10549 Route 116 Hinesburg VT 05461 Member 2. Busier, Kyle R. 20 Lewis Creek Road Hinesburg VT 05461 Member 3. Powden, Benjamin 359 North Road Hinesburg VT 05461 Has any person been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes ).No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any e ective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following information: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes OC No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of VeLnvnt as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page i �,"` ,{ •set 1' - FiI f y tr �k.�,?-' "� � . 'a.+ �; � r �' t y 4' a z l °; . i ..«,tia }' M}.. ,. "1s'u 1 I,`-,",-- -;:filati z,,,..--, _,---f,yit 3-— . ,. , :v, tr t "' 0t 1 x .' t ,„.,1, r r .» % ..,4.a,. F=.ra..«. r ...w «R:,•- 1 wa .. ra .:rye+. t-rgnr iii:."‘":4ill ks IX ;A/WA II' CERTIFICATE of ACHIEVEMENT, ,tt;: ...,.,..i This is to certify that , '-��0. 4 x' Kyle Busier .., - ; . t_ � Y has completed the course i, °-_ f . . }i Store Training -- 2nd Class Certification 1); r.o January 26, 2014 j *., .,,is, 1:-..,.. \-.. _,. ,'' � 4 , * 40„..,46,....N...., ,I ' vP, ,RNIONT ,..„4„,,,,,:‘.., < _ i DEPARTMENT Of LIQUOR CONTROL I. 4 .mil ,.a a RWPgtvrzxd ).0. z,. 4112 r-14 412,74%. 74 wit*,,,-.";:- 'i V- „ ww t t g t ; fi .,,_5 4 t � i. - v r.� - _ _ a. , 2014 LIQUOR LICENSE RENEWAL APPLICATION 7161-001-SECN-001 SECCND CLASS LICENSE TO SFT,T MALT AND VINOUS BEVERAGES Page 2 • I/We hereby certify that the information in this application is true and complete. Dated this �t f� day of cG en?&4A , 4O'(i Signature of authorized agent 11 Signature of individual or partners of corporation, company, club or association ///1011,,,r tom( (Title) Are you making this application for the benefit of any other party? Yes )('( No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of own of r�e� f AL 111. Total Membership 5 members present °7�fi � `A`"Q+ ay° °'"" "� '� ! ' , Town Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 440.f City of South Burlington ►�®o m City Clerk's Office Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME ADDRESS 6°70 L4"K Lb!) ' FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE` t2h 1 ;// a)* SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE T Chief Dou las S. Brent Dat1 / SO. BURLINGTON TAX D PT - /.1.-Ili 30-y Marta Lyons, Dep tz3 yt Tax Collector Date sent to Montpelier: 2014 LIQUOR LICENSE RENEWAL APPLICATION 3544-019-SECN-001 SECOND CLASS LICENSE TO SELT, MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF TICE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Brockton Corporation Licensee # 3544- 19 Doing Business As: Shaw's Beer & Wine Mailing Address: 570 Shelburne Road B. Nunziato South Burlington VT 05407 150 Pierce Road Ste 200 Telephone: (802) 863-8260 barbra.nunz i a 416-Ivalu.com PLEASE INCLUDE EMAIL ADDRESS: Description of Premises: Lessor: Grocery store being approximately 73,000 square feet in size, located Heathcote Associates, LP in the grocery shopping plaza on the East side of Shelburne Road, also PO Box 416027 known as 516 Shelburne Road, in the City of South Burlington, Vermjut. Boston MA 02241-6027 Last Enforcement Seminar: 05/08/2013 Fed. ID Number: 04-3344578 Incorporation Date: 01/01/1997 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Evans, Michael 55 Laurel Drive Essex VT 05452 Director 2. Marquis, Marcel R. 96 Poor Farm Road Colchester VT 05446 Stockholder 3. Shaw's, SiipPrmarkets 750 West Center Street W. Bridgewater MA 02379 Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court . of law (including traffic tickets by mail) during the last year? Yes X No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes X No If yes, please attach the following information: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN • The-applicant understands and agrees that the Liquor Control Board may obtain criminal history record information fran State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/rie hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the tr.vle name of these premises with the Secretary of State. I/We hereby certify that the information in this application is true and complete. Dated this O day of ,2, ., , o2fa/� Signature of authorized agent Signature of individual or partners gf corppration, ,- r zon Barbra A. Nunziatod Assistant Secretary (Title) Are you making this application for the benefit of any other party? Yes X No Continued on next page t- 2014 LIQUOR LICENSE RENEWAL APPLICATION 3544-019-SECN-001 SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont • Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license • may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of - - City o owl pf 4W / a Total Membership 5 members present Attest, , Town Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 i 2014 TOBACCO LICENSE RENEWAL APPLICATION 3544-019-TOBC-001 TOBACCO LICENSE TO SELL TOBACCO Page 1 Optional Fee: $100.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $0.0 0 is paid to town/city $100.00 is paid to DLC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Brockton Corporation Licensee # 3544- 19 Doing Business As: Shaw's Beer & Wine Mailing Address: .570 Shelburne Road B. Nunziato South Burlington VT 05407 150 Pierce Road Ste 200 Telephone: (8D02) 863I barbra.nunziato su elrvalu.coin PLEASE INCLUDE EMAIL ADDRESS: P Description of Premises: Lessor: Grocery store being approximately 73,000 square feet in size, located Heathcote Associates, LP in the grocery shopping plaza on the East side of Shelburne Road, also PO Box 416027 known as 516 Shelburne Road, in the City of South Burlington, Vermont. Boston MA 02241-6027 Last Enforcement Seminar: 05/08/2013 Fed. ID Number: 04-3344578 Incorporation Date: 01/01/1997 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Evans, Michael 55 Laurel Drive Essex VT 05452 Director 2. Marquis, Marcel R. 96 Poor Farm Road Colchester VT 05446 Stockholder 3. Shaw's, Supermarkets 750 West Center Street W. Bridgewater MA 02379 Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes X No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes )(No If yes, please attach the following information: Individual's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this application is true and complete. Dated this /c day of e �e , c;--a/ Signature of a»t nri7- gent Signature of individual or partners f corporati.o / y- c association Barbra A. Nunziato - Assistant Secretary (Title) Are you making this application for the benefit of any other party? Yes X No Continued on next page 2014 TOBACCO LICENSE RENEWAL APPLICATION 3544-019—TOBC-001 TOBACCO LICENSE TO SFT,T TOBACCO Page 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each indivichiwl commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED . Approved by Board of Control Comm D f 11.Commissioners of own of i Total Membership 15 , members present rg £° � -^ 0, fown Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 !A City of South Burlington 40•44 City Clerk's Office ffriff Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENANE an1laini *-off i A ry e ADDRESS Ali ianDY�' zir,„ FIRST CLASS SECOND CLASS - ;) CABARET DATE RECEIVED BY CLERK'S OFFICE ! $ 4c )/* SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date - SO. BURLINGTON FIRE DEPT ...(::- t.' yIN. 1. Chief Douglas S. Brent Da e SO. BURL GTON T DEPT / ‘--7(/et--"( 0Lec- / 4,(o, ial Marth Lyons, Deputy Tax o lector Date sent to Montpelier: .,"#°/`"' "7*(. 61° S7S threat Street Cmith Rnrlinntnn VT flFdf2 Rn7_RaR-a1nF rlleinvilloachurl rnm 2014 FIRST/SECOND CLASS LIQUOR LICENSE AND TOBACCO APPLICATION LICENSE YEAR IS MAY 1ST THROUGH APRIL 30TH OF THE FOLLOWING YEAR Martin's Foods of South Burlington, LLC Print Full Name of Person,Partnership,Corporation,Club or LLC Hannaford Food&Drug Superstore Doing Business As-Trade Name 218 Hannaford Drive Street and street number of premises covered by this application South Burlington,VT 05403 Town or City&Zip Code 802-864-0105 Telephone Number P.O.Box 1000,Attn:Jane Goulet,Portland,ME 04104 Mailing Address(if different from above) Email address: Jane.Goulet(iidelhaize.com FEES: FIRST CLASS LICENSE-$115.00 to DLC and$115.00 to Town/City Please circle appropriate categories SECOND CLASS LICENSE-$70.00 to DLC and$70.00 to Town/City FIRST CLASS SECOND CLASS TOBACCO Restaurant TOBACCO LICENSE-(there is no fee for tobacco if applying for Hotel second class) Club If applying for Tobacco only license please use the Tobacco Only form.Fee for this license is$100.00 payable to DLC Commercial Kitchen(a Liquor Control Commercial Caterer's License is needed with this license) TO THE CONTROL COMMISSIONERS OF THE TOWN/CITY OF SOUTH BURLINGTON VERMONT Application is hereby made for a license to sell malt and vinous beverages under and in accordance with Title 7,Vermont Statutes Annotated,as amended,and certify that all statements,information and answers to questions herein contained are true; and in consideration of such license being granted do promise and agree to comply with all local and state laws;and to comply with all regulations made and promulgated by the liquor Control Board. Upon hearing,the Liquor Control Board may,in its discretion,suspend or revoke such license whenever it may determine that the law or any regulations of the Liquor Control Board have been violated,or that any statement,information or answers herein contained are false. MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE,AFTER NOTICE AND HEARING. If this premise was previously licensed,indicate name:Martin's Foods of South Burlington.Inc. Uwe are applying as: (please circle one) INDIVIDUAL LIMITED LIABILITY COMPANY PARTNERSHIP CORPORATION Please fill in name and address of individual,partners,directors or members. LEGAL NAME STREET/CITY/STATE PLEASE SEE ATTACHED SHEET. Are all of the above citizens of the UNITED STATES? Yes i4la (Note:Resident Alien is not considered a U.S.Citizen) If naturalized citizen please complete the following:N/A Name Court where naturalized(City/State/Zip) Date i i Verrnont Department ®f L N iquor Con trol Certificate ®� Second Class Serninar Attendance ame (print): Signature: tP Date: ,-; ,...-- (ezpio 1:WP rs from above44), , one) 'Certificate of Second Class Sevninar Attendaulce , Category(circle : Owner Director Partner Manager. Employee r- Licensee Name: Address: Education Regu/ation 3-8 VS.A. T.7§239 DLC:I 0114:/2/07:SC vs.. Vermont Department of Liquor Control Certificate of Second Class Seminar Attendance Name (print): Signature: 1 1 .41,a0 Date I 2 (expires tviAye*from above date)r Investigator's Signature: certificate of Second Class Seminar Attendance Category (circle one): Owner Director Partner (-Manages2 Employee I Licensee Name: 1'14 I]I'4-it 7 5 'a.1.3 /-44 K.19 d /a: sg, = Address: A -frf y e A-r- / -44 -A_11 !VI 1._11 t / V Education Regulation 3-B V.S.A.T.7§239 DLC:10M:12/07:SC CORPORATE INFORMATION: N/A. If you have checked the box marked CORPORATION,please fill out this information for stockholders(attach sheet if necessary). LEGAL NAME STREET/CITY/STATE Date of incorporation Is corporate charter now valid? Corporate Federal Identification Number Have you registered your corporation and/or trade name with the Town/City Clerkifnd/or Secretary of State?_ (as required by VSA Title 11 1621,1623&1625). ALL APPLICANTS HAVE ANY OF THE APPLICANTS EVER BEEN CONVIC 1ItD OR PLED GUILTY TO ANY CRIMINAL OR MOTOR VEHICLE OFFENSE IN A1�Y COURT OF LAW(INCLUDING TRAFFIC TICKETS)AT ANY TIME? X YES NO NameIf yes,please complete the following information:(attached sheet if necessary)N/A Court/Traffic Bureau Offense Date Aivy Do any of the applicants hold any elective or appointive state,county,city,village/town office in Vermont?(See VSA,T.7,Ch.9,1223)YEs NO. If yes,please complete the following information: Name Office Jurisdiction Please give name,title and date attended of manager,director,partner or individual who has attended a Liquor Control Licensee Education Seminar,as required by Education Regulation No.3: NAME: John Michaelides,Store Mgr;Carl McCaffrey,Asst.Store Mgr.,et al. TITLE: DATE: 3/7/12(Updated Education Seminar Certificate will be forwarded upon receipt( (If you have not attended an Education Seminar prior to making application,please visit www.liquorcontrol.vermont.gov and click on Seminar Schedule for a list of Seminars in your area) FOR ALL APPLICANTS:DESCRIPTION/LOCATION OF PREMISES(Section 4) Description of the premises to be licensed:A grocery store in a one story cement and steel structure that is 45,367 sq.ft.in size and designated as 40 Fayette Road,situated due southwest of Burger King in the city of South Burlington,VT. Does applicant own the premises described?YES. If not owned,does applicant lease the premises? If leased,name and address of lessor who holds title to property: Are you making this application for the benefit of any other party? NO FIRST CLASS APPLICANTS ONLY:No first class license may be issued without the following information. HEALTH LICENSE#: Food Lodging (if licensed as a Hotel) VERMONT TAX DEPARTMENT:Meals&Rooms Certificate/Business Account# 03-0222879 Business is devoted primarily to:(Circle one) FOOD(restaurant)HOTEL CLUB COMMERCIAL CATERING BAR If you are considering Outside Consumption service on decks,porches,cabanas,etc.you must complete an Outside Consumption Permit.This form can be found on our website at www.liquorcontrol.vermont.gov and then click on licensing and then forms. ALL APPLICANTS MUST COMPLETE AND SIGN BELOW The applicant(s)understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal repositories prior to acting on this application. I/We hereby certify,under pains and penalties of perjury,that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application.(VSA,Title 32,43113). Please complete and include with your tobacco license application Please fill in for Individual,Partners,or Directors Martin's Foods of South Burlington, LLC Tax #03-0222879 Applicants Personal Information OFFICERS AND DIRECTORS NAME/TITLE/SS# BIOME ADDRESS BUSINESS ADDRESS DATE OF BIRTH PLACE OF BIRTH Bradford A.,Wise 3 Scroggie Way 145 Pleasant Hill Road 09-05-62. Waterville,ME President&Director Gorham,ME 04038 --Scarborough,ME 04074 006-64-8058 Robert J.SchooIs 17 Prosperity Lane 145 Pleasant Hill Road 06-24-57 Farmington,ME Vice President&Director Windham,ME 04062 Scarborough,ME 04074 006-58-4620 • ' GregoryM.Amoroso 215 North Pine Street 2110 Executive Drive - ' 01 22-65 Portland,ME i Treasurer Charlotte,.NC 28202 Salisbury,NC 28147 004-76-7748 - Elting H.Smith . 76 Field Road 145 Pleasant Hill Road 02-19-54 New York,NY- Assistant Secretary&Director Cumberland,ME 04021 Scarborough,ME 04074 113-38-9287 Patti M.Fletcher 6171 Gold Hill Road 2110 Executive Drive 01-19-68 Concord,NC Assistant Treasurer Concord,NC 28025% • Salisbury,NC 28147 _ 244-29-1891 , Douglas C.Pierson 175 West'Shore Road Pierson,Wadhams,Quinn&Yates 02-11-32 Mount Clair,NJ • Secretary&Clerk Grand Isle,VT 05458 253 South Union St 526-42-2541 - ', Burlington,VT 05401 • • In accordance with 21 VSA,81378(b)I/We certify,under pains and penalties of perjury,that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. If applicant is applying as an individual:I hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or am in full compliance with a plan to pay any and all child support payable under a support order.(VSA,Title 15,4795) Dated at Burlington,Vermont in the County of Chittenden and State of Vermont ,this 6t" day of January ,2014. Corporations/Clubs:Signature of Authorized Agent Individuals/Partners:(All partners must sign) Martin's s cis of So Burh gton,LLC --m, By: Douglas C. Pierson,Secretary TOWN/CITY APPROVAL/DISAPPROVAL Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended,have been fully met by the applicant,the commissioners will endorse their recommendation on the back of the applications and transmit both copies to the Liquor Control Board for suitable action thereon,before any license may be granted.For the information of the Liquor Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval.Lease or title must be recorded in town or city before-•.suancc of licee. V 1 � li J r, LJ ,Vermont, ,2014. Nate APPROVED DISAPPROVED Approved/Disapproved by Board of Control Commissioners of the City or Town(circle one)of Total Membership 16 • f .~s i a members present or Town Clerk) TOWN OR CITY CLERK SHALL MAIL ONE APPLICATION DIRECTLY TO THE DEPARTMENT OF LIQUOR CONTROL,13 Green Mountain Drive,Montpelier,VT 05602.If application is disapproved,local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class application shall be considered binding except as taken or made at an open public meeting VSA Title I 4312 SECTION 5111 AND 5121 OF THE INTERNAL REVENUE CODE OF 1954 REQUIRE EVERY RETAIL DEALER IN ALCOHOLIC BEVERAGES TO FILE A FORM ANNUALLY AND PAY A SPECIAL TAX IN CONNECTION WITH SUCH SALES ACTIVITY.FOR FURTHER INFORMATION,CONTACT: THE BUREAU OF ALCOHOL,TOBACCO&FIREARMS(Tm) (513)684-2979 DEPARTMENT OF THE TREASURY 550 MAIN STREET,CINCINNATI,OH 45202 NOTICE:All new a plications are investigated b he Enforcement and Licensing Division pLior to appro Udis4pproval of tJe lipense by the Liquor Control Board. Please note t at thispprocess can a anyw ere m wee to weeks to complete once Liquor ontr l receives the application. ,► 40I City ©f SouthBurlington le'ff.® 4 City Clerk's Office VOTE,. � Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME Gra661.8. 's -t re, ADDRESS t )333 0l/1 i,1- (D f 2 0 FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE . AR,` , AD SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE D c"-1CP '- z. l 1 Chief Douglas S. Brent at SO. BURLINGTON TAX DEPT lo t�y 1 1j ,,, /7 ons , Martha y , Deputy' Tax Collector Date sent to Montpelier: x /\/626'6oe 575 flnrcet Ctrppt Cniith Rnrlinntnn \IT 117,6n2 R119_2AF_Al(l� lL{n flin nlch .l 2014 LIQUOR LICENSE RENEWAL APPLICATION 4312-007-SECN-001 SECOND CLASS LICENSE TO SF.TJ MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Slimain Handy's Convenience Stores, Inc. Licensee # 4312- 7 Doing Business As: Gracey's Store Mailing Address: 1333 Williston Road 75 South Winooski Avenue South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 862-8553 PLEASE INCLUDE EMAIL ADDRESS: ✓0 t ACan d/ e AAA V 6941 Description of Premises: Lessor: Grocery store and deli in a one story steel building and situated Mountaha Handy on the southeast corner of Williston and Hinesburg Road and Burlington Vt designated as 1333 Williston Road in the city of So. Burlington, Vt. Last Enforcement Seminar: 11/23/2013 Fed. ID Number: 33-1234567 Incorporation Date: 04/06/2000 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Handy, Joseph 200 Hidden Oaks Drive Colchester VT 05446 Director 2. Handy, Charles 18 Ridgewood Drive Burlington VT 05401 Director 3. Handy Anthony. 4327 Harbor Rd -Shelburne • VT 05482' ._ Director 4. Handy, Laura 486 Country Lane Colchester -. VT 05446 Director 5. -'Handy,-;Joan ,. 109 Field Green Drive Colchester VT 05446 Stockholder 6. Handy, Joseph 200 Hidden Oaks Drive Colchester VT 05446 ' Stockholder 7. Handy, Charles 18 Ridgewood Drive Burlington VT 05401 Stockholder 8. Handy, Anthony 4327 Harbor Rd Shelburne VT 05482 Stockholder 9. Handy, Laura 486 Country Lane Colchester VT 05446 Stockholder 10. Handy, Joan 109 Field Green Drive Colchester VT 05446 Has any director or stockholder been convicted or pleaded guilty to any criXmal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes to If yes, please attach the following information: Individual's name, office and juri ction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in'good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 4312-007—SECN-001 SECOND CLASS LICENSE TO SETT MALT AND VINOUS BEVERAGES ?age 2 I/We hereby certify that the information in this application is true and complete. Dated this day of t i ignature f authorized agent Signature gnature of individual or partners of .. .ration, or association 'Toff, . if ,car (Title) Are you making this application for the benefit of any other party? Yes N o Upon being satisfied that the conditions precedent to the granting of this license( as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual ccemissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Pnard of Control Commissioners of e City Tto.}awn. , f fil------- Total Membership 6 members present 7.5.-"A*--�._ " ^""(., .. n Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 2014 TOBACCO LICENSE RENEWAL APPLICATION 4312-007-TOBC-001 TOBACCO LICENSE TO SFtJ TOBACCO Page 1 Optional Fee: $100.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $0.0 0 is paid to town/city $100.00 is paid to DLC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Slimain Handy's Convenience Stores, Inc. Licensee # 4312- 7 Doing Business As: Gracey's Store Mailing Address: 1333 Williston Road 75 South Winooski Avenue South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 862-8553 r— / PLEASE INCLUDE EMAIL ADDRESS: JOG,VJfiaCfC (/(l:, V Cps Description of Premises: Lessor: Grocery store and deli in a one story steel hillding and situated Mountaha Handy on the southeast corner of Williston and Hinesburg Road and Burlington Vt designated as 1333 Williston Road in the city of So. Burlington, Vt. Last Enforcement Seminar: 11/23/2013 Fed. ID Number: 33-1234567 Incorporation Date: 04/06/2000 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Handy, Joseph 200 Hidden Oaks Drive Colchester VT 05446 Director 2. Handy, Charles 18 Rid gewood dgewood Drive Burlington.. - VT 05401.° Director 3. Handy, Anthony_. 4327'HarbOr Rd- Shelburne VT 05482 Director 4. Handy,-Laura 486 Country Lane Colchester VT 05446 Director 5. Handy,-Joan - 109 Field'Green-Drive Colchester VT 05446 Stockholder • 6. Handy, Joseph 200 Hidden Oaks Drive Colchester VT 05446 Stockholder 7. Handy, Charles 18 Ridgewood Drive Burlington VT 05401 Stockholder 8. Handy, Anthony 4327 Harbor Rd Shelburne VT 05482 Stockholder 9. Handy, Laura 486 Country Lane Colchester VT 05446 Stockholder 10. Handy, Joan 109 Field Green Drive Colchester VT 05446 Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes No If yes, please attach the following information: Individual'a name, court affic bureau, offense and date In the past year has any director or stockholder of the corporation held any elect'}ve or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes X No If yes, please attach the following information: Individual's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Pnard may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page • 2014 TOBACCO LICENSE RENEWAL APPLICATION 4312-007-TOBC-001 TOBACCO LICENSE TO SFTS TOBACCO Page 2 I/We hereby certify that the information in this application is true and complete. r\ Dated this day of J LA , 4201 1 Signatur of au a e Signature of individual or partners of co rat' t y, clu association Ti$$i (t, ' Ae - (Title) Are you making this application for the benefit of any other party? Yes ((No Upon being satisfied that the conditions precedent.to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. • APPROVED DISAPPROVED Approved by Board of Control Commissioners o e City or own ofi:). )/ � Total Membership 15 , members present .114tesE � vti • ` �Town Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 o► . City of South Burlington ®�® o City Alf Donna Kinville, City Clerk tA re6.-5* FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION ' e rigg,0/ L tc DOING BUSINESS AS! TRADENANE V6P1 ADDRESS )1/4 a Kg‘74' FIRST CLASS SECOND CLASS CABARET 11a rGI� V DATE RECEIVED BY CLERK'S OFFICE 1�j ail SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE D 1 Chief Douglas S. Brent Dat SO. BURL)NGTONTAX DEPT , Mart Lyons, Deputy Collector y p y I ec..or Date sent to Montpelier: ....,- 2014 LIQUOR LICENSE RENEWAL APPLICATION 7444-002-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SETT.MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS • FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING • • Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. • Applicant: M & K Enterprises Tsr Licensee # 7444- 2 Doing Business As: Venue Mailing Address: 5 Market Street 499 Porters Point Road South Burlington VT 05403 Colchester VT 05446 PLEASE INCLUDE )E3MAIL 6ADDRESS: 7 4QC5� 't'RCC ebb_ cc at- is -��,�, ram a,w 7 Description of Premises: Lessor: 1st class license in a two story wood structure (Behind the Blue Mall) Poon Trust, LLC consisting of approx 10,000sq ft of space to include the entire first 5 Market Street floor with the second floor as storage & office space. Designated as South Burlington VT 05403 #5 Market St. in the City of South Burlington, VT. T.a Gt Enforcement Seminar: 10/18/2012 Filed Articles of Organization: Yes Date Filed: 12/02/2010 Federal ID Number: 27-4085997 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. Couture, Michael 499 Porters Point Road Colchester VT 05449 i'N;) Member 2. Niquette, Kevin 672 Severence Road Colchester VT 05441 Has any person been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any eactive or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes 7s No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 801 Vt. Dept. of Health lodging No.: Vt. Tax Dept. Meals & Rooms Cert./Acct. No.: 440-274085997E-01 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VEA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. • Continued on next page 3/10/14 M&K Enterprises LLC 5 Market Street So. Burlington,VT 05403 To Whom It May Concern, Member#3 added Carolyn J.Jones 6832 Eigth Circle Alexandria,VA 22312 DOB 07/22/1948 Address change: Kevin Niquette 36 Turf Road Burlington, VT 05408 Respectfully, Mike Couture 2014 LIQUOR LICENSE RENEWAL APPLICATION 7444-002-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SETJ MALT AND VINOUS BEVERAGES Page 2 I/We hereby,certify that the information in this application is true and caiplete. Dated this 6 day of \'i N-CL , Signature of authorized agent Signature of individual or partners of corporation, ca pany, club or association (Title) Are you making this application for the benefit of any other party? Yes No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Rand of Control Commissioners o, the City co' :. -. of Total Membership , members present CialoEwsown Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 210At 'o , 0 City of South Burlington 0�®® ;4 City Clerk's Office ty = Donna Kinville, City Clerk (01,4ilid . m 'D!;;D FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME lv)d'1) , ADDRESS ,er }' 2 , co'r---1.72.ST CLASS.-2) SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE��__!/1i�� 517 4 V/ SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT �� Chief Douglas S. Brent D to SO. BURLINGTON y DEPT ,, 76 (47( Ar274/9 3/. .ci kt Martha Lyons, Deputy De ut Ta ollector Y Date sent to Montpelier: 2014 LIQUOR LICENSE RENEWAL APPLICATION 6138-002-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SETT MALT AND VINOUS BEVERAGES Page 1 Fee: $1 1 5.0 0 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Pulcinella's LLC Licensee # 6138- 2 Doing Business As: Pulcinella's Mailing Address: 100 Dorset Street 100 Dorset Street South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 863-1000 ,� PLEASE INCLUDE EMAIL ADDRESS: e -':SRIV\-M i ��--) (a ) &. C o & Description of Premises: �� Lessor: A restaurant located at 100 Dorset Street approximately 1/10 mile on Century Partners, LLP the left from the intersection of Williston Road and Dorset Street 2 Market Street with 3,300 square feet, located in the City of South wirlington, South Burlington VT 05403 Vermont. Last Enforcement Seminar: 01/09/2012 Filed Articles of Organization: Yes Date Filed: 10/16/2006 Federal ID Number: 20-5720218 Majority of Members are US Citizens: Yes- ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES 1 AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Coany Name Address Town/City State Zip Code Member 1. Palmisano, Samuel A. 1265 Dodge Road East Montpelier VT 05651 Member 2. Palmisano, Doreen M. 1265 Dodge Road East Montpelier VT 05651 Member 3. Palmisano, Samuel S. 1-101 Gilbert Square Milton VT 05468 Has any person been convicted or pleaded guilty to any criminal or for vehicle offense in any court of law (including traffic tickets by mail) during the last year? _Yes A No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any oc77ctive or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes 1%/ No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 812 Vt. Dept. of Health Ding No.: Vt. Tax Dept. Meals & Rooms Cert./Acct. No.: 440205720218f01 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and .=..;Lees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. • I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Ccamissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 6138-002-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFTJ MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this applicationi is true and complete. N\� Dated this day of Z©l y Signature of authorized agent t Signature of individual or partners of co ration, company, club or association (Title) `/� Are you making this application for the benefit of any other party? Yes X/No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the coBmissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners o + e City of -own 0 /1 ! t• £� F Total Membership members present * - '' a < -� .e' C ,m Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 i y 2014 LIQUOR LICENSE RENEWAL APPLICATION 6138-002-OUTC-001 OUTSIDE CONSUMPTION PERMIT Page 1 Fee: $20.00 License Year Beginning May 1, 2014 ending April 30, 2015 Paid to DLC MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Pulcinella's LLC Licensee # 6138- 2 Doing Business As: Pulcinella's Mailing Address: 100 Dorset Street 100 Dorset Street South Burlington VT 05403 South lington VT 05403 Telephone: (802) 863-1000 PLEASE INCLUDE EMAIL ADDRESS: e_ h$c,S&NN;( „ V `4 + C 0 r Description of the delineated area is as follows: Area entails 12 feet deep from front of building, going 27 feet in length of the front of sun windows, on the sidewalk. Area will have seating for no more than 20 people, and will be marked off by a rope chain fence. Roped off area still leaves a five foot passage walk way on the sidewalk. April 1 through November 1 11:30 to 11:30p . I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with , respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We hereby certify that the information in this application is true and complete. Dated this Z 3 day of , 70 Signature of authorized agent Signature of individual or partners of rporation, company, club or association • mac,ri ite _ (T tle) Are you making this application for the benefit of any other party? Yes No MAKE CHECKS PAYABLE TO AND MAIL TO: VERMONT DEPAR NT OF LIQUOR CONTROL 4: 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, 6s amended, have been fully met by the applicant, the comnissioners will endorse their reccemendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED • (�D ' Approved by Board of Control Commissioners of ;iiiiiiiiiir,, of �J * @4five, Total Membership 6. , members present s to `- ''# C own Clerk • lii • 0 City of South Burlington ,I®� City Clerk's Office "Q�_ Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OFOF PPERSON,, PARTNERSHIP, CORPORATION ^^ '' 1 I DOING BUSINESS AS/ TRADENAME 41,1,(6, v;&,1) ,,arl gi. 17;r11] ADDRESS l7/D 9116tb orr(*).46 C19)1 V CrrOlpr-D FIR ST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE c ♦ ID) .6W4 SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date - SO. BURLINGTON FIRE DE 4,p...7 ,_34,? ,/g/ Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT' L-Z '---2/tie je/11/1 /e.V-i411 Marth ,t Lyons, Deputy axector Date sent to Montpelier: 575 nnrcPt .CtraPt Cniith Rnrlinntnn VT nFann. Rn9_5mR_ainG di,,,,rilla(irlchiirl rnm 2014 LIQUOR LICENSE RENEWAL APPLICATION 3279-002-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Night Flight, Inc. Licensee # 3279- 2 Doing Business As: Lake-View Bar & Grill/The Lake-View House Mailing Address: 1710 Shelburne Road 410 Shelburne Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 865-3900 PLEASE INCLUDE EMAIL ADDRESS: 7/i/i -er)1, a Ja ji" �- p/) Description of Premises: / Lessor: A restaurant located on the first and second floor of a wood frame Tark-Inns, L.P. building approximately 5000 square feet in size and situated on the east side of Shelburne Road designated as 1710 Shelburne Road in the city of South Burlington, Vermont. Last Enforcement Seminar: 03/20/2013 Fed. ID Number: 03-0350832 Incorporation Date: 02/29/1996 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Larkin, Marilyn 170 Spruce Street Burlington VT 05401 Stockholder 2. Larkin, Marilyn 170 Spruce Street Burlington VT 05401 Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes )� No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past-year has any director or stockholder of the corporation held any elective or appointive state,.county,. city, village or.town office in:Vermont (See VSA, T.7, Ch.9, Sec. 223)? - Yes X No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 3159 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Rooms Cert./Acct. No.: 12328 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance, with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page .► . ERMONT State of Vermont Michael J.Hogan,Commissioner Department of Liquor Control 13 Green Mountain Drive,Drawer 20 [phone] 802-828-2339 Montpelier,VT o562o-45O1 [fax] 802-828-1031 liquorcontrol.vermont.gov Please double check the following information on your renewal when received,'for accuracy. /6 //7/1/Z-Seminar Date l Corporation/ LLC/ Partnership Changes (corp.name change,director changes,etc.) S z- -e.__ Trade Name Info/Changes c�err Lease Info / Changes 6TX Other Info / Changes (Federal ID Number,Outside Consumption Area,Payment of Fee,etc.) SEMINARS: Please check the seminar date on your renewal. If it has been 2 years since your last seminar,an owner,director or manager needs to attend a seminar. CORPORATION / LLC/ PARTNERSHIPS: If you have had any changes to your Corporation,Partnership or LLC,please note on the renewal application and include documentation of the change (i.e. copies of changes filed with Secretary of State's office showing new information.) If you have added or removed a director, partner or member,please include minutes of the meeting where the change took place. We will also need info on any new directors (legal name,address,date of birth and place of birth) TRADE NAME: If you have changed your Trade name (d/b/a),we need a copy of the approved trade name from the Secretary of State's office,if you include a copy with your renewal application,this will speed up the renewal process. LEASE: If you have any changes in your lease, (either a new landlord or you purchased the property) we will need a copy of the new lease or title. OTHER INFO: Also just make sure to double check the renewal application for things like your Federal ID number,health number,outside consumption area,etc. and make any changes necessary, Also make sure your company check is attached for payment of your renewal fee. If you double check the renewal applications and attach copies or documentation for any changes,this can help to expedite the renewal process. Thank you. Liquor Control Board: Walter E.Freed,Chairman;John P.Cassarino,Member;Stephanie O'Brien,Member ......, Vermont Department of Liquor Control Certificate of First Class Seminar Attendance Name (print): r - „rlyvt,c,.. Signature: -1-----,, ,, - I',A.------- ''---,-----, -— Date: f ' expires two years from above date) Ty41 .it-t--------7,--- -----------** Investigator's Signature: Certificate of First Class Seminar Attendance Category (circle one): Owner Director Partner ,-" Manager ---,Employee n '''''‘, '-'-- -II:I i el.'‘, -1- ----, r?Corporation Name: 1 , 1-:-.,. ',,--- - —i-i ,,, . „.,...,, , , Q , , -L. Business Name: .;,--')._. 1,--6: li 0 Nki k (),tiq •-:--'4;fo '1'7V1 . ` 4'-'?-A V,--C-771 LA.}, Street and Town: ;7 10 StA Vorvs.1 ii-A,- ( - . i;til If Seminar held in: '2:ktivqi,A, Town/City i Education Regulation 3-B .,. V.S.A.T.7§239 I )9(--ek---/---ay-eil---- 2014 LIQUOR LICENSE RENEWAL APPLICATION 3279-002-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SETT MALT AND VINOUS BEVERAGES Rage 2 I/We hereby �certify that the information in this application is true and complete. Dated this 7 ' day of , o20/L/ Signature of authorized agent Signature of individual or partners of corporation, c �)fy, cl or association T OL't%2iy • (Title) Are you making this application for the benefit of any other party? Yes 1V No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recanmendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of a r Tow . O ( ' e (41 Total Membership 6 , members present At"ts4,,-� ` t , T'oZun Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, lora) control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town beard of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 2014 LIQUOR LICENSE RENEWAL APPLICATION 3279-002—OUTC-001 OUTSIDE CONSUMPTION PERMIT Page 1 Fee: $20.00 License Year Beginning May 1, 2014 ending April 30, 2015 Paid to DLC MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Night Flight, Inc. Licensee # 3279- 2 Doing Business As: Lake-View Bar & Grill/The Lake-View House Mailing Address: 1710 Shelburne Road 410 Shelburne Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 865-3900 y PLEASE INCLUDE EMAIL ADDRESS: /)f j i rL ,7_/ i-L-o,jr-E{41--f oar' Description of the delineated area is as follows: I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA., Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions -ie to the Department of Employment and Training. I/We hereby certify that the information in this application is true and complete. y Dated this / day of �=� =70/V / Signature of authorized ag t Signature of individual or partners ofy corporation, canpany, club or association )74qre,dir ,Z7//14 • (Title) Are you making this application for the benefit of any other party?. Yes No MAKE CHECKS PAYABLE TO AND MAIL TO: VERMONT DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISA'PROVED Approved by Board of Control Commissioners of .. - City O of4571,, ifJ 0o 11� Total Membership members present r�'`"' am ',own Clerk`. ,, �/ City of South Burlington OIL® City Clerk's Office Ere;" Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING NE 401.er—m BUSINESS AS/ TRADENA *ifOn-----C3161; fL1jrDD L ADDRESS /RA&1J'eD I%� 21/I it' FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT '''DC--- 1- 4-..CFnAir ,...V.Z.57/y Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT fLr"`l � L Mart a Lyons, Deputy! fax Collector Date sent to Montpelier: E(1 /'\'Dbillet 575 Dorset Street Smith Rnrlinntnn \!T f5Ltl? Rf19_Rt1R_einq Akinvillo(17chur1 rnn 2014 LIQUOR LICENSE RENEWAL APPLICATION 7413-001-SECN-001 SECOND CLASS LICENSE TO SF T.T, MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Aviation Deli & Fine Fonds LLC Licensee # 7413- 1 Doing Business As: Aviation Deli & Fine Foods T.TC Mailing Address: 1223 Airport Drive 1223 Airport Drive South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 399-2206 Q PLEASE INCLUDE EMAIL ADDRESS: 11Q k 4r,) ;/ (?v,G�cc t \ :k Description of Premises: Lessor: Store in a single story structure located on the west side of Airport City of Burlington Parkway desingated as #1223 directly across the road from the Burlington VT Burlington Airport in the city of South Burlington, VT Last Enforcement Seminar: 08/03/2011 Filed Articles of Organization: Yes Date Filed: 09/22/2010 Federal ID Number: 27-3535813 Majority of Members are US Citizens: Ye s ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability • Company Name Address Town/City State Zip Code Member 1. Mahoney, Robert P 45 Arrowhead Avenue Milton VT 05468 • Has any person been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes x No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes x No If yes, please attach the following information: Individual's name, office and jurisdiction • Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes di,P the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this application is true and complete. • Dated this %(*\ day of rZ}pr114./ , 2t014 Signet of authorized agent Signature of ' 'vidual or partners of wrporat' , y� a iation (Title) Are you making this application for the benefit of any other party? Yes X No Continued on next page t fl t o W J (NICd IV Ntl — I $. : * i U kI11 ��.yyi.l 1 to V � �M y L cd N I•r y o H G) 0 tccsc L . y a a' V Q Z v� Q 5 U -J zs Q W j 1 2014 LIQUOR LICENSE RENEWAL APPLICATION 7413-001—SECN-001 SECOND CLASS LICENSE TO SF11 MALT AND VINOUS BEVERAGES Page 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED J. Approved by Board of Control Commissioners o i e City o. To`. r C Total Membership members present A , Town Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OE LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 2014 TOBACCO LICENSE RENEWAL APPLICATION 7413-001-TOBC-001 TOBACCO LICENSE TO SFTT TOBACCO Page 1 Optional Fee: $100.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $0.0 0 is paid to town/city $100.00 is paid to DLC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Aviation Deli & Fine Foods LLC Licensee # 7413- 1 Doing Business As: Aviation Deli & Fine Foods LLC Mailing Address: 1223 Airport Drive 1223 Airport Drive South Burlington VT 05403 South Burlington VT 05403 • Telephone: (802) 399-2206 PLEASE INCLUDE EMAIL ADDRESS: C1fM(J1c onty (Q+ Cm in CIA nti Description of Premises: Lessor: - Store in a single story structure located on the west side of Airport City of Burlington Parkway desingated as #1223 directly across the road from the Burlington VT Burlington Airport in the city of South Burlington, VT Last Enforcement Seminar: 08/03/2011 Filed Articles of Organization: Yes Date Filed: 09/22/2010 Federal ID Number: 27-3535813 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. Mahoney, Robert P 45 Arrowhead Avenue Milton VT 05468 Has any person been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes x No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any elective or appuintive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes '( No If yes, please attach the following information: Individial's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Caumissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) • I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this application is true and complete. Dated this %tiON day of t li0.a 11 , act 1 k Signature of authorized agent Signature of individual or partners , of co atio , cc y, club or as iation (Title) Are you making this application for the benefit of any other party? Yes )(No Continued on next page 1 2014 TOBACCO LICENSE RENEWAL APPLICATION 7413-001—TOBC-001 TOBACCO LICENSE TO SFT,T TOBACCO Page 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individna1 commissioner registering either approval or disapproval. Lease or title mast be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of 4 e City or own of Total Membership _members present Attgst, Clerk TOWN OR CITY CLERIC SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 if application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 e, *, City of South Burlington e City clerk's Office "Ot �_ Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME 1 o7 ADDRESS -7 Q 1 7 FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE 1, DJ SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT cJ Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT0,271/14A4 Martha Lyons, Deputy Tax 'Collector Date sent to Montpelier: )(,$j C6® 575 Ilnr�at StrPPt Smith Riirlinntnn VT fAana Rn'LRlR_a1fc rtlkir ,tIo�chiirI rnm , 2014 LIQUOR LICENSE RENEWAL APPLICATION 406-006-SECN-001 SECOND CLASS LICENSE TO SFTT MALT AND VINOUS BEVERAGES Page 1 License Year Beginning May 1, 2014 ending April 30, 2015 Fee: $$7 0.0 0 of which $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Jolley Associates LLC Licensee # 406- 6 Doing Business As: Jolley #107 Mailing Address: 977 Shelburne Road P.O. Box 671 South Burlington VT 05403 St. Albans VT 05478-0671 Telephone: (802) 864-9654 PLEASE INCLUDE EMAIL ADDRESS: "-�--..--„-\}LPL+,\\ : ,1C.L� ,CO4rTh Description of Premises: Premises: XX Owned _Leased Grocery store located in a 1 story steel prefab building, situated on west side of Shelburne Rd. (Rt. 7) and designated as 977 Shelburne Rd. in the City of South Burlington, VT. Last Enforcement Seminar: 09/10/2013 Filed Articles of Organization: Yes Date Filed: 01/01/2013 Federal ID Number: 99-9999999 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. Jolley, Bruce 180 Overlake Drive Colchester VT 05446 Member 2. Jolley, Robert, Estate of 180 Overlake Drive Colchester VT 05446 Has any person been convicted or pleaded guilty to any criminal or t vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any ele ive or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following informat n: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby`` certify that the information in this application is true and complete.Dated this.P ✓er day of O-C 1 , Signature of authorized agent Signatur f dividual or partners • of corporation, company, club or association (Title) Are you making this application for the benefit of any other party? Yes No Continued on next page \ ,C n3 (.2.?< .�0- \O n - /o3) /4-) 2014 LIQUOR LICENSE RENEWAL APPLICATION 406-006-SECN-001 SECOND CLASS LICENSE TO SFT,T MALT AND VINOUS BEVERAGES Page 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recannendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each • individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of it Town of Total Membership 6 , members present ♦ C'WK Town Clerk • TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, lnral control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 1 • 2014 TOBACCO LICENSE RENEWAL APPLICATION 406-006—TOBC-001 TOBACCO LICENSE TO SF'TT TOBACCO Page 1 License Year Be Optional Fee: $100.00 of which ` ginning May 1, 2014 ending April 30, 2015 $0.00 is paid to town/city $100.00 is paid to DLC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Jolley Associates LLC Licensee # 406- 6 Doing Business As: Jolley #107 Mailing Address: 977 Shelburne Road P.O. Box 671 South Burlington VT 05403 St. Albans VT 05478-0671 Telephone: (802) 864-9654 � ` PLEASE INCLUDE EMAIL ADDRESS: .--�Ch c \ �. ?C._�J \\ i, �lr'" VYM Description of Premises: Premises: XX Owned Leased Grocery store located in a 1 story steel prefab building, situated on west side of Shelburne Rd. (Rt. 7) and designated as 977 Shelburne Rd. in the City of South Burlington, VT. Last Enforcement Seminar: 09/10/2013 Filed Articles of Organization: Yes Date Filed: 01/01/2013 Federal ID Number: 99-9999999 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Company NdffL Address Town/City State Zip Code Member 1. Jolley, Bruce 180 Overlake Drive Colchester VT 05446 Member 2. Jolley, Robert, Estate of 180 Overlake Drive Colchester VT 05446 Has any person been convicted or pleaded guilty to any criminal or t r vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes If yes, please attach the following information: Indivirhal's name, co /traffic bureau, offense and date In the past year has any person held any e e ive or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes to If yes, please attach the following infornatio : Indivirh,al's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of pPrjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, tinder pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this application is true and complete. Dated this t51t—day of��}.- ,C.e-/ , ,- o JL'. Signature of authorized agent Signature •vidual o, partne 00")4.0';'7 of corporation, ccnpany, club or association 1f . i/♦ • (Title) Are you making this application for the benefit of any other party? Yes (/�No Continued on next page 2014 TOBACCO LICENSE RENEWAL APPLICATION 406-006—TOBC-001 TOBACCO LICENSE TO SFT.T TOBACCO Page 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recasnendation on the back of the application and transmit it to the Liquor Control Psard for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title mast be recorded in town or city before issuance of license. • APPROVED DISAPPROVED • i AP' cif Approved by Board of Control Commissioners of Town o £.�j Total Membership 6 , members present { " Town Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, kcal control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 �"► */ City of South Burlington ®4 City Clerk's Office "d® Donna Kinville, City Clerk Q FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME U ,g \("6;� 1Lra E ADDRESS 1, 1?A lAD;J/lens_-� . . FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE . tA6/ /v/' SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT ----)C._---r: ;Aner?e, >0 (-3209 Chief Douglas S. Brent Date dj SO. BU INGTON TAX DEPT Mart a Lyons, Deput ax Collector Date sent to Montpelier: /4/ A°0}.9°1669 575 Dorset Street South Burlinaton.VT 05403 802-846-4109 dkinvillpCc churl r.nm 2014 LIQUOR LICENSE RENEWAL APPLICATION 3919-001—SECN-001 SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS • FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Bushway, Richard & Karen Licensee # 3919- 1 Doing Business As: U Save Beverage Mailing Address: 1302 Williston Raod 1302 Williston Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 862-2907 PLEASE INCLUDE EMAIL ADDRESS: Description of Premises: Lessor: A beverage and variety store in a one story building on the northerly Champlain Oil Co. side of Williston Road due west of the Mobil station, designated as Dorset Street 1302 Williston Road in the City of South Burlington, Vermont. South Burlington VT 05403 Last.Enforcement Seminar: 01/19/2012 ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Partnership Name Address Town/City State Zip Code Partner 1. Bushway, Richard 50 Barrett Street South Burlington VT 05403 Partner 2. Bushway, Karen 50 Parrett Street South Burlington VT 05403 Has any person been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes NINo If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any ellctive or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes `1k No If yes, please attach the following information: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Deployment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this application is true and complete. Dated this 2 6 day of PE b Ro 4 / , a,O 1j/ gnature thorized agent Signa e of individual or partners ratio , club or association fr"E5.2441-1")CSif 69 anti 6A/111-1L/49\ (Title) (/ Are you making this application for the benefit of any other party? Yes /- No Continued on next page • - - - Itor . 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' . .., :,..,......„..,..,..„1 Z::-:3-_,,::,. ANE4,,,- .„,- - .i. - .. - t -,:t., ' .b '- ...' ' 'f 1:- -•• • ---vi v---, , ,vv.- 's-41r-ii-7-$.v,--- ------.- '-';!..,.-- - ,- -. , --• -,,-... •-•_•_.-- v.„v.- ,-, ,,,- .,:,.. --„.., , --,,,,,,,,_ . --- -..--- .,.::,--,,h .17:-,- •-_,:-7,-...4-, ,_..i. .f-:.,--- , ----,f.- -i i„ec ,,--:.- .-_,- „...........,„.„..,_„---.-- --- - 2014 LIQUOR LICENSE RENEWAL APPLICATION 3919-001—SECN-001 SECCBD CLASS LICENSE TO SFT,T MALT AND VINOUS BEVERAGES Page 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of ,p wn o ��� 0��a mmi Total Membership 6 , members present '* &:,rosin„. ' 42464,141Swn Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control coirmissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 2014 TOBACCO LICENSE RENEWAL APPLICATION 3919-001-TOBC-001 TOBACCO LICENSE TO SFTX TOBACCO Page 1 Optional Fee: $100.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $0.00 is paid to town/city $100.00 is paid to DLC • Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Bushway, Richard & Karen Licensee # 3919- 1 Doing Business As: U Save Beverage Mailing Address: 1302 Williston Raod 1302 Williston Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 862-2907 PLEASE INCLUDE EMAIL ADDRESS: Description of Premises: Lessor: A beverage and variety store in a one story building on the northerly Champlain Oil Co. side of Williston Road due west of the Mobil station, designated as Dorset Street 1302 Williston Road in the City of South Burlington, Vermont. South Burlington VT 05403 Last Enforcement Seminar: 01/19/2012 ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Partnership Name Address Town/City State Zip Code Partner 1. Bushway, Richard 50 Barrett Street South Burlington VT 05403 Partner 2. Bushway, Karen 50 Barrett Street South Burlington VT 05403 Has any person been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? _Yes 1 No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any elective or appointive state, county, city, village or town office in Ver mat (See VSA, T.7, Ch.9, Sec. 223)? Yes v No If yes, please attach the following informa ion: Individual's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that theinformation in this application is true and complete. Dated this !� day of./-Cfa(2o f1-1 , a®f 1 Signet of autho open-. ignature of indi 1 or partners of corpo ub or ,sociation 6 ..1 ,t c_ 0c 'i'2 (Title) Are you making this application for the benefit of any other party? Yes No Continued on next page 2014 TOBACCO LICENSE RENEWAL APPLICATION 3919-001—TOBC-001 TOBACCO LICENSE TO SFTJ TOBACCO Page 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vejn&nit Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their reconuendation on • the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual con.nissioner registering either approval or disapproval. Lease or title moist be recorded in town or city before issuance of license. • APPROVED DISAPPROVED Approved by Board of Control Commissioners of r eeCity or Toian""of L7 JL./1 ,rrf Total Membership ` �PoClerk members present Att °"' r I' TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, 1Ma1 control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 ,I City of South Burlington ►5��. ! City Clerk's Office V°T` Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME \b/&10'10 P4, )D0'--)31°•i /1 ADDRESS / 7v5 1,O,Tii/ on , FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE e ,y). 16 ADP SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE PT 4 , Chief Doug as S. Brent D'ate� SO. BURLINGTON TAX DEPT 717 - 't . dket i/i) /ilk/ Martha Lyons, Deputy Tax collector Date sent to Montpelier: c-7 flnrcAt ctraPt Smith Rnrlinntnn 11T f1Ft1.f12 2f1?_24R_Q1f1F rlLinIfillonchnrl rnrn i i 2014 LIQUOR LICENSE RENEWAL APPLICATION 7102-001-1RST-001 • FIRST CLASS RESTAURANT/BAR LICENSE TO SFT,T MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which • License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Sportsgrill Entertainment Inc. Licensee # 7102- 1 Doing Business As: Vermont Sportsgrill Mailing Address: 1705 Williston Road 7 Saxon Hillow Drive South Burlington VP 05403 Essex Jct VT 05452 Telephone: (802) 860-2009 �b PLEASE INCLUDE EMAIL ADDRESS: ( �0- 401r- C.triN Description of Premises: Lessor: Restaurant in a single story brick building approx. 65x70 in size Gabriel G Handy located on teh south side of Williston Road designated as #1705 1/10 Colchester VT of a mile west of the intersection of Airport Parkway in the city of South Burlington VT Last Enforcement Seminar: 01/13/2012 Fed. ID Number: 27-0824932 Incorporation Date: 09/01/2009 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ' ATTACH AN ADDITIONAL+ SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code President 1. Murray, Jeffrey 464 Golf Course Road Williston VT 05495 Secretary 2. Trono, Todd 7 Saxon Hollow Drive Essex Jct VT 05452 Director 3. Murray, Jeffrey 464 Golf Course Road Williston VT 05495 • Director 4. Trono, Todd 7 Saxon Hollow Drive Essex Jct VT 05452 Has any director or stockholder been convicted or pleaded guilty to any cr 1 or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes If yes, please attach the following information: Individual's name, court/ affic bureau, offense and date In the past year has any director or'stockholdPr of the corporation held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? . Yes ktNo If yes, please attach the following information: Individual's name, office and'jurisdiction Vt. Dept. of Health Food License No.: 1157 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Roams Cert./Acct. No.: 440-270824932F-01 • Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Rnard may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes chip the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page ,-4'',I.; • C - -._.__.__m a#A Rk7E'Df -eS�S�' �Kt�wal�e=-�7Li�1a>mt !Ria �" • ICI`. — s# Y' a r sat I s � _ E .ry.4k-;•';',L.;. • T r.,_€sE Y1 , (4� , f E c:} s3 x } -y f ' : b F. CD a CD v. X a q ! f , ,,,07.7., .:14,4h, ,,,iiiiiitliHr,,,,,,:i. :::_4:01.,,,i0t,,_::::._‘....,:.:::,,,:; ,.._;:::::,,,,;:,,,i,:.;;!,,,,i.,,,,,,:::,74.:;;;.,,i,:;,r,,,.1,_:a.---#.7.-4.:,/,..:7-,-,3,..,:xir',_. '.,,,"-_-&-..,,,'7.:‘,--,s;;;?:!:-'',1:',1"‘'1,-'...7.;../..,i7;:;-:""'''.77---;:::r:7-.1::::N ii--':;:;f:?:'-'I':''''''''''.1:::;';''llt:::::''T:ijt('''''': I 4 ', ' 1 li ° 0 • ! '#tt max{ I (0 ci y '�/ • tVd �., CA col' a'L'. - 4,,,.....„_.,, ,,--; ..% s.. a) ,_.,.. 1:4-,er—oiii41„..3.-ii: 0.) J C; • ? ® � , CD CD a • .' �_ = _{� � % �� o 0 I rk P s Ei� #F= r iiisw *f. a _ F , �- 0 CD < 4'-':\n.* .--' CD ;r1.ye - -6,2 e ni , ., F T sit ,- -- i.c3,P"L rt � xz sar ,. .`"" 17°�5'�'zn^°,.rr^ar-..1 C... ass s.�"_ `' WS'S ta2t,,� Y"`#"'l,g .,. �;,� � . 2014 LIQUOR LICENSE RENEWAL APPLICATION 7102-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFLT. [ALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. • Dated this 1 3 day of 1:34.4f4 , 240 Signature of authorized agent Signature of individual or partners of corporation, company, club or association t.----pittO JebirteftcS (Title) /( Are you making this application for the benefit of any other party? Yes NNo Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of ity o. Town of.. .�U r/J Total Membership 5 members present Att st` �1 Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, lnral control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 igqCity of South Burlington City Clerk's Office Donna Kinville, City Y Clerk `.r0.°14b FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME IIVA &rale ADDRESS FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE ; ,)52 , 2e;)/4 SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON F DE T �3zs 4 Chief Douglas .Brent Dat SO. BURLINGTON TAX ,DEPT -(1/..76/1; 61.-- //TV-3 Martha Lyons, Dep ty Tax Collector Date sent to Montpelier: ono one Afl .11,:....;ll,./1,.L....1 ........ 2014 LIQUOR LICENSE RENEWAL APPLICATION 4040-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFTr MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Waterfront Yogurt & Sandwich Company Licensee # 4040- 1 Doing Business As: Waterfront Catering Group Mailing Address: ' 1712 Shelburne Road �n n_,,i ot � I / f�2 t South Burlington VT 05403 South Burlington V `+l Telephone: (802) 658-3663 VT 05403 PLEASE INCLUDE EMAIL ADDRESS: { Description of Premises: Lessor: A restaurant located on the fourth floor of a four story wood & brick Night Flight, Inc./Larkin Real building, approx. 3,200 sq.ft., located in the western most corner in 410 Shelburne Road the Holiday Inn Express hotel at 1712 Shelburne Road in the City of Burlington VT 05401 South Burlington, Vermont. Last Enforcement Seminar: 03/20/2013 Fed. ID Number: 03-0347641 Incorporation Date: 05/25/1995 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address ��ffyj//p� Town/City State Zip Code Director 1. Provost, Gary 20 %. dwin Avenue ocq South Burlington VT 05403 Director 2. Provost, Diane 20 :.'. ' Avenue South Burlington VT 05403 Stockholder 3. Provost, Gary 20 Bal. ' Avenue in(a d South Burlington VT 05403 Stockholder 4. Provost, Diane 20 Bal. Avenue "— mid fy South Burlington VT 05403 Has any director or stockholder been convicted or pleaded guilty to any cc)r^'�'m_�,o,�`'1 or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes V No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any electiv r appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 12006 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Roans Cert./Acct. No.: 104089 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full cmpliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 4040-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SETT MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. Dated this day ofe7 Signature of authorized agent Signature of individual or partners of corporation company, lub or asso iation (Title) Are you making this application for the benefit of any other party? Yes No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners o e City or Tcn . Total Membership , , members present Attest, ..j I eThwn. Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, lora1 control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 ,► �% City of South Burlington — . City Clerk's Office cEVO7E Donna Kinville, CityClerk � FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENANE -- --ii'ann D'iS ADDRESS -73g qi.)66/1 64-6---157ar4C , -----PU ( ECONDCLASS1ETdilliW DATE RECEIVED BY CLERK'S OFFICE SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT -le,___"--1-, v,„--e-,.., aticr Chief Douglas S. rent IJat SO. BURLINGTON TAX DEPT - 7, a--thei,e9Z. ' , -- /tY1.-- _, 2/1/11/itti Marth Lyons, Deputy Tax/Collector Date sent to Montpelier: (---_ 7i, y.*__r,1,6i,vvyrep �7F Ilnrcot CtrApt Cniith Rill linntnn 1/T f1Fdf1'; Rf19_2 1R_d1(1F d1'r ninon ehnrl rum 2014 LIQUOR LICENSE RENEWAL APPLICATION 1757-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFT.T MALT AND VINOUS BEVERAGES Page 1 License Year Beginning May 1, 2014 ending April 30, 2015 Fee: $2 3 0.0 0 of which $115.0 0 is paid to town/city $115.0 0 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Franny 0's Inc. Licensee # 1757- 1 Doing Easiness As: Franny 0's Mailing Address: 733 Queen City Park Road 733 Queen City Park Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 863-2909 1 PLEASE INCLUDE EMAIL ADDRESS: P I`b r tier) %® � QO 1 .earn Description of Premises: Lessor: 1st Class approx 1300sq ft in a one story building designated as Clark Hinsdale Jr. 733 Queen City Park Road, located west of Rt. 7 in the City of South 294 Winooski Ave. Burlington, VT. Burlington VT 05401 Last Enforcement Seminar: 01/31/2013 Fed. ID Number: 03-0332484 Incorporation Date: 02/07/1992 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Ye s ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. O'Brien, Francis 88 Nulty Road St. George VT 05495 Director 2. O'Brien, Barbara 88 Nulty Road St. George VT 05495 Stockholder 3. O'Brien, Francis 88 Nulty Road St. George VT 05495 Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes N(No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following information: Individual's name, office and jur4sdiction Vt. Dept. of Health Food License No.: 1277 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Roans Cert./Acct. No.: 95717 Disclosure of Non-profit Organization?: Yes XX No ALL"APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes die the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 1757-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SF i MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. Dated this _ day of Fe6ry totA , a 01 y Signature of authorized agent Signature of individual or partners of corporation, company, club or association (Title) Are you making this application for the benefit of any other party? - Yes )(No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of a e City or o Total Membership J members present Attest w nor.• "^ Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 2014 LIQUOR LICENSE RENEWAL APPLICATION 1757—0019 57-001—OUTC—Of OUTSIDE CONSUMPTION PERMIT .e 1 License Year Beginning May 1, 2014 ending April 30, 2015 Fee: -2 0.0 0 P. • tor • MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS ` FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Franny O's Inc. Licensee # 1757- 1 Doing Business As: Franny O's Mailing Address: 733 Queen City Park Road 733 Queen City Park Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 863-2909 55 PLEASE INCLUDE EMAIL ADDRESS: 4,00c. en %'z aQe)1 , G®M Description of the delineated area is as follows: Deck connected to the east side of the building, only accessed by the main building. 4' half wall on the other 3 sides. Year round use, with hours of 11:00 AM to 2:00 AM. All week long. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with re:, t to or in full cumplia.nce with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions tine to the Department of Employment and Training. I/We hereby certify that the information in this application is true and complete. Dated this J O day of , AO't} Signature of authorized agent11 Signature of individual or partners of corporation, carpany, club or association tire S (Title) Are you making this application for the benefit of any other party? Yes No MAKE CHECKS PAYABLE TO AND MAIL TO: VERMONT DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED 4 Approved by Board of Control Commissioners o' the City o Tom of . „ 3. Total Membership members present A • Clerk ' �, �/ City of South Burlington a City Clerks Office OTE Donna Kinville, City Clerk `110."14 FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME e) ADDRESS FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FI DEPT / t Chief Douglas S. rent at SO. BURLINGT N TAX DEPT -A9 Vt16/1/11-1( Marta Lyons, Deputy ax` Collector Date sent to Montpelier: F7F flnrcot Ctrcat Cm th Rurlinntnn \iT f ci1f1? QM_Rdfl_i11f1F It in iillo chi rl nnm 2014 LIQUOR LICENSE RENEWAL APPLICATION 7828-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SF.r,7 MALT AND VINOUS BEVELS Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 09065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Outback Steakhouse of Florida LLC Licensee # 7828- 1 Doing Business As: Outback Steakhouse (AKA) Franchini Mailing Address: 150 Dorset Street 2202 N.West Shore Blvd South Burlington VT 05403 5th floor Telephone: (802) 862-0003 Tampa FL 33607 PLEASE INCLUDE EMAIL ADDRESS: ii(et1SclItrmt1 c @ 0(.tibi . COvY\ Description of Premises: Lessor: Restaurant South East end of single story strip mall located Dorset Square Assc. East side of Dorset street designated as #150, 1/4 mile South of 30 Kimball Ave Suite 101 intersection of Williston Pd it city of South Burlington c/o Neville Companies Inc South Burlington VT 05403 Last Enforcement Seminar: 03/21/2012 Filed Articles of Organization: Yes Date Filed: 07/17/2007 Federal ID Number: 59-2848217 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. Kadow, Joseph 850 S. Newport Avenue Tampa FL 33606 Has any person been convicted or pleaded guilty to any criminal or for vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes T No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 12414 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Roans Cert./Acct. No.: 440-592848217F-01 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control pn2rd may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing.with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 7828-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SF11 MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. Dated this 21 day of_ r t4C4r' , 244 Signature of authorized agent Signature of individual or partners of corporation, c club or association VC U i' (Title) Are you making this application for the benefit of any other party? Yes No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each ihdivichial commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of e Cit o of c )• i�L 441 E Total Membership 5 members present ' ''Town Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312. ► */ City of SouthBurlington /IMP o City Clerk's Office "a:� Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME v ie- 0e1 ADDRESS GJv 1 1Dt r - L4F, FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE #. t/ e SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FI DEPT Chief Douglas S 'Brent Date SO. BU tL NGTOWAX DEPT —1-7���1 Ll q/,t( Martha Lyons, Deputy T `collector Date sent to Montpelier: oy* yr °DID. 575 Dorset Street South Burlinuton,VT 05403 802-846-4105 dkinville@sburl.com t 1 1 2014 LIQUOR LICENSE RENEWAL APPLICATION 4073-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFJJ MALT AND VINOUS BEVERAGES Page 1 License Year Beginning May 1, 2014 ending April 30, 2015 Fee: $1 1 5.0 0 of which $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Hart Hotels of Vermont, Incorporated Licensee # 4073- 1 Doing Business As: Green Mountain Suites Hotel Mailing Address: 401 Dorset Street 401 Dorset Street South Burlington VT 05403 South Burlington VT 05403 Tel PLEASEphone: 2 INCLUDE )EMAIL 1ADDRESS: d k0-i`tt- (9 11,a4--ko"f"2AS . C o 01 Description of Premises: Lessor: 1st Class in a one story wood frame building at 401 Dorset Street in Dorset Hote/Hart Land Company the city of South Burlington, Vermont. So. Burlington Vt Last Enforcement Seminar: 03/20/2013 Fed. ID Number: 03-0359487 Incorporation Date: 10/26/1998 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Deslauriers, Charles 60 Stockbridge Road Charlotte VT 05445 Director 2. Hart, David 39 Edgewater Drive Orchard Park NY 14127 Director 3. Scott, Christopher 401 Dorset Street S. Burlington VT 05401 Stockholder 4. Hart, David 39 Edgewater Drive Orchard Park NY 14127 Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes Nb If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any electi e or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes uz No If yes, please attach the following information: Individual's name, office and j isdiction Vt. Dept. of Health Food License No.: 11906 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Roans Cert./Acct. No.: 11102717 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 4073-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFi,T MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. Dated this o"l day of , 6;14L' Signature of authorized agen Signature of ' ••vidual or partners of corporation, company, club or association (Title) Are you making this application for the benefit of any other party? Yes No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully fret by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control B nrd, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners o e City or wn of . r)> Total Membership , members present t At , Town Clerk C,. TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 2014 LIQUOR LICENSE RENEWAL APPLICATION 4073-001—OUTC-001 OUTSIDE CONSUMPTION PERMIT Page 1 ' Fee: $20.00 License Year Beginning May 1, 2014 ending April 30, 2015 Paid to DLC MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Hart Hotels of Vermont, Incorporated Licensee # 4073- 1 Doing Business As: • Green Mountain Suites Hotel Mailing Address: 401 Dorset Street 401 Dorset Street South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 860-1212 PLEASE INCLUDE EMAIL ADDRESS: clkawte kra;if tli` ,rj ,Co vvv Description of the delineated area is as follows: A veranda/patio area that is off from the lobby area; The area is totally enclosed, from 5:00 p.m. to 8:00 p.m...Properly supervised. • I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full co pliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We hereby certify that the information in this application is true and cotmplete. Dated this 0, 1 day of -t , de/41 Signature • a . o a nt Signature of individual or partners of corporation, f'J association (Title) Are you making this application for the benefit of any other party? Yes Y No MAKE CHECKS PAYABLE TO AND MAIL TO: VERMONT DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license APPROVED DISAPPROVED • • Approved by Board of Control Commissioners of . - City o of 0. Total Membership .. , members present "� 1 t own Clerk '► / City of South Burlington OI�� City Clerk's Office 4,1 Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME v rr► ' �-yic& r ADDRESS 1LD A,Kiburri6 r . FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE 5ian, / , aD1L/' SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEP ,3 .2._,,h,f Chief Douglas S. Brent at SO. BURLINGTON TAX DEPT '-/ i(//ileZAL, ./.- Vt_ ),/1.7„J dz5hy Martha Lyons, Deputy ax Collector Date sent to Montpelier: /1° A°1'''''6 co 5.1 fnrcpt Street Cniith Riirlinntnn \IT flSAfl^, Rfl)_PLIP_AlrIF ( 2014 LIQUOR LICENSE RENEWAL APPLICATION 1742-001-SECN-001 SECOND CLASS LICENSE TO SF.T,r MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. • Applicant: Bourne-Meyer, Inc. Licensee # 1742- 1 Doing Business As: Bourne's Service Center Mailing Address: 760 Shelburne Road 760 Shelburne Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 658-6460 /� PLEASE INCLUDE EMAIL ADDRESS: 030y', , ff,or+V' .f c f Ct,1. t Description of Premises: Lessor: Grocery store, wood and cement structure, 2000 sq ft., on the first Gary Bourne floor of a building known as Bourne's Service Center, designated as 414 W. Grove Street 760 Shelburne Rd., in City of uth Burlington, VT. Middleboro MA Last Enforcement Seminar: 02{1 /2013 Fed. ID Number: 03-0319235 Incorporation Date: 03/01/1989 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Bourne, Rene 116 Lakeview Drive Williston VT 05495 Director 2. Meyer-Bourne, Sharon -y116 Lakeview Drive Williston VT 05495 Director 3. Bourne, Gary • 414 W. Grove Street Middleboro MA 02346 Stockholder 4. Bourne, Rene 116 Lakeview Drive Williston VT 05495 Has any director or stockholder been convicted or pleaded guilty to any crime or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective er appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes ✓No If yes, please attach the following information: name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes du., the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page State of Vermont Michael J.Hogan,Commissioner Department of Liquor Control 13 Green Mountain Drive,Drawer 20 [phone] 802-828-2339 Montpelier,VT 05620-4501 [fax] 802-828-1031 liquorcontrol.vermont.gov Please double check the following information on your renewal when received,'for accuracy. /1 4003 Seminar Date Corporation/ LLC/Partnership Changes (corp.name change,director changes,etc.) a Trade Name Info /Changes .- Lease Info/ Changes kOther Info /Changes (Federal ID Number,Outside Consumption Area,Payment of Fee,etc.) SEMINARS: Please check the seminar date on your renewal. If it has been 2 years since your last seminar, an owner, director or manager needs to attend a seminar. CORPORATION / LLC / PARTNERSHIPS: If you have had any changes to your Corporation, Partnership or LLC,please note on the renewal application and include documentation of the change (i.e. copies of changes filed with Secretary of State's office showing new information.) If you have added or removed a director, partner or member,please include minutes of the meeting where the change took place. We will also need info on any new directors (legal name,address,date of birth and place of birth) TRADE NAME: If you have changed your Trade name (d/b/a),we need a copy of the approved trade name from the Secretary of State's office, if you include a copy with your renewal application,this will speed up the renewal process. LEASE: If you have any changes in your lease, (either a new landlord or you purchased the property) we will need a copy of the new lease or title. OTHER INFO: Also just make sure to double check the renewal application for things like your Federal ID number,health number,outside consumption area,etc. and make any changes necessary,Also make sure your company check is attached for payment of your renewal fee. If you double check the renewal applications and attach copies or documentation for any changes, this can help to expedite the renewal process. Thank you. Liquor Control Board: Walter E.Freed,Chairman;John P.Cassarino,Member;Stephanie O'Brien,Member 2014 LIQUOR LICENSE RENEWAL APPLICATION 1742-001-SECN-001 SECOND CLASS LICENSE TO SFT.T MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the/VA" information in this application is true and complete. Dated this /b* day of0/ Signature of authorized agent Signature of individual or partners of corporation, c y, club or association • (Title) y Are you making this application for the benefit of any other party? Yes Ao Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully net by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual ccantissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED • Approved by Board of Control Commissioners of City o Town of L r � Total Membership members present Att .�, }� u1 ; 31 Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 ) 2014 TOBACCO LICENSE RENEWAL APPLICATION 1742-001—TOBC-001 TOBACCO LICENSE TO 5E17 TOBACCO Page 1 Optional Fee: $100.00 of which License Year Beg inning May 1, 2014 ending April 30, 2015 $0.0 0 is paid to town/city $100.00 is paid toDLC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Bourne-Meyer, Inc. Licensee # 1742- 1 Doing Business As: Bourne's Service Center Mailing Address: 760 Shelburne Road 760 Shelburne Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 658-6460 PLEASE INCLUDE EMAIL ADDRESS: itt,r,/,^,ito pofipr,"/cp ,,n LYf`/eAr Description of Premises: Lessor: Grocery store, wood and cement structure, 2000 sq ft., on the first Gary Bourne floor of a building known as Bourne's Service Center, designated as 414 W. Grove Street 760 Shelburne Rd., in City ofuth Burlington, VT. Middleboro MA Last Enforcement Seminar: /1 f2013 Fed. ID Number: 03-0319235 Incorporation Date: 03/01/1989 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Bourne, Rene 116 Lakeview Drive Williston VT 05495 Director 2. Meyer-Bourne, Sharon 116 Lakeview Drive Williston VT 05495 Director 3. Bourne, Gary 414 W. Grove Street Middleboro MA 02346 Stockholder 4. Bourne, Rene 116 Lakeview Drive Williston VT 05495 Has any director or stockholder been convicted or pleaded guilty to any crur motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes If yes, please attach the following information: Individial's name—court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective p appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes l/No If yes, please attach the following information: IndividiAl's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this application is true and complete. Dated this / day of CPeC/ ,p2 c2f Signature of authorized agent Signature of individual or partners of corporation, c y, club or association (Title) Are you making this application for the benefit of any other party? Yes A No Continued on next page 2014 TOBACCO LICENSE RENEWAL APPLICATION 1742-001-TOBC-001 TOBACCO LICENSE TO SF.T.T TOBACCO Page 2 • Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Tease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of we Cit or Town o 04 • Total Membership members present � C„ i Town Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city •ard of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 ,► oi, City of South Burlington 1. .00.;4 City Clerk's Office VOTEN9Donna Kinville, City Clerk Er FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME ..411 Oros �� ADDRESS 1 66 3 ;) o aL.--0 FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE ,C42, / f E-F SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DE 7:- C.c.,.. --2. .21 il Chief Douglas S. Breti`t D Y SO. BURLINGTON TAX D- l aA-1J14,.._ EP t✓Vi �° � y Marta Lyons, Deputy Tax Collector Date sent to Montpelier: zr DG^6® 575 IlnrcPt Ct rPPt Cnnth Pull linntnn VT nFfln4 R117_Raq_d1nF rILinvilloT7chnrl rum 2014 LIQUOR LICENSE RENEWAL APPLICATION 3423-009—SECN-001 SECOND CLASS LICENSE TO SFT.T MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Kinney Drugs, Inc. Licensee # 3423- 9 Doing Business As: Kinney Drugs #55 Mailing Address: 1653 Williston Road 1653 Williston Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 860-0714 PLEASE INCLUDE EMAIL ADDRESS: labor) e v\If G�1 e S( J/ Yl m t,(1(Il i`itg s eeKVI Description of Premises: Lessor: A drug/convenience store located in a one story cement and steel TKJ Properties, T.Tr building approximately 10,080 square feet in size, due east of the 5730 Thompson Road Ground Round Restaurant in the city of South Burlington, Vermont. DeWitt NY 13214 Last Enforcement Seminar: 03/07/2012 rujil ItAiv1/4 Ac lit,110/ Fed. ID Number: 03-0352444 Incorporation Date: 01/01/1928 Valid Charter?: Yes State of Charter: New York Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Robinson, Norman 66 Terrace Street Montpelier VT 05602 Director 2. McCoy, Stephen 6078 Hiller Drive Cicero NY 13039 Director 3. Painter, Craig P.O. Box 541 Carmel Valley CA 93924 Director 4. Aldan, -Bernard p cfJL UO' 2 d Greftsbuzy VT.=0 R& Stockholder 5. Kinney Drugs, Inc., 29 East Main St. Gouverneur NY 13642 Has any director or stockholder been convicted or pleaded guilty to any crimipBl or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any electi. r appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes V No If yes, please attach the following information: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Co:anissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions (chip to the Department of Ebployment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page UNANIMOUS WRITTEN CONSENT OF THE SOLE SHAREHOLDER OF KINNEY DRUGS,INC. The undersigned, being the sole shareholder of Kinney Drugs, Inc., a Vermont corporation (the "Corporation"),hereby adopts the following resolution in writing: RESOLVED, that Craig C. Painter, Stephen P. McCoy and Norman Robinson be elected Directors of this Corporation, to hold such offices until the next Annual Meeting of the Board of Directors of the Corporation and until their successors shall have been duly elected and shall have qualified. KINNEY DRUGS, INC. By: Jefoiaie4,---,-- Craig Cnter Dated: April 25, 2013 2014 LIQUOR LICENSE RENEWAL APPLICATION 3423-009-SECN-001 SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES ?age 2 I/We hereby certify that the information in this application is true and complete. Dated this day of reAT114-0.AA1 a�� Signature of authorized agent Signature of individual or partners of corporation, company, club or association (Title) Are you making this application for the benefit of any other party? Yes o Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of ei T of Total Membership 5 , members present C. , Town Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 2014 TOBACCO LICENSE RENEWAL APPLICATION 3 4 2 3—0 0 9—TOBC—0 01 TOBACCO LICENSE TO SFTJ TOBACCO Page 1 Optional Fee: $100.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $0.0 0 is paid to town/city $100.00 is paid to DLC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Kinney Drugs, Inc. Licensee # 3423- 9 Doing Business As: Kinney Drugs #55 Mailing Address: 1653 Williston Road 1653 Williston Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 860-0714 PLEASE INCLUDE EMAIL ADDRESS: ittlAyi e of P ekeS(E 1j) ti N t y (1A IA9'$ Description of Premises: Lessor: A drug/convenience store located in a one story cement and steel TKJ Properties, LLC building approximately 10,080 square feet in size, due east of the 5730 Thomson Road Ground Round Restaurant in the city of South�- Burlington, Vermont. DeWitt NY 13214 i" Last Enforcement Seminar: 03/07/2012 War. A41-.L 1C1A I Fed. ID Number: 03-0352444 Incorporation Date: 01/01/192g � Valid Charter?: Yes State of Charter: New York Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Robinson, Norman 66 Terrace Street Montpelier VT 05602 Director 2. McCoy, Stephen 6078 Hiller Drive Cicero NY 13039 Director 3. Painter, CraigJ ^ P.O. Box 541 Cannel Valley CA 93924 Director 4. p1 den, 2arnard A^^�ID V1 2233 Coi l;no n>h e Road Qrttftabury •VT 05826 • Stockholder 5. Kinney Drugs, Inc., 29 East Main St. Gouverneur NY 13642 Has any director or stockholder been convicted or pleaded guilty to any criminjel or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any electivyor appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes ��,.//No If yes, please attach the following information: Individual's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes rhea the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with • respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this applicationu is true and complete. Dated this i day of �{ {Gila./ , c20 I Signature of authorized agent// Signature of individual or partners �yy� of corporation,j� (� company, club or association r 'I I AC�.A�J 1�1 / te./-3 P of-Evict,skt.t,ej PI (Title) Are you making this application for the benefit of any other party? Yes o Continued on next page 2014 TOBACCO LICENSE RENEWAL APPLICATION 3423-009—TOBC-001 TOBACCO LICENSE TO SFrr TOBACCO Page 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Beard for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED • Approved by Board of Control Commissioners of I e City or own of Total Membership members present Att st wn Clerk 11, TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control ccmmissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city heard of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 ,411 �, City of South Burlington City Clerk's Office Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME Ck.)4/1CYL )-e. ir.iiis ADDRESS 149illi -Dri.„-di, iD FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE / SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT .� . . �:�.c -3/2j ft/ Chief Douglas S. Brent Dat J SO. BURLINGTON TAX DEPT / /! Martha q,yons, Deputy Tax Collector Date sent to Montpelier: . ,.. ... .,... .. E f 2014 LIQUOR LICENSE RENEWAL APPLICATION 6798-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFTT MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Charlie's on Fire, LLC Licensee # 6798- 1 Doing Business As: Charlie's on Fire, LLC Mailing Address: 1160 Williston Road 1160 Williston Road S. Burlington VT 05403 S. Burlington VT 05403 Telephone: (802) 862-1211 PLEASE INCLUDE EMAIL ADDRESS: "t(A4 () C �y(\ Q J}-,. cJo\ Description of Premises: Lessor: Restaurant in a single story strip mall on the north side of Williston Precourt Investment Co. • Road designated as #1160 unit #2, 1/4 mile east of I89 off ramp in Shelburne VT 05482 the city-of South Burlington, VT Last Enforcement Seminar: 09/21/2011 —'> V'l l tD! ' U`� Filed Articles of Organization: Yes Date Filed: 02/14/2000 Federal ID Number: 03-0365684 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Cam:any Name Address Town/City State Zip Cola Member 1. Kinstantonis, Taso M2 Stonehedge Dr S. Burlington VT 05403 Member 2. Intini, Lori S M2 Stonehedge Drive S. Burlington VT 05403 Member 3. Farmer, Patricia M 7 Stonehedge Drive S. Burlington VT 05403 Member 4. Fisher, David 25 Pheasant Way S. Burlington VT 05403 Member 5. Hudson, Dennis N9 Stonehedge Dr S. Burlington VT 05403 Has any person been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes x No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes XNo If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 12416 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Roans Cert./Acct. No.: 440-030365684E-01 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page k 5 --., l g. r-.—.'i...._1',-.!.1AV'-.t.'..-".l—.'.,,'- -j-.i-., ,erg es1F iw 1su uksfesSi4{ it-seuift. esaasrs� mansslss 4t¢ �f i- 4 •1ts { _ .- is S C W 14- +s..I `C "(f n U.) U :r- ,1:::::,::::::;1,:',',. Z" I zrr' 4 ss Q .F.r N Cv g. -- . ''4 Ci CO -c N o 3 I# . a ._. c� l ` 0 o r. `y, Q _a n W .4 i 0 N r ,vim t r`, t f 4'v' Li.. ; J } 44�t6' k •iI C C Q F co `' >c .c o .� -f C r I s a : NL ,€ `; g1 `- W a) � jq f o U) z • fl _ .• w 11•14,„-;,:t . g °?` � .. te _ ».... '� Y* ' 2014 LIQUOR LICENSE RENEWAL APPLICATION 6798-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SRT,T,MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. Dated this i`}� day of Apo]. Signature of authorized agent Signature of individual or partners of corporation, company, club or association (Title) Are you making this application for the benefit of any other party? Yes No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED t Approved by Board of Control Commissioners of . e City y o• Town of .r-� � '1J /` 41,v Total Membership members present A } s , ,� wn Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 % City of South Burlington ®• City Clerk's Office " i, Donna Kin villa, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME anrmFoi- ne.' droT ADDRESS i D r j-‘. 4 FIRST CLASS SECOND CLASS ) CABARET DATE RECEIVED BY CLERK'S OFFICE /ii5 ea®/ il SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE D , je/.2.44/fp Chief Douglas S, Bret :r1 Dat SO. BURLINGTON TAX DEPT /l � j Marth Lyons, Deputy ut Y J Tax collector Date sent to Montpelier: 74° C/ azco C-!C Il,......♦ Q+.....♦ C.. +1. 0 I:..,.4,... NT ncAn0 onn 0AC n 1nC 2014 FIRST/SECOND CLASS LIQUOR LICENSE AND TOBACCO APPLICATION LICENSE YEAR IS MAY 1ST THROUGH APRIL 30TH OF THE FOLLOWING YEAR Martin's Foods of South Burlington, LLC Print Full Name of Person,Partnership,Corporation,Club or LLC Hannaford Food&Drug Superstore Doing Business As-Trade Name 217 Dorset Street,University Mall Street and street number of premises covered by this application South Burlington,VT 05403 Town or City&Zip Code 802-863-63ll Telephone Number P.O.Box 1000,Attn:Jane Goulet,Portland,ME 04104 Mailing Address(if different from above) Email address: Jane.Goulet(adelhaize.com FEES: FIRST CLASS LICENSE-$115.00 to DLC and$115.00 to Town/City Please circle appropriate categories SECOND CLASS LICENSE-$70.00 to DLC and$70.00 to Town/City FIRST CLASS SECOND CLASS TOBACCO Restaurant TOBACCO LICENSE-(there is no fee for tobacco if applying for Hotel second class) Club If applying for Tobacco only license please use the Tobacco Only form.Fee for this license is$100.00 payable to DLC Commercial Kitchen(a Liquor Control Commercial Caterer's License is needed with this license) TO THE CONTROL COMMISSIONERS OF THE TOWN/CITY OF SOUTH BURLINGTON VERMONT Application is hereby made for a license to sell malt and vinous beverages under and in accordance with Title 7,Vermont Statutes Annotated,as amended,and certify that all statements,information and answers to questions herein contained are true; and in consideration of such license being granted do promise and agree to comply with all local and state laws;and to comply with all regulations made and promulgated by the liquor Control Board.Upon hearing,the Liquor Control Board may,in its discretion,suspend or revoke such license whenever it may determine that the law or any regulations of the Liquor Control Board have been violated,or that any statement,information or answers herein contained are false. MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE,AFTER NOTICE AND HEARING. If this premise was previously licensed,indicate name:Martin's Foods of South Burlington,Inc. I/we are applying as: (please circle one) • INDIVIDUAL LIMITED LIABILITY COMPANY PARTNERSHIP CORPORATION Please fill in name and address of individual,partners,directors or members. LEGAL NAME STREET/CITY/STATE PLEASE SEE ATTACHED SHEET. Are all of the above citizens of the UNITED STATES? Yes Ida (Note:Resident Alien is not considered a U.S.Citizen) If naturalized citizen please complete the following:N/A Name Court where naturalized(City/State/Zip) Date CORPORATE INFORMATION: N/A. If you have checked the box marked CORPORATION,please fill out this information for stockholders(attach sheet if necessary). LEGAL NAME STREET/CITY/STATE Date of incorporation Is corporate charter now valid? Corporate Federal Identification Number Have you registered your corporation and/or trade name with the Town/City Clerkrind/or Secretary of State?_ (as required by VSA Title 11 1621,1623&1625). ALL APPLICANTS HAVE ANY OF THE APPLICANTS EVER BEEN CONVICTED OR PLED GUILTY TO ANY CRIMINAL OR MOTOR VEHICLE OFFENSE IN ANY COURT OF LAW(INCLUDING TRAFFIC TICKETS)AT ANY TIME? x YES NO If yes,Name please complete the following information:(attached sheet if necessary)N/A Court/Traffic Bureau Offense Date ecre',1,-Y -Ntylort &fur' yvutko-v--p o Do any of the applicants hold any elective or appointive state,county,city,village/town office in Vermont?(See VSA,T.7,Ch.9,1223)k ES NO. If yes,please complete the following information: Name Office Jurisdiction Please give name,title and date attended of manager,director,partner or individual who has attended a Liquor Control licensee Education Seminar,as required by Education Regulation No.3: NAME:Stuart J.Bird TITLE:Mgr. DATE:9/11/12 (If you have not attended an Education Seminar prior to making application,please visit www.liquorcontroLvermontgov and click on Seminar Schedule for a list of Seminars in your area) FOR ALL APPLICANTS:DESCRIPTION/LOCATION OF PREMISES(Section 4) Description of the premises to be licensed:A supermarket in a one story steel and cement block building in the University Mall Shopping Center, Dorset Street,in the City of South Burlington,VT. Does applicant own the premises described?_NO_If not owned,does applicant lease the premises?YES If leased,name and address of lessor who holds title to property:University Mall Realty Trust,3 Burlington Woods Drive,Burlington,MA 01803 Are you making this application for the benefit of any other party? NO FIRST CLASS APPLICANTS ONLY:No first class license may be issued without the following information. HEALTH LICENSE#: Food Lodging (if licensed as a Hotel) VERMONT TAX DEPARTMENT:Meals&Rooms Certificate/Business Account# 03-0222879 Business is devoted primarily to:(Circle one) FOOD(restaurant)HOTEL CLUB COMMERCIAL CATERING BAR If you are considering Outside Consumption service on decks,porches,cabanas,etc.you must complete an Outside Consumption Permit.This form can be found on our website at www.liquorcontroLvermontgov and then click on licensing and then forms. ALL APPLICANTS MUST COMPLETE AND SIGN BELOW The applicant(s)understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal repositories prior to acting on this application. I/We hereby certify,under pains and penalties of perjury,that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application.(VSA,Title 32,43113). Please complete and include with your tobacco license application Please fill in forindividual,Partners,orDirectors Martin's Foods of South Burlington, LLC Tax #03-0222879 Applicantis Personal Information OFFICERS AND DIRECTORS NAMEMTLEISSii HOME ADDRESS BUSINESS ADDRESS DATE OF BIRTH PLACE OF BIRTH Bradford A.:Wise 3 Scroggie Way 145 Pleasant Hill Road 09-05-62. Waterville,ME President&Director Gorham,ME 04038 • Scarborough,ME 04074 006-64-8058 • Robert J.Schools 17 Prosperity Lane 145 Pleasant Hill Road 06-24-57 Farmington,ME Vice President&Director Windham,ME 04062 Scarborough,ME 04074 006-58-4620 • ' Gregory M.Amoroso 215 North Pine Street 2110 Executive Drive 01-22-65 Portland,ME Treasurer Charlotte,-NC 28202 Salisbury,NC 28147 004-76-7748 -I Elting H.Smith 76,Field Road 145 Pleasant Hill Road 02-19-54 New York,NY• Assistant Secretary&Director Cumberland,ME 04021 Scarborough,ME 04074 113-38-9287 Patti M.Fletcher 6171 Gold Hill Road 2110 Executive Drive 0I-19-68 Concord,NC Assistant Treasurer Concord,NC 28025, Salisbury,NC 28147 _ 244-29-1891 Douglas C.Pierson ' 175 West'Shore Road Pierson,Wadhams,Quinn&Yates 02-11-32 Mount Clair,NJ • Secretary&Clerk Grand Isle,VT 05458 253 South Union St 526-42-2541 Burlington,VT 05401 . } In accordance with 21 VSA,81378(b)I/We certify,under pains and penalties of perjury,that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. • If applicant is applying as an individual I hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or am in full compliance with a plan to pay any and all child support payable under a support order.(VSA,Title 15,4795) Dated at Burlington,Vermont in the County of Chittenden and State of Vermont ,this 6`h day of January ,2014. Corporations/Clubs:Signature of Authorized Agent Individuals/Partners: (All partners must sign) Martin', ods of S th B on,LLC By: Douglas C. Pierson,Secretary TOWN/CITY APPROVAL/DISAPPROVAL Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended,have been fully met by the applicant,the commissioners will endorse their recommendation on the back of the applications and transmit both copies to the Liquor Control Board for suitable action thereon,before any license may be granted.For the information of the Liquor Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval.Lease or title must be recorded in town or city ttlar issuanc of licen . c1�Lay 1 C/ Vermont, ,2014. Town/City Date APPROVED DISAPPROVED Approved/Disapproved by Board of Control Commissioners of the City or Town(circle one)of Total Membership T I members present Attest, ;fit` �L4/v., +-�"-},Dd.i}.. ttk'.�{�, ? (�ity or Town Clerk) TOWN OR CITY CLERK SHALL MAIL ONE APPLICATION DIRECTLY TO THE DEPARTMENT OF LIQUOR CONTROL,13 Green Mountain Drive,Montpelier,VT 05602.If application is disapproved,local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class application shall be considered binding except as taken or made at an open public meeting VSA Title I 4312 SECTION 5111 AND 5121 OF THE INTERNAL REVENUE CODE OF 1954 REQUIRE EVERY RETAIL DEALER IN ALCOHOLIC BEVERAGES TO FILE A FORM ANNUALLY AND PAY A SPECIAL TAX IN CONNECTION WITH SUCH SALES ACTIVITY.FOR FURTHER INFORMATION,CONTACT: THE BUREAU OF ALCOHOL,TOBACCO&FIREARMS(Tm) (513)684-2979 DEPARTMENT OF THE TREASURY 550 MAIN STREET,CINCINNATI,OH 45202 NOTICE:All ne plications are investigated byttheEnforement and Licensing Division or to a pprovl/disappmval of the license by the Liquor Control Board. Please note teat process can take anyw ere m weeksto weeks to complete once Liquor controlreceives the application. • City of South Burlington . # 4 City Clerk's Office ve Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME 0 v/11 g CD. ,(1"CaerlD ADDRESS 1P33 DO ► 1114 ,O1 t 0 FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE c�ri , '®/ G5t/2/1k SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date - SO. BURLINGTON FIR DEPT ,) - Chief Douglas S. rent D e 111( SO. BURLINGTON�p TAXy DEPT / JJj - 7//il ti.!1✓ A Lam '. I /l� '\r"'-.,1. ,�� ;t Marhfr Lyons, Deputy Iax( Collector � ' rl t Date sent to Montpelier: 575 Dorset Street South Burlington,VT 05403 802-846-4105 dkinville©shurl.com 2014 LIQUOR LICENSE RENEWAL APPLICATION 7967-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SETT, MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Prime.Restaurants, LLC Licensee # 7967- 1 Doing Business As: Guild & Company Steakhouse Mailing Address: 1633 Williston Road 139 Bank Street South Burlington VT 05403 Burlington VT 05401 Telephone: (802) 999-1440 �G / (tk (v✓ PLEASE INCLUDE EMAIL ADDRESS: G( • Description of Premises: / Lessor: • Restaurant in a single story building with storage in the basement. Roostertail, Inc. Located on the west side of Williston Road, designated as #1633 in the P.O. Box 2252 city of South Burlington, Vermont. c/o Katherine Burns South Burlington VT 05403 Last Enforcement Seminar: 09/24/2012 Filed Articles of Organization: Yes Date Filed: 06/27/2011 Federal ID Number: 45-4929192 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. Downey, Robert 101 Henry Street Burlington VT 05401 Member 2. Sayler, Paul 88D Maple Street Burlington VT 05401 Member 3. Davis, Jed 19 Brigham Hill Road Essex Jct VT 05452 Has any person been convicted or pleaded guilty to any criminal or motol vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes 1io If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any ele e or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 15614 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Rooms Cert./Acct. No.: 440-454929192E-01 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full carpliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and'all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page STATE OF YERNIONT OFFICE OF SECRETARY OF STATE Certificate of Trade Name Registration I,James C. Condos,Vermont Secretary of State hereby certify that GUILD TAVERN was registered on January 22,2014 per copy attached. January 29,2014 Given under my hand and the seal of the State of Vermont, at Montpelier, the State Capital C. (',r,.oe., dil,„,.. James C. Condos Secretary of State h ade name expires 5 years from the date of registration/renewal ta :; 'i January 30, 2014 Ms. Donna Kinville City of South Burlington Ms. Kinville, We have changed the tradename of our restaurant at 1633 Williston Road, South Burlington. Previous Tradename: Guild &Company New Tradename: Guild Tavern This tradename change was official after I had completed and submitted the liquor license renewal forms to your office. Please find enclosed new Certificate of Trade Name Registration form for the business. There is no change to the LLC name -this remains "Prime Restaurants LLC",and there is no change to ownership. Please advise if any further action is required on my end to keep our renewals on schedule. Th k u Jed D vis 802-999-1440 jd0407@gmail.com Aka Tie ;� ' 2014 LIQUOR LICENSE RENEWAL APPLICATION 7967-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFiS MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. Z G Dated this \ day of , ,{r+) 20/ Signature of authorized agentnt tur of individual or partners of repo ation, ..,,,.. y, club or as ociatio Ti e) Are you making this application for the benefit of any other party? Yes 0U Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their reconmendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED s .. Approved by Board of Control Commissioners of ... lk.Z cJ�®! )� `t �;' • Total Membership members present C, Wkown Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control casnissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 u e City of South Burlington !I®® � City Clerk's Office IDonna nville, City�� Ki Y Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME ch � ,, ---rrAs ADDRESS it iii io `W; 11I 'dri -1 i FIRST CLASS (::- SECOND CLASTh CABARET DATE RECEIVED BY CLERK'S OFFICE r.'4f rJ , l t / i �l SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date - SO. BURLINGTON FIRE DEPT —(:"--- sivilli9( - Chief Douglas S. Brent D to SO. BURLINGTON TAX4ryj/Q -4( _ / /Ok Martha Lyons, Deputy x Collector Date sent to Montpelier: 0.,..+4. D II.,..+,... VT nCAnn on'1 OAC AInC 2014 LIQUOR LICENSE RENEWAL APPLICATION 6320-001-SECN-001 SECOND CLASS LICENSE TO SF7,T MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Maro, Inc. Licensee # 6320- 1 Doing Business As: Cheese Traders Mailing Address: 1186 Williston Road 1186 Williston Road Suite 200 Suite 200 South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 863-0143 �� PLEASE INCLUDE EMAIL ADDRESS: robed- ( che-e coders (A) Description of Premises: . Lessor: Store utilizing the basement and first floor of a one story wood Charles & Janet Perkins framed building occupying approximately 8,000 square feet and Burlington VT 05401 located on the North side of Williston Road, designated as 1186 Williston Road Suite 200, in the City of South Burlington, Vermont. Last Enforcement Seminar: 08/09/2013 Fed. ID Number: 20-8847353 Incorporation Date: 04/13/2007 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Bachofen, Robert H. 260 Village Glen Manchester VT 05254 Director 2. Bachofen, Luz Marina 260 Village Glen Manchester VT 05254 Dircotor 3. Alexander, Charlco P.O. Box 217 Shelburne VT 05482 re„cic:k// Diroctor 4. lllfaro Alexander, Ana Maria P.O. Box 217 Shelburne VT 05482 fegi Director 5. Samuelson, Matthew P.O. Box 1091 Manchester VT 05255 Stockholder 6. Bachofen, Robert H. 260 Village Glen Manchester VT 05254 Stockholder 7. Bachofen, Luz Marina 260 Village Glen Manchester VT 05254 Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mall) during the last year? Yes /No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes ✓No If yes, please attach the following information: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Rnard may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Comtissioner of-Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 6320-001-SECN-001 SECOND CLASS LICENSE TO SFT,T MALT AND VINCUS BEVERAGES Page 2 I/We hereby certifyyy�/ that the information in this application is true and complete. Dated this g/hJday of tcA+Lt7 , off Signature of authorized agent Signature of individual or partners of rpo 'on, company, club or association T VP( Tre fttr-er (Title) • Are you making this application for the benefit of any other party? Yes P/ No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. • APPROVED DISAPPROVED I pi Approved by Board of Control Commissioners of City o „Tpwn of y� Total Membership members present A . jy438an Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, lord control commissioners shall notify the applicant by letter. • No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 ,► �/ City of South Burlington eIs'.-,.+, City Clerk's Office ° S Donna Kinyille, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION C?\) DOING BUSINESS AS/ TRADENAME ... herfA-Dri,,A(61-rroy1-1- ,ore - ADDRESS ,, J ' 7D t0 1111 ,01'Z-� 4)G�iGC� an* SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE 44 ;J. l4 49\ . / SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIREr .mil- - irk1(1CA4 ,,,,,,_, - Chief Dou asfS. Br Da1re SO. BURLINGTON TAX DEP -----/ CL--(2tYLe /6)11/3 ,77//d/Y Martha Lyons, Deput Tax Collector Date sent to Montpelier: //1# 6400,J1elre6tkkt p 'rik F75 Mrc At .Ctrp Pt Cnnth RI rlinntnn 1!T ncan{ Rm_RAR_ainc rllrirmillonchnrl rnm 1 2014 LIQUOR LICENSE RENEWAL APPLICATION 3780-002-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFTJ MALT AND VINOUS BEVERAGES Page 1 License Year Beginning May 1, 2014 ending April 30, 2015 Fee: $1 1 5.0 0 of which $115.00 is paid to town/city $115.00 is paid toDLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. • Applicant: Sheraton Vermont Corporation Licensee # 3780- 2 Doing Business As: • Sheraton Vermont Corporation (c) Mailing Address: 870 Williston Road Valerie Hockert South Burlington VT 05403 870 Williston Road Telephone: (802) 865-6600 Souqh Bur gton VT 05403 PLEASE. INCLUDE EMAIL ADDRESS: 0 b ) �..l.-f ��11 i D ,LC ,--- Description of Premises: Lessor: A Cabaret located in a one story section of Sheraton Vermont hotel Felcor Suites Ltd. Partnership located in the city of South Burlington, Vermont. 545 E. John Carpenter Freeway Irving TX Last Enforcement Seminar: 10/08/2013 Fed. ID Number: 03-0355208 Incorporation Date: 11/12/1997 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR, Corporation Name Address Town/City State Zip Code Director 1. Dojlidko, Michael 315 East 72nd Street New York NY 10021 Director 2. Houghton, Kerry 37 Richmond Hill Road Irvington NY 10533 Director 3. Donat, Marshall 142 Lincoln Avenue Purchase NY 10577 Director 4. Creed, Jason 2624 East Spring Road Phoenix AZ 85032 Director 5. Halladay, Angela 503 Florida Street Orlando FL 32806 c+n..Yhn Ttt cam- - - lder 6 Cam- tit._'.c 6ELStaL Qtree+ �..�,.0 114-0iiv9- Has any director or stockholder been convicted or pleaded guilty to any cr�n'�m�,ra,�l or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes n No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes <No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Ebod License No.: 2326 Vt. Dept. of Health Lodging No.: 4885 Vt. Tax Dept. Meals & Roams Cert./Acct. No.: 440-030355208F-01 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from r State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 3780-002-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFLI%MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and camplete. Dated this \ day of f "/C'.J , (-16.1, Z 0\j' - Signature of authorized agent Signature of individual or partners of corporation, company, club or association 1�\ 4 `).J...-.G 1 v 1 (Title) Are you making this application for the benefit of any other party? Yes No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual cammissioner registering either approval or disapproval. Lease or title most be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners o e City Cr- . of V.+Y J' 8, F Total Membership 5 �t members present - - C Atiown Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 • 2014 LIQUOR LICENSE RENEWAL APPLICATION 3780-001-1HTL-001 FIRST CLASS HOTEL LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Sheraton Vermont Corporation Licensee # 3780- 1 Doing Business As: Sheraton Vermont Corporation Mailing Address: 870 Williston Road 870 Williston Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 865-6600 ((t 7 r -\ .�� , L. i PLEASE INCLUDE EMAIL ADDRESS: �\��-j,,�t Description of Premises: Lessor: 1st class in a four story vinyl clad block and concrete building being FelCor Suites Ltd. Partnership 250,000 square feet in size containing 2 restaurants, 2 lounges, pool 545 E. John Carpenter Express exhibition hall, conference and.ballrocros at 870 Williston Road in Suite 1300 the city of South Burlington, Vermont. Irving TX 75062 Last Enforce, nt Seminar: 10/08/2013 Fed. ID Number: 03-0355208 Incorporation Date: 11/12/1997 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Dojlidko, Michael 315 East 72nd Street New York NY 10021 Director 2. Houghton, Kerry 37 Richmond Hill Road Irvington NY 10533 Director 3. Donat, Marshall 142 Lincoln Avenue Purchase NY 10577 Director 4. Creed, Jason 2624 East Spring Road Phoenix AZ 85032 Director 5. Halladay, Angela 503 Florida Street Orlando FL 32806 +S.tockho -gestea L_Q2 nA Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes XXNo If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes �No If yes, please attach the following information: Individual's name, office and juris ction Vt. Dept. of Health Food License No.: 2326 Vt. Dept. of Health Lodging No.: 4885 Vt. Tax Dept. Meals & Roans Cert./Acct. No.: 440-030355208F-01 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information fran State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with reelect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registeLed the trade name of these premises with the Secretary of State. Continued on next page Corporations Division Page 1 of 1 -� a _7 AtIczago ti - l,_ l CgRPORACrONs'DI WsiON Back Business Information ---_--- --- —...— Business Details -_—._ Business Name: SHERATON VERMONT CORPORATION : 0117229 Business Type: Domestic Profit Corporation Business Status:Active Corporation Subtype: GENERAL Business Description: HOTELS/RESTAURANT Fisca Date of Incorporation/Registration Date: 11/12/1997 Principal Business Office Address: ONE STAR POINT,STAMFORD,CT,06902,USA Mailing Address: 15147 N SCOTTSDALE RD,SUITE H-210,SCOTTSDALE,AZ,8 Citizenship/State of Incorporation: DomesticNT Last Annual Report Year. 2012 I Principals Information Name/Tide: Business Address: MICHAEL DOJLIDKO President ONE STAR POINT,STAMFORD,CT,06902,USA ANGELA K HALLADAY Vice President 9002 SAN MARCO COURT,ORLANDO,FL,32819,USA KERRY HOUGHTON Vice President ONE STAR POINT,STAMFORD,CT,06902,USA _ _. View All Prir IRegistered Agent Information Name: CT CORPORATION SYSTEM Physical Address: 400 CORNERSTONE DR#240,WILLISTON,VT,05495,USA Mailing Address: 400 CORNERSTONE DR#240,WILLISTON,VT,05495,USA Trade Name Information Trade Name Business ID Business Status .` SHERATON BURLINGTON HOTEL&CONFERENCE CENTER 0196665 Inactive Back Filing History Name History Shares Return to Search • https://www.vtsosonline.com/onlineBusinessInquireBusinesslnformation?businesslD=11... 2/14/2014 f ---1 r -ii v ; .r 0 W �� Eo a�1) / 0 0 • -et -( a) a., a ©•pari a) ",,,,....j -,, \,....-:„-,,,, , • J. ,- Ct ' ) \ cr, to o N 'Et' Q, CID Z 63 •- ao can co) °' o o Z 0 6 a al on 0 a) 0 • Z cn Q U U m (/) rn W 1 2014 LIQUOR LICENSE RENEWAL P FIRST CLASS ROTEL LICENSE TO SELL MALT AND VINOUS BCE�N 3 7 8 0-0 O 1-1 HTL-0 e 1 I/We hereby certify that the in Page 2 formation in this Dated this \ n day of application is true and Clete. 1�+ � l �,il �� Signature of authorized agent —�� of cavany, club or association Signature of indi t)y 1 or partners (Title) Are you making this application for the benefit of any other party? yes No Upon being satisfied Statutes Annotated, that the conditions precedent to the license the back of the applicats ion and try been fully met bygranting of this may granted, transmit it the Liquor the applicant, the commissioners 11 ovided in Title 7 of the Vermont n individual For information of the to 9uor Control Board for suitable endorse commissioner theregistering either fluor Control Control. Board, table action their recaaiure ofon h issuance of license. all a thereon, before tense. approval or disapproval. applications any license approval, Lease or shall the signature each t title must be recorded intown° or city before DISAPPROVED r I To by Board of Control -- Commissioners of r J �— Sotal Membership� e City o of members present - s J TOWN OR CITY CLERK SHALL MAIL own Clerk DEPARTMENT OF LIQ OR CONTROLAPPRO�D RENEWAL DIRECTLY TO: 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If applition is disapproved local control cou nissianers shall notify the applicant by No formal action taken by any agency or authority second class license letter. application shall be consideredory of any town board of selectmen binding except tormad city board of aide p as taken or made at aldermen on a first or an open public meeting, USA T-1,Sec.312 4 City of South Burlington ®®® � City Clerk's Office VOT Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME '"Fe3)11"1 ADDRESS /DOI ,.... --eihorr-7Espiltd , FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE a0/4- SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT -3116-111 Chief Douglas rent Date SO. BURLINGTO TAX DEPT Martha Lyons, Deputy ax Collector Date sent to Montpelier: /°)" CGGD 575 Dnrset StrP.At Smith RiirGnntnn VT f1Uf1; Sfl7_RAR_A1f1F r leinv Ilan^hurl porn • 2014 LIQUOR LICENSE RENEWAL APPLICATION 2396-032—SECN-001 SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Wesco, Inc. Licensee # 2396- 32 Doing Business Ps: Champlain Farms Mailing Address: 1041 Shelburne Road 32 San Remo Drive South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 864-0157 PLEASE INCLUDE EMAIL ADDRESS: f")(tPC e.1 t (e CA\(IXV1 `n�Ct 1,� � V y S C C> v� Description of Premises: i Lessor: Store in a one story brick and wood framed building being Wesco Corp. approximately 500 square feet in size and located on the West side of South Burlington VT 05403 Shelburne Road, designated as 1041 Shelburne Road, in the City of South Burlington, Vermont. Last Enforcement Seminar: 09/27/2013 Fed. ID Number: 03-0273319 Incorporation Date: 09/21/1979 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Simendinger, David 88 Calloway Drive Williston VT 05495 Director 2. Simidinger, William 12 Whiteface Street S Burlington VT 05403 Director 3. Simendinger, Joann 43 Summit Ridge Williston VT 05495 Stockholder 4. Simendinger, David 88 Calloway Drive Williston VT 05495 Stockholder 5. Simendinger, William 12 Whiteface Street S Burlington VT 05403 Stockholder 6. Simendinger, Joann 43 Summit Ridge Williston VT 05495 Has any director or stockholder been convicted or pleaded guilty to any crimio1 or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes ✓No If yes, please attach the following information: •Individual's ice, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective pr appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes t If yes, please attach the following information: Indivirb,si's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VIA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full cliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page Health License Expires December 31, 2014 L 2014 LIQUOR LICENSE RENEWAL APPLICATION 2396-032-SECN-001 SECOND CLASS LICENSE TO SETT,MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the\\ information in this application is true and complete. Dated this \ J1 day of OCVA.A , a.)0 Si of authori ed agent Signature of individual or partners of co ration, c y,'cl or as i tion VT-- Up�500, \V'C_ Wp,Sj (Title) Are you making this application for the benefit of any other party? Yes No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED • Approved by Board of Control Commissioners • of Total Membership 5 , members present s141 a I ,''down Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 2014 TOBACCO LICENSE RENEWAL APPLICATION 2396-032-TOBC-001 TOBACCO LICENSE TO SFia TOBACCO Page 1 Optional Fee: $100.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $0.0 0 is paid to town/city $100.00 is paid to DLC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Wesco, Inc. Licensee # 2396- 32 Doing Business As: Champlain Farms Mailing Address: 1041 Shelburne Road 32 San Remo Drive South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 864-0157 PLEASE INCLUDE EMAIL ADDRESS: „SdQC('t 1(aC 0\ S LvNEVN Description of Premises: • Lessor: Store in a one story brick and wood framed building being Wesco Corp. approximately 500 square feet in size and located on the West side of South Burlington VT 05403 Shelburne Road, designated as 1041 Shelburne Road, in the City of South Burlington, Vermont. Last Enforcement Seminar: 09/27/2013 Fed. ID Number: 03-0273319 Incorporation Date: 09/21/1979 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH'AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Simendinger, David 88 Calloway Drive Williston VT 05495 Director 2. Simendinger, William 12 Whiteface Street S Burlington VT 05403 Director 3. Simendinger, Joann 43 Summit Ridge Williston VT 05495 Stockholder 4. Simendinger, David 88 Calloway Drive Williston VT 05495 Stockholder 5. Simendinger, William 12 Whiteface Street S Burlington VT 05403 Stockholder 6. Simendinger, Joann 43 Summit Ridge Williston VT 05495 Has any director or stockholder been convicted or pleaded guilty to any crim T or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes VNo If yes, please attach the following information: Individnal's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective er appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes ✓No If yes, please attach the following information: Individual's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Coamissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 TOBACCO LICENSE RENEWAL APPLICATION 2396-032-TOBC-001 TOBACCO LICENSE TO SFTT TOBACCO Page 2 I/We hereby certify that the information in this application is true and complete. Dated this , day of , -bF'-11-` ignature autho iz gem of co a Signature of individual or partners 'on, c y, ub ass ion Vti0 S rv..12,Yl yc t S C OJ A L 1V 'f P.Si C_USLs'1 V (Title) Are you making this application for the benefit of any other party? _Yes LLNo Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each indivirkial commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED I Approved by Board of Control Commissioners of - City o, Town o f Total Membership C5 members present A test C* Pbwn Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 At ►` �/ City of South Burlington ®' ' City Clerk's Office VOTE Donna Kin ville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSIINESS AS/ TRADENANE ADDRESS /ADD a>r DY 4SWSECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE 5.,11, ,��� D/ SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEP Chief Douglas S. Bren Da e SO. BURLINGTON TAX DEPT -771KiTYlte, MarthLyons, Deputy Tam- Collector Date sent to Montpelier: F7F llnrcnt Ctroot Cnnth Rinrlinntnr, \IT ncAna Rn9_RAR_A1nF rlLinullln(nlchnrl nnt., 2014 LIQUOR LICENSE RENEWAL APPLICATION 8056-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SF:T,T MALT AND VINOUS BEVERAGES Page 1 • Fee: $230.00 of which • License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Skinny Pancake Airport,The, LLC Licensee # 8056- 1 Doing Business As: Skinny Pancake Mailing Address: 1200 Airport Dr 88 Oak St So. Burlington VT 05463 Burlington VT 05401 Telephone: (802) 598-3028 PLEASE INCLUDE EMAIL ADDRESS: ' pC1 `\ l t r(v Lt. . Description of Premises: Lessor: Restaurant 3 separate locations within the Burlington Int. Airport one Burlington Int Airport in the main concourse one in the south terminal and one in the North So Burlington VT terninal(see more detailed descrip in file) Located on the east side of airport rd designated as #1200 in city of So.Burlington Last Enforcement Seminar: 10/15/2013 Filed Articles of Organization: Yes Date Filed: 09/24/2012 Federal ID Number: 38-3888214 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. Adler, Benjamin F. 28 Crambie Street Burlington VT 05401 Member 2. Adler, Jonathan 195 Howard Street Burlington VT 05401 Has any person been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any ele ive or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)7 Yes }4No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 15754 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Roans Cert./Acct. No.: 440-383888214f-01 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pairs and penalties of perjury, treat I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 8056-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SF7.T, MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. Dated this day of��j,at ` , ZL y Signature of authorized agent Signature of individual or partners of corporation,F y, club ociation V`YJ9 er (Title) Are you making this application for the benefit of any other party? Yes $ No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont • Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. • APPROVED DISAPPROVED Approved by Board of Control Commissioners . J own of D. 0 V B' I� 1i� d Total Membership members present cotes; ,,mow ,„ '=,:-...,,,,,, .:.--"y, ;' 1 CAlliglkown Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 � 4) City of SouthBurlington O40 i40 ;. City Clerk's Office "Er*_ Donna Kin villa, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME lJ read d) . ADDRESS FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE r , 30.1 J . SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE D Chief Douglas S. Bre Date SO. BURLINGTON TAX DEPT IfCA r �a � (1J /:// kt tha Lyons, Deputy Tax Collector Date sent to Montpelier: F7F RnrcPt CtrPPt Cnuth Rurlinntnn 1/T f1Fdf1? Rl7_R[iR_d1fc rILin,rilIolachrirl rnm 2014 LIQUOR LICENSE RENEWAL APPLICATION 2606-001-SECN-001 SECOND CLASS LICENSE TO SFPT MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $7 0.0 0 is paid to town/city $70.00 is paid to DEC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Klinger's Bread Company Licensee # 2606- 1 Doing Business As: • Klinger's Bread Company Mailing Address: '10 Farrell Street 10 Farrell Street South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 860-6322 • PLEASE INCLUDE EMAIL ADDRESS: G�CrJ%/L� R� /• cam, Description of Premises: Lessor: A grocery store located in a one story steel structure, approximately The Davis Company 3500 square feet on the corner of Swift and Farrell Street and 431 Pine Street designated as 10 Farrell Street in the city of South Burlington Burlington Vt 05403 Vermont. Last Enforcement Seminar: 02/13/2012 Fed. ID Number: 03-0338032 Incorporation Date: 05/10/1993 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Klingebiel, David 319 Bunker Hill Rd Salem NY 12865 Director 2. Klingebiel, Judith 319 Bunker Hill Rd Salem NY Director 3. Klingebiel, Edward R. 423 Highlands Drive Williston VT 05495 Director 4. Klingebiel, Cheryle 423 Highlands Drive Williston VT 05495 Director 5. Staub, Sandra 831 Middlewood Road Williston VT 05495 Stockholder 6. Klingebiel, Edward R. 423 Highlands Drive Williston ' VT 05495 Stockholder 7. Klingebiel, David 319 Bunker Hill Rd Salem NY 12865 Stockholder 8. Klingebiel, Judith 319 Bunker Hill Rd Salem NY Has any director or stockholder been convicted or pleaded guilty to any crimil or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any electives appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes no If yes, please attach the following information: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes }4C No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 2606-001-SECN-001 SECOND CLASS LICENSE TO SFTT MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the ormation in this application is true and complete. Dated this pq i day ofu jj , .t-a/ Signature of authorized agent Signature of individual or partners .• of corporation, company, club or association // J 1 1 Y L (Title) Are you making this application for the benefit of any other party? Yes i... Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Pna rd, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title mast be recorded in town or city before issuance of license. APPROVED DISAPPROVED .../ " Approved by Board of Control Commissioners of -.e City o • of Total Membership '�J masters present ` ` s'"' 1 C'crown Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 a *% City of South Burlington ►••fAii City Clerk's Office "Q Donna Kinyille, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME b 4 6&Tt Vrb ADDRESS W . 6)bUrel/fel ''6I * FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE , A.6 1 „WIZ/. SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEP /,' r / tP i ifChief Douglas S. Bren Date t SO. BURLINGTON TAX DEPT ---7rxt ---7‘;//,/ '1‘s-Yri N('D 1671/11( 74 Martha Lyons, Deput Tax Collector Date sent to Montpelier: 575 Dorset Street South Burlinoton.VT 05403 802-246-4105 rikinviilnOshiirl cr,m 2014 LIQUOR LICENSE RENEWAL APPLICATION 8205-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFr,T,MALT AND VINCJS BEVERAGES Page 1 Fee: $1 1 5.0 0 is which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: VT Koto, Inc Licensee # 8205- 1 Doing Business As: Koto Restaurant Mailing Address: 792 Shelburne Road 792 Shelburne Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) P,+ CO PLEASE INCLUDE EMAIL ADDRESS: i(l�d �.G�1,b Description of Premises: Lessor: Restaurant in a single story building located on the East Side of Mountain Handy Trust Shelburne Road designated as #792 just South of the I89 on ramp on the South Burlington VT city of South Burlington, VT. Last Enforcement Seminar: 12/13/2012 Fed. ID Number: 45-4694470 Incorporation Date: 02/23/2012 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Zhang, David 29 Vale Drive South Burlington VT 05403 Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes X No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elect've or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 547 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Roans Cert./Acct. No.: 440-454694470E-01 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support • order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 1 '_ li 3 �y S yY. i F.-iR,i#SA v.iii■ii-hire-4RYS.,,,.S5£§RT11 ,, tt.�!! f.S.Y>C!:.x �3"erS` •.s.za:': k'€t arR. 48 +»:R&i9t92zF a'e �t i, ni i -44' x< 1/ . [ ;. 2 rn 1_ 44 * CD .} . e mill .1a. —I ammi ,'0, '''-'?i,i'...'..-it'' 0 D = l'if €+- [ CD to d r i i4 CD Ommia .:« CI) vs ',, ,. . j 0rn ;. x -, x �U/)� �h w �/, 0_ N 3 ,a ) y W 3 ,,yy W r- r ,-.1. VI N 1.,. A ffi .t 0 i 7is 4F> 1 , fff' f - 3 m a c 3 A{ rn ?y+ =� �' ; r -' O z } ti y > ---J'f : a a ,, t gym. - E+t- a r - 'YY . d - . � ` 2� 1" " > ,r y �?, F -U , ..-4, T 3 � a: y 4ir h. '`u' y .Nt .,. Y 2014 LIQUOR LICENSE RENEWAL APPLICATION 8205-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFTT MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. Dated this CA" day of Februar`7 . 2Q11/ Signature of authorized agent Signature of individual or partners of corporation, club or association 51,7 au) ,aria/ ?(es/Alt (Dirt char (Title Are you making this application for the benefit of any other party? Yes )(No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Boardot of Control Commissioners of •- City o 7dY*m G Total Membership �.J , members present Att -�� '¢, �«._ �.>n. 21.445. Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 ..4 .► City of South Burlington o�®*0 City Clerk's Office V 0 El*" Donna Kinyille, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME ADDRESS i1171ii / 0171 4 SECOND CLASS CABARET ----4 ;1 DATE RECEIVED BY CLERK'S OFFICE �. SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT 31141tf Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT I 1 - 3/ Deputyollector.Martha Lyons, Ta Date sent to Montpelier: 575 Dorset Street Smith Rnrlinntnn VT n540; 2f17-24A-41f15 rlkinvillanshnrl rnm 9 6K tdo2q 0t '15' 2014 LIQUOR LICENSE RENEWAL APPLICATION 6435-001-1HTL-001 FIRST CLASS HOTEL LICENSE TO SFLL MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid toDLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. 15 1,,Y 1 Applicant: Rich Burlington Hotel, TIC Licensee # 6435- 1 Doing Business As: Doubletree Hotel Burlington Mailing Address: it/7 1)j/e /) D 1117 Williston Road 1752-it Route-2 /(' ��c�(` South Burlington VT 05403 Wate y 6 76 Ji .4.4 4i • ./^( �'F6r� ( o S 0 � Telephone: (802) 6M 8IL 50 vl ��� j j � y� • pT.F.ACE INCLUDE EMAIL ADDRESS: AI/� rs,�()[p /Q,Q w Description of Premises: Lessor: Hotel in a two story brick faced stell and cement black building with Rich Burlington Hotel, LLC two levels of guest roans totaling 161 roans. Includes attached rest. 1117 Williston Road of approx. 2000 so ft attached banquet roars of approx 4700 sq ft and South Burlington VT 05403 courtyard area of approx 1000 sq fL. Last Enforcement Seminar: 10/01/2013 Filed Articles of Organization: Yes Date Filed: 07/11/2007 Federal ID Number: 20-8716341 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. RBH-VT, TIC, 1752 US Rte 2 Waterbury VT 05676 Member 2. RBH-Mezz, LLC, 1752 US Route 2 Waterbury VT 05676 7600 East Orchard Road Member 3. RBH-DEL, LLC, Suite 230 South Greenwood Village CO 80111 Member 4. Goodman, David M 1752 US Route 2 Waterbury VT 05676 Has any person been convicted or pleaded guilty to any criminal or moor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes moor If yes, please attach the following information: Individiia1's name, court/traffic bureau, offense and date In the past year has any person held any ive or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following info1..; titon: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 656 Vt. Dept. of Health Lodging No.: 4266 Vt. Tax Dept. Meals & Roams Cert./Acct. No.: 440260547202E01 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full • compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page • • CERTIFICATE of ACHIEVEMENT This is to certify that David Goodman has completed the course Server Training - 1st class Seminar Certification January 29,2014 2014 LIQUOR LICENSE RENEWAL APPLICATION 6435-001-1HTL-001 FIRST CLASS HOTEL LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in thist��application� is true and complete. Dated this !!t T day of ,/ n J} , Off'/(f Signature of auth.rized agent Signature of individual or partners of tion, . .,-. , club or association G.,11rQ/j. Med,r4j- (Title) y( Are you making this application for the benefit of any other party? Yes '\ No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Boardrd of Control Commissioners of Town D. Ai • Total Membership ✓ , members present At '"' ; " Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 • • .;T:--..eVrWPAT • • !A City of South Burlington off®® ! City Clerk's Office Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME 6 Iiburr Varei4 Z-Z-C.,, ADDRESS /4161 ,g xibory-)E,' f FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE 4111 -1:7 6, e:Rog-/-- SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT e}o 3 f i Ff i f Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT r ,--//),1„,(2) ;24( Martha Lyons, Deputy aT` Xllector Date sent to Montpelier: �((/� ,A? �D� 575 Dorset Street Smith Rurlinntnn VT I) 4!1S Rn7-R4R-41M rlkim,ill chHHrl rnm 2014 LIQUOR LICENSE RENEWAL APPLICATION 6118-001-SECN-001 SECOND CLASS LICENSE TO SFTJ MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Shelburne Road Variety, LLC Licensee # 6118- 1 Doing Business As: Shelburne Road Variety Mailing Address: 1855 Shelburne Rd. 1855 Shelburne Rd. South Burlington VT 05403 ryry �+ South Burlington VT 05403 TePLEASE INCLUDE hone: )EMAIL 32ADDRESS: A C)ern)6S97 r y/9-4.00• Goiu) • Description of Premises: Lessor: A grocery/convenience store in a one story cement block building Champlain Oil Company, Inc. situated on the west side of Shelburne Town Line and designated South Burlington VT 05403 as 1855 Shelburne Road in the city of South Burlington, Vermont. Last Enforcement Seminar: 11/14/2013 Filed Articles of Organization: Yes Date Filed: 10/25/2006 Federal ID Number: 03-0370543 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. Cater, Frank Edward 11 Ira Place Milton VT 05468 Has any person been convicted or pleaded guilty to any criminal or or vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes VNo If yes, please attach the following information: Individuals name, court/traffic bureau, offense and date In the past year has any person held any el ive or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following informa ion: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this application is true and complete. Dated thiSFS-6V day of" 11.-„ti14(a,j , U Signature of authorized agent Signature of individual or partners of corporation, company, club or association (ft/-4/4/ -z•„.,e-tzeict,,t,ft/( L,e-:6:6-%-2 (Title) Are you making this application for the benefit of any other party? Yes Nc Continued on next page • • 2014 LIQUOR LICENSE RENEWAL APPLICATION 6118-001-SECN-001 • • SECOND CLASS LICENSE TO SELL MALT AND VIRUS BEVERAGES Page 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners o- the City or of �)/ 1 _/ Total Membership , members present Ates"gr{iown Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, lcral control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town yrwrd of selectmen or city herd of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 • 2014 TOBACCO LICENSE RENEWAL APPLICATION 6118-001—TOBC-001 TOBACCO LICENSE TO SPIT TOBACCO Page 1 Optional Fee: $100.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $0.0 0 is paid to town/city , $100.00 is paid to DEC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Shelburne Road Variety, Tar Licensee # 6118- 1 Doing Business As: Shelburne Road Variety Mailing Address: 1855 Shelburne Rd. 1855 Shelburne Rd. South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 658-0332 PLEASE INCLUDE EMAIL ADDRESS: • Description of Premises: Lessor: A grocery/convenience store in a one story cement block building Champlain Oil Company, Inc. situated on the west side of Shelburne Town Line and designated South Burlington VT 05403 as 1855 Shelburne Road in the city of South Burlington, Vermont. Last Enforcement Seminar: 11/14/2013 Filed Articles of Organization: Yes Date Filed: 10/25/2006 Federal ID Nimber: 03-0370543 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. • Limited Liability Company Name Address Town/City State Zip Code Member 1. Cater, Frank Edward 11 Ira Place Milton VT 05468 Has any person been convicted or pleaded guilty to any criminal or or vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes %JJJ���JJJ No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any e ctive or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following information: Individual's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan.approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this application is true and complete. Dated this F p rday of e1R.( y , Iq Signature of authorized agent Signature of individual or partners of corporation, company, club or association Z ` 6/2 (Title) Are you making this application for the benefit of any other party? Yes No Continued on next page 2014 TOBACCO LICENSE RENEWAL APPLICATION 6118-001-TOBC-001 TOBACCO LICENSE TO SFT,T, TOBACCO Page 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the conenissioners will endorse their recommendation on • the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of e City o own of rd r s� Total Membership ✓ , members present A es Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL • 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. 1 No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 • ,. /.�► Cityof South Burlington ,Io ' City Clerk's Office v,-oyTF� Donna Kin ville, City Clerk `L7 s®_ FIRST, SECOND CLASS AND CABARET- LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS! TRADENAME ADDRESS � D aU7v rr - , FIRST'CLASS--) SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE _� D SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT 3tork Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT Mart a Lyons, Deputy De ut Tark Y Date sent to Montpelier: • 575 Dorset Street South Burlington,VT 05403 802-846-4105 dkinville@sburl.com 2014 LIQUOR LICENSE RENEWAL APPLICATION 4717-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SF1.r MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: SL UNO Burlington, Incorporated Licensee # 4717- 1 Doing Business As: SL UNO Burlington, Incorporated Mailing Address: 1330 Shelburne Road 100 Charles Park Road South Burlington VT 05403 West Roxbury MA 02132 Telephone: (802) 865-4000 n�� / PLEASE INCLUDE EMAIL ADDRESS: UC�l (`iJ /�/jf1s .63/91 Description of Premises: Lessor: A-restaurant located in a one story brick and cement building, SL Properties Inc. approximately 5700 square feet in size, due south of Im;perial Drive South Burlington Vt designated as 1330 Shelbune Road in the city of South Burlington, Vermont. Last Enforcement Seminar: 02/04/2013 Fed. ID Nsrber: 03-0370271 Incorporation Date: 05/02/2001 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes Atc.ATTACH AN ADDITIONAL SHEET TO THIS ALICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATESPP THAT HAVE OCCURRED DURING THE PAST YEAR. Coipuration Name Address Town/City State Zip Code President 1. Baines, Ian H. 5518 Morningside Drive Dallas TX 75206 Secretary 2. Herz, George 2614 Route 516 Old Bridge NJ 08857 Director 3. Psallidas, Louie 2614 Route 516 Old Bridge NJ 08857 vsz�6v� 11' L ' T - Director 5. Soulier, Edward 11 Sunny Knoll Avenue Lexington MA 02421 Stockholder 6. Properties, SL, Inc. 100 Charles Park Road West Roxbury MA 02132 • Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes .✓NIo If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective or appointive state, county, • city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes \,./No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 01143 Vt. Dept. of Health lodging No.: Vt. Tax Dept. Meals & Rooms Cert./Acct. No.: 1110343510 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from • State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 1',-..,-1't'j. ';'.-77'..'-'''f'.".'".,4-;,,,- ., ',.:7.''' .it;;4:t.:-'. ‘,?•,-.'..-7-'• - !'' . 'I.';• , .0 ' .11.-,...---4 :: - . ,...." ,_._,., 'il'. ile .P.,..., c.-.'..- l''''-44;11.11." 7'4 r.,, -^.;-,•Ai.....-. ,lk 1,'- .417,".-gt."-;?T.7;7.3::::-;'''''''111r.' 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'":'..'''-',-'''' - 1 `,'-'-'-'Y--''''41.-'-'''", l'ij:•4' ,','+' '--:.'''''''''.:7. -4:'' ' ,:.'''t! ';.',' 4,,i".'4-'r.' ''';'.'-'' : L.-'' ',:... '-€' --:' . F ,':') , ,. - -._ ,, . •.. UNANIMOUS WRITTEN CONSENT OF SOLE STOCKHOLDER The undersigned, being the sole stockholder of each of the Corporations listed on Exhibit A attached hereto and incorporated herein by reference, pursuant to the applicable state statutes, does hereby consent and agree that the following resolution be adopted as the action of the sole stockholder of each Corporation: RESOLVED: To accept the resignation of Louis P. Miaritis as Director of the Corporation. RESOLVED: That George W. Herz II be elected as Director of the Corporation, to serve as such until the next annual meeting of the Board of Directors and until his successor is duly chosen and qualified. Dated: Effective as of September 1, 2013 SL PROP R IES, INC. By: Louie allidas, Sr. Vice President-Finance EXHIBIT A SL Una Burlington, Inc. SL Uno Ellicott City, Inc. SL Uno Franklin Mills, Inc. SL Uno Frederick, Inc. SL Uno Gurnee Mills, Inc. SL Uno Hyannis, Inc. SL Una Portland, Inc. SL Uno Potomac Mills, Inc. SL Uno Waterfront, Inc. H.WPDOCStCORPORATEl2017,STOCKHOLDER-SL PROPERTIES,WC.•ELECTION Of DIRECTORS GWH.DOC RIDER TO 2014 LIQUOR LICENSE RENEWAL APPLICATION THE OFFICERS,DIRECTORS, AND SHAREHOLDER OF • SL UNO BURLINGTON, INC. ARE AS FOLLOWS: PERCENTAGE NAME TITLE ADDRESS OF OWNERSHIP Ian H. Baines President, Chief 5518 Morningside 0% Executive Officer& Drive,Dallas, TX Director 75206 Louie Chief Financial Officer, 4 Memory Lane 0% Psallidas Senior Vice President— N. Reading, MA 01864 Finance, Treasurer, Assistant Secretary& Director George W Senior Vice President, 5 Berns Adams Way 0% Herz II and Secretary Westborough, MA Director 01581 Edward G. Vice President of HR& 11 Sunny Knoll Ave. 0% Soulier Jr. Asst. Secretary Lexington, MA 02421 SL Properties, Shareholder 100 Charles Park Road 100% Inc. West Roxbury, MA 02132 1/14/2014 2014 LIQUOR LICENSE RENEWAL APPLICATION 4717-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SELL,MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. Dated this /51# day of Signature of authorized agent Signature of individual or partners of corporation, company, club or association � $Owen • (Title) Are you making this application for the benefit of any other party? Yes yNo Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual conmi_ssioner registering either approval or disapproval. Lease or title mast be recorded in tcwn or city before issuance of license. APPROVED DISAPPROVED } Approved by Board of Control Commissioners of -own of ,�9• t Total Membership 255 members present _e- } etiiiik Town Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 ® �f City of South Burlington 0i** 4 City Clerk's Office Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLI ION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION 41 nVaMor i) 6Dini)1Q(/ DOING BUSINESS AS/ TRADDENANE ADDRESS 61)1' iG)6 G®1'. t)i- 4ID h FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE J dj C:V 4' SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE EPT % A Kilt( Chief Douglas S. B nt � Date SO. BURLINGTON TAX DEPT 7 7" JAI r , f ilL/ Martha Lyons, Deputy Collector Date sent to Montpelier: F7� nnrcpt Ctrront Cnuth Rf19_RAR_A1f1F in nlinnch .l n 1 2014 LIQUOR LICENSE RENEWAL APPLICATION 3944-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFTJ MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: JAM Golf, LLC Licensee # 3944- 1 Doing Business As: Vermont National Country Club Mailing Address: 1227 Dorset Street c/o Chris Barron South Burlington VT 05403 1227 Dorset Street Telephone: (802) 864-7770 Sou Bur ington VT 05403 PLEASE INCLUDE EMAIL ADDRESS: (:)(\C i5 a k)4 C mO s-t nek cmo,1.C.O ril Description of Premises: Premises: XX Owned Leased A restaurant located in a two story wood and cement structure being approximately 3,000 square feet in size and designated as 1227 Dorset Street in the city of So. Burlington, Vt. Last Enforcement Seminar: 02/20/2013 Filed Articles of Organization: Yes Date Filed: 03/17/1998 Federal ID Number: 03-0357770 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. McDonald, James A. Box 4 E. Burke VT 05832 Has any person been convicted or pleaded guilty to any criminal dr moor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes X No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes XNo If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 11910 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Roans Cert./Acct. No.: 126814 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 3944-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SF,T MALT AND VINOUS BEVERAGES cage 2 I/We hereby certify that the information in this application is true and complete. Dated this 0 day of l e rtitAcy 'p`i S • -tur authorized agent Signature of individual or partners of �.;�tionCny, club or association eh eras line (Title) Are you making this application for the benefit of any other party? Yes No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board., all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title mast be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners the City o wn of t) )1 Total Membership 5 members present • iilt,ewn Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 2014 LIQUOR LICENSE RENEWAL APPLICATION 3944-002-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFTX MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: JAM Golf, LLC Licensee # 3944- 2 Doing Business As: Vermont National Country Club Mailing Address: 1227 Dorset Street 1227 Dorset Street South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 264-9428 PLEASE INCLUDE EMAIL ADDRESS: C iN c .5 b V Q(rno i ; 11Gt C o ncl\.Corr\ Description of Premises: Premises: XX Owned Leased A Restaurant within a two story wood constructed building with an approximate size of 450 square feet, this being a separate building on the grounds of the VT National Country Club and designated as 1227 Dorset Street, in the City of South Burlington, Vermont. Last Enforcement Seminar: 02/20/2013 Filed Articles of Organization: Yes Date Filed: 03/17/1998 Federal ID Number: 03-0357770 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Company Ndfk Address Town/City State Zip Code Member 1. McDonald, James A. Box 4 E. Burke VT 05832 Has any person been convicted or pleaded guilty to any criminal or moor vehicle offense in any court of law (including traffic tickets hymen) during the last year? Yes &No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any ele ive or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 12278 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Rooms Cert./Acct. No.: 128814 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories.. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 3944-002-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SPIT MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. Dated this l�tday of �l)ri.(Gr j/ , 1(1 • e of -,a.^.rized agent Signature of individual or partners of co ra c«._ , : club or association General ThOne of (Title) V Are you making this application for the benefit of any other party? Yes V No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual camiissioner registering either approval or disapproval. Lease or title mast be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners the City„ T wn of, O, / Total Membership 5 , members present , Town Clerk • TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 1 r f 2014 LIQUOR LICENSE RENEWAL APPLICATION 3944-001-OUTC-001 OUTSIDE CONSUMPTION PERMIT Page 1 Fee: $20.00 License Year Beginning May 1, 2014 ending April 30, 2015 Paid to DLC • MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: JAM Golf, car Licensee # 3944- 1 Doing Business As: Vermont National Country Club Mailing Address: 1227 Dorset Street c/o Chris Barron South Burlington VT 05403 1227 Dorset Street Telephone: (802) 864-7770 `_ Sou Burl' gton 05403 PLEASE INCLUDE EMAIL ADDRESS: C 1` +5() a UP('Monk- (1C4:or'4 ,cC Y Description of the delineated area is as follows: Golf course with natural barriers. Beverage cart service.' Patio area adjacent to pro shop, defined by stone walls. 8:00 - 8:00 Outside deck to include upper and lower, tented area on north lawn, 11:00a.m. to 1:00 a.m. .year round. Also 1 room approx 450 square feet in size, 2nd floor between pool & tennis courts, patio 50x75 enclosed by fence, trees & shrubs. 10:00 a.m to 10:00 p.m. May through Sept. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with resp ct to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We hereby certify that the ii\ }tinformation in this application is true and complete. Dated this 1- day of ekL4A(y ).4 1 L( •i•. .ture rized agent Signature of individual or partners of •-. ... ion, i' •club or association IF er7era/ //Jai/1q/// rzt (Title) en b Are you making this application for the benefit of any other party? Yes V No MAKE CHECKS PAYABLE TO AND MAIL TO: VERMONT DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vemmnt Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license • may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED • Le Approved by Board of Control Commissioners of .r a,�f..50 . i� fill � Total Membership 6 , members present "t, , own Clerk 'n° ,o �r City of South Burlington 4 City Clerk's Office VDTE Donna Kinuille, CityClerk 4 ......-b FIRST, SECOND CLASS AND CABARET LICENSEAPPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENANE ,14 V 1 /0ritei. , i ADDRESS 14 6 irD -0-. 73a4 FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE--- `s�-b� �'�✓ !`� SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON F DEPT t- Slit t Chief ouglas S. rent Dat SO. BURLINGTON TAX DEPT - -,;-7/ .2 .?�11 �'1`i Marth a Lyons De u [ Tax Coll t y , p yCollector Date sent to Montpelier: 2014 LIQUOR LICENSE RENEWAL APPLICATION 7284-002—SECN-001 SECOND CLASS LICENSE TO SETT MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $7 0.0 0 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Leisure World Inc. Licensee # 7284- 2 Doing Business As: Leisure World Inc. Mailing Address: 1245 Airport Parkway 1245 Airport Parkway South Burlington VT 05403 South Burlington VT 05403 one:PLEASE INCLUDE )EMAILS2 ADDRESS: {oG!° klSuv'Lw06'(47( ® y .(1(00 , (o' Description of Premises: /Premises: XX Owned Leased Store in a single story building located on the north side of Airport Parkway designated as #1245 consisting of approx 3600 sq ft in the city of S uth Burlington, VT Last Enforcement Seminar: 11,48242011 /I 1D f/[/ • Fed. ID Number: 03-0227944 Incorporation Date: 03/08/1971 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Bessery, Tod R 921 River Road Hyde Park VT 0565tr SS Director 2. Bessery, Elaine M 921 River Ridge Hyde Park VT 056df Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes it/No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date f In the past year has any director or stockholder of the corporation held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes ((Io If yes, please attach the following information: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN • The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full conpliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section. 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this application is true and complete. Dated this � . day of MG„(,h , •40 I Y Signature of authorized agent Signature of individual or partners of corporation, ccmpan , cl or association ,� r V�( / )oLt A,`— (Title) Are you making this application for the benefit of any other party? Yes ✓ No Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 7284-002-SECN-001 SECOND CTASS LICENSE TO SEra MALT AND VINOUS BEVERAGES ?age 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of th City -'I30.4m,„.cf ' II( l6,,sVAIL Total Membership 6 members present es '$ `'° — !""" } I TOwn Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, lcral control ccumissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 04° /► City of South Burlington SSA® 0 City Clerk's Office VDT E°ff° Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME ot,jilla, Pates ) ic- . ADDRESS LSD Dr e , FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE Q t. 1/ /4 SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT 3 IL( Chief Douglas S. Brent Date. SO. BURLINGTON TAX DEP Martlia Lyons, Deput `Tax Collector Date sent to Montpelier: 575 Dcrsst StrR?t Smith Rill linntnn VT (- fv--1 Rf17-R4R-a1(1F 11 invillo 7chnrl rim • • c,K-t7o? 2014 LIQUOR LICENSE RENEWAL APPLICATION 7978-001-1RST-001 • FIRST CLASS RESTAURANT/BAR LICENSE TO SFLI, MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $1 1 5.0 0.idatoo town/city itiCWIIIMP . Wa Town: 04'. - SOUTH c INGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Osaka Hana, Inc. Licensee # 7978- 1 Doing Business As: Osaka Hana, Inc. Mailing Address: 150 Dorset Street 150 Dorset Street South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 448-3525 j PLEASE INCLUDE EMAIL ADDRESS: h( Y�S-X UYGI7VE l.Z.q&')1 C.c,n 1 Description of Premises: Lessor: Restaurant located in the north west corner of a single story strip Dorset Square Associates mall consisting of approximately 2500 sq feet. Situated on the east 28 Day Lane side of Dorset Street designated as #150 approx 1/8 of a mile south Williston vt 05495 of the intersection of Williston Rd. in the city of South Burlington. Last Enforcement Seminar: 07/26/2012 Fed. ID Number: 45-5588337 Incorporation Date: 04/05/2012 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code 54 North Champlain President 1. Li, Jian Feng Apartment F Burlington VT 05401 54 North Champlain Director 2. Li, Jian Feng Apartment F Burlington VT 05401 Has any director or stockholder been convicted or pleaded guilty to any crinpal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes ?,No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any electi e or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes )No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 14489 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Rooms Cert./Acct. No.: 440-455588337E-01 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Cotmissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of 1 contributions due to the Department of Employment and Training. { I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 7978-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFLT.MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. 1 2a Dated this 1.2.. day of J;q11 UJlY�1 1 1(1 Signature of authorized agent Signature of individual or partners of corporation, ccaspany, club or association PIES ICIent (Title) Are you making this application for the benefit of any other party? Yes )(No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control RoPrd, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Ak Approved by Board of Control Commissioners of . e City or ow n 2,..150170r1 Total Membership ./ , members present Atte , , Town Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: • DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE . MONTPELIER, VT 05602 If application is disapproved, loral control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town hoard of selectmen or city heard of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 • t City of South Burlington 0.4* City Clerk's Office Q® Donna Kinville, City Clerk ` /P6. FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENANE Ire r�lar �� r e ADDRESS FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT " T 31TI I l Chief Douglas S. Brent D to SO. BURLINGTON TAX DEPT 041-7-Aek-- 4/6-14. Martha'Lyons, Deputy a1�'xllector Date sent to Montpelier: 575 DnrSP.t StrPPt Smith Rin-Iinntnn \IT Rfo_R[lR_11nR rl liinvilln(rr`ch .l �.,r„ i csol, 0779oa 2014 LIQUOR LICENSE RENEWAL APPLICATION 6858-002—SECN-001 ECCOD CLASS tarciNSF. TO SR I! ..I.?. AND ,ING, H.v_..PF;'l_S ?age Fee: $140.00 of which. • License Year Beginning May 1, 2014 ending April 30, 2015 $70 00 is paid to 'oc.dcity �S'Td.00 is raid to . • Town: 040Ti3--SZTUTH BURL�TON • MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING • Applicant: Review all of the information presented on this fora, indicating any changes in the spaces provided. • Rpp-lica::t: Independent Brewers United Ca,rporiation Licensee 6858- 2 • Doing Business As: Independent Brewers United Corporation (2ral) Nailinc Address: 5 Bartlett Bay Road 5 Sartlett Bay Read: • S. Burlington VT 05403 S. Burlington VT 05403 • Telephone: (802) 658-2739 � PLEASE INCLUDE EMAIL AL/DRESS: v` Lan ci .Ccr) t i Description of Presses: 1o5s,,r: Store in a steel building consisting of approx. 4,300 square feet Antonio B & Rita II Porer_lean located on/within a manufacturing facility Iity locate nort h_ _ side :n s ito;; VT of Bartlett Bay Road. Designated as #5, 1 /_0 of a mile west of the intersection of t e 7 in the city of South Burlington, VT Last Enforcement Se irtar: 03l1/2013 Fed. ID Number; 91-1258355 Incorporation Date: 03/271199.84 Valid Charter?: Yes State of Charter: Washington Majority of Directors are US Citizens: Yes i ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES 1 AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corrugation Name Address Town/City State Zip Code • Director 1. Palmer, Raquel V 1:_ West 17th Street 11G Sew York NY 10011 Director 2. Madden, Kevin M 305 W 13th St Apt 4H New York NY 1001.4 Director 3. ocyniak, Richard 18 Brcrts Grove Hill Pittsford NY 14534 Director 4. Pendegraft, Jere 16 Redbrick Road Orchard Park NY 1412 Director 5. Harrington, Daniel 45 Turning Leaf Drive Pittsford NY 14534 • Stockholder T Independent Brewers Lit r Pie tee Suite 9-14 Bt rii_ VT 05401 • • Has any director or stockholder been convicted or pleaded guilty to any cr, or motor vehicle offense in any court of law (including traffic tickets by mail) during the sty r? Yes • If yes, please attach :the follow _ng information: `cO c tia s • name, court/traffic bureau, offense and - In the past year has any director rr stockholder of the corpiration held any e appointive t_v;e slat county, city, .village or to•rs office Vermont See VSA, - a S? 22 z >s 7� > f yea, please attach the following information: _..c_v_duat s _are, office and ,r_...Se ctio_ • Disc: s e of Non-pro=it Organization?: Yes Y;;: i s ALL APPLICANTS MUST COMPLETE AND SIGN • The applicant linderstands and :-._e_.. that chic Liquor Cor.trol Board My'obtain criminal history r_ o u intormation froin • State and Federal record repositories. _-We hereby -.: if', ides the pains and penalties of _ that 1/re are in good standing with respect to or in ?'_1 ; compliance with a plan approved by the CONTia55i0nec Of Taxes to .a' any and all taxes due the State of Vermont as of the date • of this application. VOA Title 32, Section 3113) I/ge hereby certify e are not under an obligation to pay child : tnst II/We are in good tape ng with • respect to child support or are in full. compliance with a plan to pay any and all child support payable under a support • order. (VSA, Title 15, Section 795) In accordance with 21 '=Sy, Section Ia-S b:, I/We certify, under pains and penalties of perjury, that Ilhe are in good standing with respect to or in full compliance with a fa_: to pay contributionsy and a'l or payments in lieu of • contributions due to the Department of Employment and Training. • I/We have registered the trade name of these premises with the Secretary of State. Continued on newt page • •• • , 2014 LIQUOR LICENSE RENEWAL APPLICATION 6858-002-SECN-001 SECOND CLASS LICENSE TC SEL., MALT AND VINOIS B JER?LES Page 2 I I/We hereby certify that the infcemoico in pplit It c n is true and complete. Dared this 24 day of I f7,/ ,d4aaajj Signature of authorized agent Signatuie of individual or partners of croor pion company, club or association 1L1 Ti:tle) Are you making this application for the benefit of any other party: Yes noon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the V'enront Statutes Annotated, as amended, have been fully met by the applicant, the ccmrissioners will endorse their recommendation on the back of the application arai transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the _nfor_rati.,. of Lue Liquor Control Control Board, all applications shall carry the signature of each individAual cocmissioner registering eL`her approval or disapproval. Lease or title rust be recorded in town or city before issuance of license. AFeRY'ED DISAPPROVED Approved by Beard of Control_ro'i Commissioners of - n of gat✓ J Total Membership 6 members present AISAL ;erk ir TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 ..f application is disapproved, local control ccsmm ss.oners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aideruun on a first or second class license application shall to considered binding except as taker or Rade at an open public meeting. VSA 7-7.,Sec,312 • • • • • • a, City of South Burlington o � City Clerk's Office Donna Kinyille, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESAS AS/ TRADENAME ADDRESS 1So) FIRST CLASS SECOND CLAS—SM CABARET DATE RECEIVED BY CLERK'S OFFICE =e52. Li eAD4.- SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT Chief Douglas S. Brent Dat SO. BURLINGTON TAX DEPT 17/1/0 Martha Lyons, Deputy TaCollector ,17-//y Date sent to Montpelier: /.)/0\90.,PC6D F7F [Threat Ctrc at Cnnth Pt,rrnnt,- \/T ()RAW' Qm_Qna_nif)G 2014 LIQUOR LICENSE RENEWAL APPLICATION 2396-020—SECN-001 SECOND CLASS LICENSE TO SETT MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $7 0.0 0 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Wesco, Inc. Licensee # 2396- 20 Doing Business As: Champlain Farms South Burlington Mailing Address: 1800 Williston Road 32 San Remo Drive South Burlington VT 05403 South Burlington VT 05403-6310 Telephone: (802) 860-5845 PLEASE INCLUDE EMAIL ADDRESS: c4td1LCSA0 C k CIJIY\Q`01-iNn\aire1 S •(,Corn Description of Premises: Lessor: A convenience store in a one story cement building, approximately Wesco 2100 square feet at the corner of Airport Drive and Williston Road P.O. Box 2287 designated as 1800 Williston Road in the city of South Burlington South Burlington Vt 05403 Vermont. Last Enforcement Seminar: 09/27/2013 Fed. ID Number: 03-0273319 Incorporation Date: 09/21/1979 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Simendinger, David 88 Calloway Drive Williston VT 05495 Director 2. Simendinger, William 12 Whiteface Street S Burlington VT 05403 Director 3. Siirendinger, Joann 43 Summit Ridge Williston VT 05495 Stockholder 4. Sinendinger, David 88 Calloway Drive Williston VT 05495 Stockholder 5. Simendinger, William 12 Whiteface Street S Burlington VT 05403 Stockholder 6. Simendinger, Joann 43 Summit Ridge Williston VT 05495 Has any director or stockholder been convicted or pleaded guilty to any crim rsal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes 1/No If yes, please attach the following information: Indivifiia:'s name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any electivo'or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes ''No If yes, please attach the following information: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page Health License Expires December 31, 2014 2014 LIQUOR LICENSE RENEWAL APPLICATION 2396-020-SECN-001 SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 2 • I/We hereby certify that the information in this application is true and ca[plete. Dated this i��' day of ��C9 \-QCX- . i7�\ 1 Signature • -uthori.ed a t Signature of individual or partners of co ••„tion, . cl • or' ssociat'on �CTN\CA & X'( A vL �1�es L8) A (Title) Are you making this application for the benefit of any other party? Yes P/No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the caanissioners will endorse their recaamendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual caanissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED i Approved by Board of Control Caanissioners •� of ,A;), I� �` _ _!fi _,. �� Total Membership members present • 3 - C 'Town Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: • DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE • MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 • 1 1 1 2014 TOBACCO LICENSE RENEWAL APPLICATION 2396-020-TOBC-001 TOBACCO LICENSE TO SFTL TOBACCO Page 1 Optional Fee: $100.00 of which • License Year Beginning May 1, 2014 ending April 30, 2015 $0.0 0 is paid to town/city $100.00 is paid toDLC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Wesco, Inc. Licensee # 2396- 20 Doing Business As: Champlain Ferns South Burlington Mailing Address: 1800 Williston Road 32 San Remo Drive South Burlington VT 05403 South Burlington VT 05403-6310 Telephone: (802) 860-5845 `n (�� � PLEASE INCLUDE EMAIL ADDRESS: Q ��G�\C1 u(V�1p {jam c WC1'�/�S - OY"` Description of Premises: Lessor: A convenience store in a one story cement building, approximately Wesco 2100 square feet at the corner of Airport Drive and Williston Road P.O. Box 2287 designated as 1800 Williston Road in the city of South Burlington South Burlington.Vt 05403 Vermont. • Last Enforcement Seminar: 09/27/2013 Fed. ID Number: 03-0273319 Incorporation Date: 09/21/1979 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Simendinger, David 88 Calloway Drive Williston VT 05495 Director 2. Simendinger, William 12 Whiteface Street S Burlington VT 05403 Director 3. Simendinger, Joann 43 Summit Ridge Williston VT 05495 • Stockholder 4. Simendinger, David 88 Calloway Drive Williston VT 05495 Stockholder 5. Simendinger, William 12 Whiteface Street S Burlington VT 05403 Stockholder 6. Simendinger, Joann 43 Summit Ridge Williston VT 05495 Has any director or stockholder been convicted or pleaded guilty to any crimi9of or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes vIslo If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any electiv /or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes V No If yes, please attach the following information: Individual's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information fran State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full co pliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page • 2014 TOBACCO LICENSE RENEWAL APPLICATION 2396-020-TOBC-001 TOBACCO LICENSE TO SFT•J TOBACCO Page 2 I/We hereby certify that the information in this application is true and complete. Dated this __,/ day of Q.Nk.l)c..;(L\ , of authorized ag Signature of individual or partners of corporate , cl or a 'atio • )..De.,s (.,t) vac_ �es dam. (Title) Are you making this application for the benefit of any other party? Yes V No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners off . cr f{, Igi, _ ! Total Membership I , members present `"'te - $ CAOLOown Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, ln'al control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town hoard of selectmen or city board of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 .) City of South Burlington ® City Clerk's Office ,;* Donna Kinyille, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME ‘11ArniAgeeirl. ADDRESS �l I13 )1 111 DYI Y��r FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE �• LD, eiV)//46/' SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT (( Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT „ , --/717--d11 621'1- Marth//:(Lyons, Deputy T x Collector Date sent to Montpelier: Cs, .t n yr r.cnno onv one n1nc 2014 LIQUOR LICENSE RENEWAL APPLICATION 2396-030—SECN-001 . SECOND CLASS LICENSE TO SFT,T MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Wesco, Inc. Licensee # 2396- 30 Doing Business As: • • Champlain Farms Mailing Address: i 1118 Williston Road 32 San Remo Drive South Burlington VT 05403 South Burlington VT 05403-6310 Telephone: (802) 863-6611 CC ` PLEASE INCLUDE EMAIL ADDRESS: S C e-6` C& c..),-,o-hn 0 r n cCA cre\S .COS Description of Premises: Lessor: Store located within a wood constructed building being approximately Wesco, Inc. 2,200 square feet in size, designated as 1118 Williston Road, in the South Burlington VT 05403 City of South Burlington, Vermont. Last Enforcement Seminar: 09/27/2013 Fed. ID Number: 03-0273319 Incorporation Date: 09/21/1979 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes { ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Simendinger, David 88 Calloway Drive Williston VT 05495 Director 2. Simendinger, William 12 Whiteface Street S Burlington VT 05403 Director 3. Simendinger, Joann 43 Summit Ridge Williston VT 05495 Stockholder 4. Simendinger, David 88 Calloway Drive Williston VT 05495 Stockholder 5. Simendinger, William 12 Whiteface Street S Burlington VT 05403 Stockholder 6. Simendinger, Joann 43 Summit Ridge Williston VT 05495 Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes /No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any electivee/�or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes VNo If yes, please attach the following information: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support • order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of • • contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page Health License Expires December 31,2014 2014 LIQUOR LICENSE RENEWAL APPLICATION 2396-030-SECN-001 SECOND CLASS LICENSE TO SFT,T MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in l�this application is true and complete. Dated this G� day of l ^ , t :\(y S' ure of au ri d ag Signature of individual or partners of corpo ation, y, cl or a oc ation �c�•�t d w.e—r, c.k U-) n Sc O, lVic +f 2Si c Sze (Title) Are you making this application for the benefit of any other party? Yes VNo Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recandation on the back of the application and transmit it to the liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each indivich,al commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED 11 1 Approved by Board of Control Caamissioners of City or •f �� ! s► %d IOIF �Iy,��,�,�[ Total Membership members present A � � i.7�1C7WC1 Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 2014 TOBACCO LICENSE RENEWAL APPLICATION 2396-030-TOBC-001 TOBACCO LICENSE TO SFT,T TOBACCO Page 1 Optional Fee: $100.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $0.0 0 is paid to town/city $100.00 is paid to DLC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Wesco, Inc. Licensee # 2396- 30 Doing Business As: Champlain Farms Mailing Address: 1118 Williston Road 32 San Remo Drive South Burlington VT 05403 South Burlington VT 05403-6310 Telephone: (802) 863-6611 PLEASE INCLUDE EMAIL ADDRESS: tk[1 Ce f k CSC t.lM \c&i(A4P0. )1ENS LdVVX Description of Premises: Lessor: Store located within a wood constructed building being approximately Wesco, Inc. "! 2,200 square feet in size, designated as 1118 Williston Road, in the South Burlington VT 05403 City of South Burlington, Vermont. Last Enforcement Seminar:nar: 09/27/2013 Fed. ID Number: 03-0273319 Incorporation Date: 09/21/1979 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Simendinger, David 88 Calloway Drive Williston VT 05495 Director 2. Simendinger, William 12 Whiteface Street S Burlington VT 05403 Director 3. Simendinger, Joann 43 Summit Ridge Williston VT 05495 Stockholder 4. Simendinger, David 88 Calloway Drive Williston VT 05495 Stockholder 5. Simendinger, William 12 Whiteface Street S Burlington VT 05403 Stockholder 6. Simendinger, Joann 43 Summit Ridge Williston VT 05495 Has any director or stockholder been convicted or pleaded guilty to any crimigal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes 1../No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any electiv or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes iNo If yes, please attach the following information: Individual's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this application is true and complete. Dated this 1-' day ofJ\0-1A-U d\ 'gnature o uthor ed ag Signature of individual or partners of torpor i n, tampon cl or 'ation (Title) Are you making this application for the benefit of any other party? Yes tJ No Continued on next page 1- • 2014 TOBACCO LICENSE RENEWAL APPLICATION 2396-030-TOBC-001 TOBACCO LICENSE TO SF1T TOBACCO Page 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as_amended, have been fully met by the applicant, the canmissioners will endorse their reccmmendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED I Approved by Board of Control Commissioners of - City or own of / at Total Membership 5 , members present Af �,,.' �:° Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control cacmissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 ®` 40 City of South Burlington QS®®I4te City Clerk's Office v ' Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME I ors ADDRESS // 6 5id�a� vni loll )(;1\.) FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE . a1"1. f a®/ ' SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGT'ONN „FIRE DEPT Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT Martha Lyons, D-eputy'Tax Collector Date sent to Montpelier: F7F Ilnrcot Strout Cnnth Rinlinntnn vT fFnn Rn9_PAP_ninG lLin ill�(nlcL .l 2014 LIQUOR LICENSE RENEWAL APPLICATION 517-002-1CLB-001 FIRST CLASS LICENSE FOR CLUB TO SFT,T. MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Eagles, Champlain Aerie #793, F.O.E., Inc. Licensee # 517- 2 Doing Business As: Eagles, Fraternal Order of Aerie #793 Mailing Address: 1233 - B Shelburne Road 1233 - B Shelburne Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 651-9004 i f n � 5j!? C 1)�� PLEASE INCLUDE EMAIL ADDRESS: j'y Il/1 N 7 ;'�' Description of Premises: Premises: XX Owned Leased Restaurant located within a one story wood framed building on the west side of Shelburne Road designated as 1233 Shelburne Road, located in the city of South Burlington, Vermont Last Enforcement Seminar: 02/20/2013 Fed. ID Number: 03-0123326 Incorporation Date: 11/19/1949 Valid Charter?: Yes State of Charter: Vermont Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code Director 1. Brown, Lynn 36 Howard Street Burlington VT 05401 Director 2. Deal, Kathy 19 Case Parkway pairlington VT 05401 Has any director or stockholder been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes X,No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Roans Cert./Acct. No.: 440030123326F-01 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands that he/she must maintain a list of the names and residences of paid up members, a list of club officers, and a list of employees of the club and their annual salaries. These lists must remain on the licensed premises and be available for inspection upon request. The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page Veiiiiont Department of Liquor Control Certificate of First Class Seminar Attendance Name(print): r t 14-1 Signature: Date: 9...;« (expired two years from above date) Investigator's Signature: Certificate of First Class Seminar Attendance Category(circle one): Owner Director Partner -Manager) Employee Corporation Name: Business Name: ; er. - s:•-s s _ , s Street and Town: : „. t Seminar held in: Town/City • Education Regulation 3-B V.S.A.T.7 §239 fti (W-{ trill 0 o.0 ,- c a tri C j bd rn Z n ~-'d 0 �, n d }`�w w N . 'b S `f7 .�i Gl, v, FCp Rm CaD yQ .c9 o a H Qp CD ` g, O_ a. h co O O ;t (D Vi H o � a. nw 0. 0_ � � o " 0 0 �° w cnD cc pp., CD • 0 °`� y C> o w o„ �^ w G vi w • CD yo. (D ram,• m'd $.g2a O ,> •r• co +{'.^� w (� ~ - am � TJoOa 0o 50- p,,0 • 0 0 CD G d $a P'CD ca, �" on x -I- OR w¢ r dya C� 5O ❑ ajDh,Nd o- o f < P- f ,�. Fc a .E a ; a-5'oroo d Py O t~ ni G on CD •� 04 0 C 0d . as o al n en Pr o� s CD • � ' a a goow< C cow Rowcm dCo a C n v � C cy0 00 DO • in ol III ., H 'J F+ y �Ny,.p a ,0 r•F �0 c _ 0�+ (a R CD En cr S.?'8 ^c (D 0 h '0 r, �' Y0, Fes,. o O � 0 O F11w Z r7 n P , I' � P' 0.0. .Fo pQ, s aw H 0 rtQ . EIIhH nj 1-41 .O O r, O co a 69 (--+ g x . ' Z L .. CD ILt lb, CD `-C Q+ r, 0 " \•° otal P. iI pq c p. CD CD N . CD -0 . y . V. r+ o o o. i:cj 0 CD p O r� I (D ' ' � CDh jII co rc Cn o to c d w n �• o-' ti la). 'C w N p s R o w GI CD p p j `- --L- 1'3 0 p 811. 0a0 0 g r tdApP wx nw O D N n r * 0., gOo, o m el F. 1" O . O E F5D C c^ .- o !L !!!I1! +e:nrfiw.-..arrm.-w.+nw'na..rnm .-r'wt..... o., acxm-rvTm n.....Aw:- ievra fswrar.r✓n . . _-. •..•... ..w^:n.wr-' 'rnx+rssrnea nn^.mTI.81Taeer✓:irn•.+'rv.,-rn vrrw.e-n• b C7 ,73 O � 1 wN lb CD ' i y fi, CD / xty , p t, N `C00 r tokw' co I ' ifit; ? � o C' .� 0 d O � a' to t`' w w -0 p- 0- y 5 o ti m 0 (o `< o O t� Ca pi << \J ''co i \' w o cD w . w, o c`°o .;, us 0.- w,d i CD CD C0 ,_, F ZcD r-, � 0 , h • Q Z . F� p c,_ Cr' '"n , 0w o 10 . o O nM Ad 1 , co 0 . 1O ° `3 r/V CD 0, ia w o ty r^ , C) 5 QG p• n' rn oA- ( {�} o n _ � p 0 \. \A w F3 2014 LIQUOR LICENSE RENEWAL APPLICATION 517-002-1CLB-001 FIRST CLASS LICENSE FOR CLUB TO SFLT, MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify tha,/tTme information in this (application is true and complete. Dated this f/ day eir �" "' m 0 i Signature of authorized,agent Signature of individual or partners of corporation, company, club or association ;319,10.4...4./1/.11.9U t • (Title)Are you making this application for the benefit of any other party? Yes N No • Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont • Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their reccnmendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance'of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of City or own of Total Membership 5 , members present Attelt t F ) j ; i Clerk r '4 $ TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city hoard of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 i Y c,14': YR 727 2014 LIQUOR LICENSE RENEWAL APPLICATION 517-002-OUTC-QA� OUTSIDE CONSUMPTION PERMIT - j Fee: $20.00 License Year Beginning May 1, 2014 ending April 30, 2015 MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Eagles, Champlain Aerie #793, F.O.E., Inc. Licensee # 517- 2 Doing Business As: Eagles, Fraternal Order of Aerie #793 Mailing Address: 1233 - B Shelburne Road 1233 - B Shelburne Road South Burlington VT 05403 _South Burlin on VT 05403 Telephone: (802) 651-9004 i PLEASE INCLUDE EMAIL ADDRESS: t.: i Ir" IN 144 ' :Oka Description of the delineated area is as follows: Deck on back of north side of building 16x16 11:00am to 12:00am year round use I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We hereby certify that/i tie information in this application is true and complete. r Dated this ! 7 day of-ithP Lt ,Z,0 Icf.'. Signature of authorized agent Signature of individual or partners of corporation, company, club or association Jam`✓ y g-�i/ j'VLF`--�. �vS'✓`- (Title) Are you making this application for the benefit of any other party? Yes No MAKE CHECKS PAYABLE TO AND MAIL TO: VERMONT DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title most be recorded in town or city before issuance of license. APPROVED DISAPPROVED �- },�, Approved by Board of Control Commissioners o jown of Total Membership 55 , members present a .-- - y " ;"Town Clerk • r-$° wi-i s-li ems,,-'-"'Y x. 2014 LIQUOR LICENSE RENEWAL APPLICATION 517-002—OUTC-0Q2 OUTSIDE CONSUMPTION PERMIT a 1 Fee: $20.00 License Year Beginning May 1, 2014 ending April 30, 2015 Pal t..0 MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Eagles, Champlain Aerie #793, F.O.E., Inc. Licensee # 517- 2 Doing Business As: Eagles, Fraternal Order of Aerie #793 Mailing Address: 1233 - B Shelburne Road 1233 - B Shelburne Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 651-9004 PLEASE INCLUDE EMAIL ADDRESS: 041"/7-J C6. 144 Description of the delineated area is as follows: Back Side roped off with stakes. Two Doors from building to enter • roped area. 50' x 44' x 30', 11am - llpm During the sunm r with fundraisers or Sundays. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Cai issioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We hereby certify that t�dd,'Einformation in this application is true and complete. Dated this / 7' day of-✓/ L' , 'C • Signature of authorized agent Signature of individual or partners • �of corporation, company, club or association s 1 `-e a (Title) Are you making this application for the benefit of any other party? Yes � No MAKE CHECKS PAYABLE TO AND MAIL TO: VERMONT DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title :rest be recorded In town or city before issuance of license. APPROVED DISAPPROVED • • Approved by Board of Control Commissioners of or Town of or +( / `Total Membership 5 members present Attest) �, \y I,(:)AL clerk Jse.1 y-14 ira ni's^4e :Ai City of South Burlington 0$11164 City Clerk's Office V ' Donna Kin ville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENANE Svo- r' ,1---kbo ADDRE S S J9 GP ill MOrii4-Er/-36K FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE doll . / a12-1- SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT .�::-0,t...- 0 -St\lf- Chief Douglas S. Brent Date SO. BURLINGfTON TAX DEPT / fil7-5 Martha Lyons, Deput}�Tax Collector Date sent to Montpelier: F7F flnrcPt CtrPPt Cnnth Riirlinntnn VT ncan? Rn9_RaR_atnF rlhinvillo(7churl rnm 2014 LIQUOR LICENSE RENEWAL APPLICATION 7835-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFT.T MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to SIC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Sugarsnap, LIC Licensee # 7835- 1 Doing Business As: Sugarsnap Mailing Address: 30 Community Drive 30 Caammity Drive South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 661-2951 L PLEASE INCLUDE EMAIL Abel el ( +1,2 5V)3fV+. GDwy Description of Premises: Lessor: Restaurant consisting of approx 4000sq ft of space in the west end of John Illick a single story building. Building in a industrial park known as 30 Community Drive Suite #4 "TECHNOIAGY PARK" designated as #30 Cammuntiy Drive Suite #9 in the South Burlington VT 05403 city of South Burlington, VT Last Enforcement Seminar: 10/17/2012 Filed Articles of Organization: Yes Date Filed:. 08/18/2003 Federal ID Number: 12-0484379 Majority of Members are US Citizens: Yes 51-o48437.q ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. Duke, Abigail 82 Village Green Purlington VT 05408 Member 2 Rnart, Rnm""rt 71A Gray Annd ➢l ainf_i of d .- (ZOber *WiliV4 AO I 0 4 tr ' re)dwlbtr 64' ! L.I.C. fee dig{v..174144- Has any person been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes ,(No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? _Yes 'cm If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 14072 Vt. Dept. of Health Lodging No.: Vt. Tax Dept. Meals & Roams Cert./Acct. No.: 440-510484379-F02 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page EXHIBIT A ASSIGNMENT AND ASSUMPTION Abigail Duke (the"Purchaser") and Rob Smart(the"Seller") are parties to a certain Membership Interest Purchase Agreement (the"Agreement") dated as of May `3 ,2013. Pursuant to the Thousand Agreement, the Seller agreed to sell of his legal and beneficial owner of Four Hundred (400,000) membership interests(collectively the "Interests") in Sugarsnap LLC, a Vermont limited liability company,to the Purchaser. In consideration of the premises and the mutual representations, warranties, covenants and promises contained in the Agreement, the Seller hereby assigns and otherwise transfers to the Purchaser, all of his right, title and interest in and to the Interests to the Purchaser pursuant to the terms and conditions of the Agreement, and the Purchaser hereby accepts such assignment and transfer and assumes all liability of the Seller arising under or in connection with the Interests. IN WITNESS WHEREOF, the Seller has executed and delivered this Assignment and Assumption as of November .1:", 2013. SEL Rob Smart PURCHASER: le — ' 7j--A Abi, • l uke 2014 LIQUOR LICENSE RENEWAL APPLICATION 7835-001-1RST-001 FIRST CLASS RESTAURANT/BAR LICENSE TO SFr,7 MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete.I Dated this day of ",'' '"' , Signature of authorized agent Signature of individual or partners of corporation, company, club or association (Title) Are you making this application for the benefit of any other party? Yes No Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title oust be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of - - City o Town o£� Total Membership5 members presentt, .� , .r ✓ 'ay-, levitown Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, 1. Al control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 ,1 40 City ofSouth Burlington ®► �r ►I® 1 City Clerk. s Office DTE Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS! TRADENAME ADDRESS /019 to;1); 'OIL(7e.0-'? )di..., en M.) rr\494'ID FC) FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICEj7, 1_1 O r it SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIREDEP32-L-2gten4s,sd 7(\ Chief Douglas S. Brent Date SO. BURLINGTON TAX DEPT J Martha Lyons, Deputy aT x Collector Date sent to Montpelier: 575 Dorset Street South Burlington,VT 05403 802-846-4105 dkinville@sburl.corn 2014 LIQUOR LICENSE RENEWAL APPLICATION 5037-002-1HTL-001 FIRST CLASS HOTEL LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 1 Fee: $230.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $115.00 is paid to town/city $115.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Larkin,JiiS Marilyn Licensee # 5037- 2 Doing Business As: Champlain School Apartments Partnership (H) Mailing Address: 1068 Williston Road 1068 Williston Road South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 864-7444 + PLEASE INCLUDE EMAIL ADDRESS: \or @ kairi& recu / . �lei1 Description of Premises: Premises: XX Owned Leased Hotel in a 4 Story building on the Northerly side of Williston Road, adjacent to the entrance ramp of I-89, designated as 1068 Williston Road, in the City of South Burlington, Vermont. Last Enforcement Seminar: 02/21/2013 ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Partnership Name Address Town/City State Zip Code Partner 1. Lin, John 170 Spruce Street Burlington VT 05401 Partner 2. Larkin, Marilyn 170 Spruce Street Burlington VT 05401 Has any person been convicted or pleaded guilty to any criminal or motor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes _CNo If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any person held any elective or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes X No If yes, please attach the following information: Individual's name, office and jurisdiction Vt. Dept. of Health Food License No.: 4844 Vt. Dept. of Health Ding No.: 4844 Vt. Tax Dept. Meals & Rooms Cert./Acct. No.: 030347091E-01 Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 5037-002-1HTL-001 FIRST CLASS HOTEL LICENSE TO SRT,T, MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. • Dated this day of 1,bf try , o)L Signature of authorized agent Signature of individual or partners of corporation, company, club or association >27° (Title) Are you making this application for the benefit of any other party? Yes X No • Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont • Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information cf the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED • Approved by Board of Control Commissioners of aig,- oTrw? S !/ i tr Total Membership 6 , members present Art ? ,"Zownn Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 i r` 2014 LIQUOR LICENSE RENEWAL APPLICATION 5037-002-OUTC-I . OUTSIDE CJNSUMETION PERMIT 'age 1 Fee: $20.00 License Year Beginning May 1, 2014 ending April 30, 2015 d to D. MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Larkin,! Marilyn Licensee # 5037- 2 Doing Business As: Champlain School Apartments Partnership (H) Mailing Address: 1068 Williston Road 1068 Williston Road • South Burlington VT 05403 South Burlington VT 05403 Telephone: (802) 864-7444 • {� PLEASE INCLUDE EMAIL ADDRESS: 4 C(r�(1 e I0.r 1 rea -1 i ()�-1 Description of the delineated area is as follows: / outdoor pool area being 54'x80' in size with small 13'x7' long alcove with fence around entire area. Lower patio area 14'x48' in size to be used after fence installed Year round use 8am to lipm • I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support • order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We hereby certify that the information in this application is true and complete. Dated this day of �2,J r a a fi , aC)1 1-1 Signature of authorized agent Signature of individual or partners of corporation, company, club or association • • (Title) Are you making this application for the benefit of any other party? Yes X No MAKE CHECKS PAYABLE TO AND MAIL TO: VERMONT DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the conmissioners will endorse their recommendation on • the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title mist be recorded in town or city before issuance of license. APPROVED DISAPPROVED • Approved by Board of Control Commissioners of the City or Town o ' �! 1. / Total Membership 5 , members present Attest, , Town Clerk • 1 ,I ,e City of South Burlington OW'4 City Clerk's Office OTE Er* Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME .. libr-)- ,q-1-... - 4 04- II ADDRESS )43: 1) . hK).),OrilkK. ' 12i • . FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date - SO. BURLINGTON FIRE DEP Me : 1- SZfrfiy Chief' Douglas S. Brent a e SO. BU INGTO TAX DEPT 77 a'(.14reL 6W1,(1/2( --- - - - Mart Lyons, Deputyax Collector • Date sent to Montpelier: i xr d 120"L `s i 575 Dorset Street South Burlington,VT 05403 802-846-4105 dkinville@sburl.com I I 2014 LIQUOR LICENSE RENEWAL APPLICATION 406-011—SECN-001 SECOND CLASS LICENSE TO SELL MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Jolley Associates LLC Licensee # 406- 11 Doing Business As: Short Stop #104 Mailing Address: 1830 Shelburne Road P.O. Box 671 South Burlington VT 05403 St. Albans VT 05478-0671 Telephone: (802) 658-2965 PLEASE INCLUDE EMAIL ADDRESS: d.-r-i„ Z—c \\0 , ' vo\\ -``1 , Description of Premises: Premises: XX Owned Leased Grocery store in a one-story concrete block building, being approximately 3,120 square feet in size and located on the corner of Shelburne Road and Allen Road and designated as 1830 Shelburne Road, in the City of South Burlington, Vermont. Last Enforcement Seminar: 04/02/2013 Filed Articles of Organization: Yes Date Filed: 01/01/2013 Federal ID Number: 99-9999999 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability CarPanY Name Address Town/City State Zip Code , Member 1. Jolley, Bruce 180 Overlake Drive Colchester VT 05446 Member 2. Jolley, Robert, Estate of 180 Overlake Drive Colchester VT 05446 Has any person been convicted or pleaded guilty to any criminal or otpr vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes (�C1To If yes, please attach the following information: Individual's name, co /traffic bureau, offense and date In the past year has any person held any el�eve or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? _Yes /'Jt No If yes, please attach the following informati n: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full • , compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page _ �� --,7- �� or, Jo 3 L f l 2014 LIQUOR LICENSE RENEWAL APPLICATION 406-011-SECN-001 SECOND CLASS LICENSE TO SFTJ,MALT AND VINOUS BEVERAGES Page 2 I/We hereby certifythat the information in this application is true and complete. Dated this` 3 " day of 't)/t) / Signature of authorized agent Signe - .f individua or • .7)110/ of corporation, company, club or association I •fr % (Title) Are you making this application for the benefit of any other party? Yes t XPIo Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED �w ai .Approved by Board of Control Commissioners of -e City of .+ of . i� 1/ Total Membership , members present t C.�i!Itwn Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of seleLLftIn or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 i- 2014 TOBACCO LICENSE RENEWAL APPLICATION 406-011-TOBC-001 TOBACCO LICENSE TO SFT,J TOBACCO Page 1 Optional Fee: $100.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $0.0 0 is paid to town/city $100.00 is paid to DLC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Jolley Associates LLC Licensee # 406- 11 Doing Business As: Short Stop #104 Mailing Address: 1830 Shelburne Road P.O. Box 671 South Burlington VT 05403 St. Albans VT 05478-0671 PLEASEe INCLUDE(802) 5 EMAIL 6ADDRESS: e-C'‘ cC.) 'Qr\\ (. 3bc ID`\GA/ , CO Description of Premises: Premises: XX Owned Leased Grocery store in a one-story concrete block building, being approximately 3,120 square feet in size and located on the corner of Shelburne Road and Allen Road and designated as 1830 Shelburne Road, in the City of South Burlington, Vermont. Last Enforcement Seminar: 04/02/2013 Filed Articles of Organization: Yes Date Filed: 01/01/2013 Federal ID Number: 99-9999999 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. Jolley, Bruce 180 Overlake Drive Colchester VT 05446 • Member 2. Jolley, Robert, Estate of 180 Overlake Drive Colchester VT 05446 Has any person been convicted or pleaded guilty to any criminal or t vehicle offense in any court of law (including traffic tickets by mail) raring the last year? Yes NQ�Q If yes, please attach the following information: Individual's name,daft/traffic bureau, offense and date In the past year has any person held any ele. ive or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? _Yes t If yes, please attach the following infonnati : Individual's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this application is true and complete. Dated this��� day of c J06-1l C , ;;;)(2)/ i_-/ il Signature of authorized agent Sin 1'- of indivi. - or .. i, er:00110,11/1105:7 of corporation, congknny, club or association �' /% i/ (Title) Are you making this application for the benefit of any other party? Yes t/(No Continued on next page 1—; ( -Gc\ \r-Th _C(-CM Q tom -. c-Th . /0 - -i- ��/Li 2014 TOBACCO LICENSE RENEWAL APPLICATION 406-011—TOBC-001 TOBACCO LICENSE TO SFr.r TOBACCO Page 2 Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on • the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual ccnmissioner registering either approval or disapproval. Lease or title most be recorded in town or city before issuance of license. APPROVED DISAPPROVED • 4.1 Approved by Board of Control Commissioners of . e City o Town of env Total Membership :' _ members present , Town Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 .► City of South Burlington * V ®.o City Clerk's Office ; ' Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ TRADENAME 41 ADDRESS /3/4 %111 -DY r . FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DEPT ter' 3\SANf Chief Douglas S, Brent Date SO. BURLINGT N TAX 4 , . ` 4/(iiii Martha Lyons, Depu Collector Date sent to Montpelier: 1"\°D 575 Dorset Street Smith Rnrlinntnn VT M40; R(17-R4R-tllfl5 lkinvillmt?chnrl rum I • 2014 LIQUOR LICENSE RENEWAL APPLICATION 406-007-SECN-001 SECOND CLASS LICENSE TO SF•iT MALT AND VINOUS BEVERAGES Fee: $1 4 0.0 0 of which License Year Beginning May 1, 2014 ending April 30, 2015 $7 0.0 0 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Jolley Associates LTC' Licensee # 406- 7 Doing Business As: Short Stop #105 Mailing Address: 1314 Williston Road P.O. Box 671 South Burlington VT 05403 St. Albans VT 05478-0671 • Telephone: (802) 658-4635 `_ PLEASE INCLUDE EMAIL ADDRESS: �t°Yi-Na-CL-�lC,\\C'15 c.. \C)\, .- -C� Description of Promises: J Premises: XX Owned Leased Grocery store in a one story building approx. 936 sq. ft. located on the northwest corner of intersection of Williston Rd. & Patchen Rd. designated as 1314 Williston Rd., City of South Burlington, VT. Last Enforcement Seminar: 11/19/2013 Filed Articles of Organization: Yes Date Filed: 01/01/2013 Federal ID Number: 99-9999999 Majority of Members are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Limited Liability Town/City State Zip Code Co many N� Address Member 1. Jolley, Bruce 180 Overlake Drive Colchester VT 05446 Member 2. Jolley, Robert, Estate of 180 Overlake Drive Colchester VT 05446 Has any person been convicted or pleaded guilty to any criminal or u•tor vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes /,, • If yes, please attach the following information: Individual's name, co t/traffic bureau, offense and date In the past year has any person held any e e ive or appointive state, county, city, village or town office in Vermont (See USA, T.7, Ch.9, Sec. 223)? Yes If yes, please attach the following informatio : Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full campliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) that I/We are in good In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties ofperjury, standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this applica ion is true and complete. Dated this)45-\- day of CZta.,s' , ;:;;?O// j Signature o£ authorized agent Signature ' dividual or er of corporation, company, club or association (Title) Are you making this application for the benefit of any other party? Yes YIo Continued on next page i 2014 LIQUOR LICENSE RENEWAL APPLICATION 406-007-SECN-001 SECOND CLASS LICENSE TO SETT MALT AND VINOUS BEVERAGES Page Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual cczmsissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED • Approved by Board of Control Commissioners of it�t of _/• r/ '1E410 Total Membership 6 members present +�►rY]` 11, Town Clerk TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 t 2014 TOBACCO LICENSE RENEWAL APPLICATION 406-007-TOBC-001 TOBACCO LICENSE TO SFr.T TOBACCO Page 1 Optional Fee: $100.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $0.0 0 is paid to town/city $100.00 is paid to DLC Fee due only if licensee does not have a liquor license Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: Jolley Associates LLC Licensee # 406- 7 Doing Business As: Short Stop #105 Mailing Address: 1314 Williston Road P.O. Box 671 South Burlington VT 05403 St. Albans VT 05478-0671 Telephone: (802) 658-4635 PLEASE INCLUDE EMAIL ADDRESS: .�C,--,e_.\\ a tcc,o\\O"J. Core-) , Description of Premises: Premises: XX Owned Leased Grocery store in a one story building approx. 936 sq. ft. located on the northwest corner of intersection of Williston Rd. & Patchen Rd. designated as 1314 Williston Rd., City of South Burlington, VT. Last Enforcement Seminar: 11/19/2013 Filed Articles of Organization: Yes Date Filed: 01/01/2013 Federal ID Number: 99-9999999 Majority of Members are US Citizens: Yes • ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING TICE PAST YEAR. Limited Liability Company Name Address Town/City State Zip Code Member 1. Jolley, Bruce 180 Overlake Drive Colchester VT 05446 Member 2. Jolley, Robert, Estate of 180 Overlake Drive Colchester VT 05446 Has any person been convicted or pleaded guilty to any criminal or t r vehicle offense in any court of law (including traffic tickets by mail) during the last year? Yes o If yes, please attach the following information: Individual's name/traffic bureau, offense and date In the past year has any person held any elect've or appointive state, county, city, village or town office in Veu,unt (See VSA, T.7, Ch.9, Sec. 223)? Yes If yes, please attach the following informatior2. Individual's name, office and jurisdiction ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. . I/We have registered the trade name of these premises with the Secretary of State. I/We hereby certify that the information in this �application/ is true and complete. Dated this) day of G)t,Q; , OC�4 7 "Pl. Signature of authorized agent individual or •. - of corporation, company, club or association ��/ ---���/, (Title) Are you making this application for the benefit of any other party? Yes ✓Np Continued on next page (°vimv i- C Q C 2 Nt �c y-, --) - )0 �-- "3 ) - /L-/ 2014 TOBACCO LICENSE RENEWAL APPLICATION 406-007-TOBC-001 TOBACCO LICENSE TO SFJ TOBACCO Page 2 /Jpon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Veinunt Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control Board for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners of • - p Town of cS'., Town Clerk Total Membership ) , members present 1 TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city hoard of aldermen on a tobacco license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 • 4 ,40 .0 City Southurlington ►�®� City Cleric's Office Donna Kinville, City Clerk FIRST, SECOND CLASS AND CABARET"LICENSE APPLICATION FULL NAME OF PERSON, PARTNERSHIP, CORPORATION DOING BUSINESS AS/ T",t AME K 0367 ADDRESS q G f r FIRST CLASS SECOND CLASS CABARET DATE RECEIVED BY CLERK'S OFFICE SO. BURLINGTON POLICE DEPT Chief Trevor S. Whipple Date SO. BURLINGTON FIRE DE 31141�f Chief Douglas S. Brent11 Date SO. BURLINGTO TAX DEPT Martha Lyons, ITeput ax Collector Date sent to Montpelier: 575 Dorset Street South Burlington,VT 05403 802-846-4105 . dkinville@sburl.com E • 2014 LIQUOR LICENSE RENEWAL APPLICATION 7199-002-SECN-001 SECOND CLASS LICENSE TO SETT MALT AND VINOUS BEVERAGES Page 1 Fee: $140.00 of which License Year Beginning May 1, 2014 ending April 30, 2015 $70.00 is paid to town/city $70.00 is paid to DLC Town: 04065 - SOUTH BURLINGTON MISREPRESENTATION OF A MATERIAL FACT ON ANY LICENSE APPLICATION SHALL BE GROUNDS FOR SUSPENSION OR REVOCATION OF THE LICENSE, AFTER NOTICE AND HEARING Applicant: Review all of the information presented on this form, indicating any changes in the spaces provided. Applicant: K Mart Corporation Licensee # 7199- 2 Doing Business As: K Mart #7039 Mailing Address: 947 Shelburne Road Dept 768 Tax B2-113A • South Burlington VT 05403 3333 Beverly Road Telephone: (802) 864-4575 of� Estates IL 60179 S T `G�C�� PLEASE INCLUDE EMAIL ADDRESS: le CC OV e . OC P. Description of Premises: Lessor: Store in a single story block building in a strip mall at the Martins Foods of S. Burlington intersection of Queen City Parkway & Shelburne Road designated as attn Real Estate Dept PO 1000 #947 Shelburne Road in the city of South. Burlington, VT Portland ME 04104 Last Enforcement Seminar: 02/15/2013 Fed. ID Number: 38-0729500 Incorporation Date: 07/13/2004 Valid Charter?: Yes State of Charter: Michigan Majority of Directors are US Citizens: Yes ATTACH AN ADDITIONAL SHEET TO THIS APPLICATION NOTING ANY NECESSARY CORRECTIONS OR CHANGES AND UPDATES THAT HAVE OCCURRED DURING THE PAST YEAR. Corporation Name Address Town/City State Zip Code President 1. Johnson, W. Bruce 1310 N Astor Street Chicago IL 60610 Secretary 2. Meerschaert, Lawrence J. 4950 Pickford Drive Troy MI 48098 Director 3. Johnson, W. Bruce 1310 N Astor Street Chicago IL 60610 Director 4. Meerschaert, Lawrence J. 4950 Pickford Drive Troy MI 48098 Director 5. Jasser, Alfred H 951 Drake Road Glenview IL 60025 Director 6. Phelan, William K. 4950 Pickford Drive Troy MI 48098 Stockholder 7. K Mart Corporation, Detroit MI Has any director or stockholder been convicted or pleaded guilty to any cr�l or motor vehicle offense in any court . of law (including traffic tickets by mail) during the last year? _Yes No If yes, please attach the following information: Individual's name, court/traffic bureau, offense and date In the past year has any director or stockholder of the corporation held any elenive or appointive state, county, city, village or town office in Vermont (See VSA, T.7, Ch.9, Sec. 223)? Yes No If yes, please attach the following information: Individual's name, office and jurisdiction Disclosure of Non-profit Organization?: Yes XX No ALL APPLICANTS MUST COMPLETE AND SIGN The applicant understands and agrees that the Liquor Control Board may obtain criminal history record information from State and Federal record repositories. I/We hereby certify, under the pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan approved by the Commissioner of Taxes to pay any and all taxes due the State of Vermont as of the date of this application. (VSA, Title 32, Section 3113) I/We hereby certify that I/We are not under an obligation to pay child support or that I/We are in good standing with respect to child support or are in full compliance with a plan to pay any and all child support payable under a support order. (VSA, Title 15, Section 795) In accordance with 21 VSA, Section 1378(b), I/We certify, under pains and penalties of perjury, that I/We are in good standing with respect to or in full compliance with a plan to pay any and all contributions or payments in lieu of contributions due to the Department of Employment and Training. I/We have registered the trade name of these premises with the Secretary of State. Continued on next page 2014 LIQUOR LICENSE RENEWAL APPLICATION 7199-002—SECN-001 SECOND CLASS LICENSE TO SFTT MALT AND VINOUS BEVERAGES Page 2 I/We hereby certify that the information in this application is true and complete. Dated this tr-522ay of \\-k -ture of authoriz-• Signature of individual or partners of c• ation, c• y_,y, c •sociation (Title) Are you making this application for the benefit of any other party? Yes KNo Upon being satisfied that the conditions precedent to the granting of this license as provided in Title 7 of the Vermont Statutes Annotated, as amended, have been fully met by the applicant, the commissioners will endorse their recommendation on the back of the application and transmit it to the Liquor Control pnard for suitable action thereon, before any license may be granted. For the information of the Liquor Control Control Board, all applications shall carry the signature of each individual commissioner registering either approval or disapproval. Lease or title must be recorded in town or city before issuance of license. APPROVED DISAPPROVED Approved by Board of Control Commissioners o of Total Membership :J , members present tt ` leek TOWN OR CITY CLERK SHALL MAIL APPROVED RENEWAL DIRECTLY TO: DEPARTMENT OF LIQUOR CONTROL 13 GREEN MOUNTAIN DRIVE MONTPELIER, VT 05602 • If application is disapproved, local control commissioners shall notify the applicant by letter. No formal action taken by any agency or authority of any town board of selectmen or city board of aldermen on a first or second class license application shall be considered binding except as taken or made at an open public meeting. VSA T-1,Sec.312 ®r -� City of South Burlington �4 V City Clerk's Office tomDonna Kinville, City Clerk SPECIAL EVENT(ENTERTAINMENT) OR CATERING PERMIT ' A/'?)/11' 11)( FULL NAME OF PERSON, PARTNERSHIP OR CORPORATION: o CONTACT PHONE NUMBER OR E-MAIL: rip oryi ADDRESS:r6 TD DATE RECEIVED BY CLERK'S OFFICE: - i,/6))/4 POLICE APPROVED: ! . . DATE: 121. FIRE APPROVED: ail/ DATE: / ZONING APPROVED: ail) DATE: .3a ' /- RECREATION APPROVED: DATE: HIGHWAY/HEALTH DEPT APPROVED: C;) i DATE: CITY COUNCIL DATE: v! / DATE SENT TO MONTPELIER: STATE OF VERMONT / DEPARTMENT OF LIQUOR CONTROL 2/' 13 Green Mountain Drive (CarizIaD� Montpelier,VT 05602 APPLICATION FOR SPECIAL EVENT PERMI Fee: $35.00 Check payable to Vermont Department of Liquor Control must accompany this application Licensee name Su...)% + b0,44 17P IA-)Q (- ) -t✓-- d/b/a 5 ifv i Yt h t, ..'.. i u 0 r'd -s /Yl ) l h-e_ Address: / jt Q C/y ) ,Arai? Town/City: )r I Y2Gr Yl Zip 0 J 6 I Manufacturer's License No: 55 3 y Z _ O 6 I -n'G 4 Email: Canclav z ✓ (4'mg' 1. Describe the special event: far" � 2. Location(specify defined area, include address of event): �/�hi1" (3,'D I/y1C L J Ct I Y c e f7'1 b� J /) tti+( \ s)v rn iced BU I) Yz e ion -1,77 0311 3. Date of event: ill v rs C%G pr';) �`h 2 G/y 4. Hours of operation: Beginning 7- 6 f Ending 91 CO Pik, Signed: aet60 i` '1 -'' ' ' Date 3 + / / z 01 (manufacturer) (circle one) APPROVED DISAPPROVED Town/City Clerk signature Town/City Date Submit to Town/City at location of special event. After action by local control commissioners, this application will be forwarded to the Vermont Liquor Control Board at least 5 days prior to the date of the event. Laura From: Justin Rabidoux Sent: Tuesday, March 25, 2014 10:39 AM To: Laura Subject: RE: permits/ent licenses Ok with me From: Laura Sent:Tuesday, March 25, 2014 10:37 AM To:Trevor Whipple;Terry Francis; ray;Justin Rabidoux Subject: permits/ent licenses Hello- Attached are two 2014 annual entertainment licenses for Sheraton& Franny O's.also one for another taste testing event at Higher Ground on 4/24/2014. Let me know if ok. Laura ea ; Laura Kimball Deputy City Clerk City of South Burlington 575 Dorset Street South Burlington,Vt. 05403 lkimball@sburl.com Notice-Under Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared for use in matters concerning City business,concerning a City official or staff,or containing information relating to City business are likely to be regarded as public records which may be inspected by any person upon request,unless otherwise made confidential by law.if you have received this message in error,please notify us immediately by return email.Thank you for your cooperation. 1 Laura From: ray Sent: Tuesday, March 25, 2014 11:27 AM To: Laura Subject: RE: permits/ent licenses No zoning issues. Ray Beiair Administrative Officer City of So. Burlington 575 Dorset Street So. Burlington, VT 05403 802-846-4106 www.sburl.com www.sboathtosustainabilitv.com Notice-Under Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared for use in matters concerning City business,concerning a City official or staff or containing information relating to City business are likely to be regarded as public records which may be inspected by any person upon request,unless otherwise made confidential by law.If you have received this message in error,please notify us immediately by return email. Thank you for your cooperation. From: Laura Sent:Tuesday, March 25, 2014 10:37 AM To:Trevor Whipple;Terry Francis; ray;Justin Rabidoux Subject: permits/ent licenses Hello- Attached are two 2014 annual entertainment iiceiises for Sheraton. P Frannv 0's,also cne for another taste testing event at Higher Ground on 4/24/2014. Let me Kris w if ok. Laura fir ' Laura From: Justin Rabidoux Sent: Tuesday, March 25, 2014 10:39 AM To: Laura Subject: RE: permitslent licenses Ok with me From: Laura Sent:Tuesday, March 25, 2014 10:37 AM To:Trevor Whipple;Terry Francis; ray;Justin Rabidoux Subject: permits/ent licenses Hello- Attached are two 2014 annual entertainment licenses for Sheraton & Franny O's.also one for another taste testing event at Higher Ground on 4/24/2014. Let me know if ok. Laura e 044 • Laura Kimball Deputy City Clerk City of South Burlington 575 Dorset Street South Burlington,Vt. 05403 lkimball@sburl.com Notice-Under Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared for use in matters concerning City business,concerning a City official or staff,or containing information relating to City business are likely to be regarded as public records which may be inspected by any person upon request,unless otherwise made confidential by law.If you have received this message in error,please notify us immediately by return email. Thank you for your cooperation. 1 • Laura From: ray Sent: Tuesday, March 25, 2014 11:27 AM To: Laura Subject: RE: permits/ent licenses No zoning issues. Ray Belau- Administrative Officer City of So. Burlington 575 Dorset Street So. Burlington, VT 05403 802-846-4106 www.sburl.com www.sbpathtosustainability.com Notice-Under Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared for use in matters concerning City business,concerning a City official or staff,or containing information relating to City business are likely to be regarded as public records which may be inspected by any person upon request,unless otherwise made confidential by law.if you have received this message in error,please notify us immediately by return email. Thank you for your cooperation. From: Laura Sent:Tuesday, March 25,2014 10:37 AM To:Trevor Whipple;Terry Francis; ray;Justin Rabidoux Subject: permits/ent licenses Hello- Attached are two 2014 annual entertainment licenses for Sheraton & Franny 0's.also one for another taste testing event at Higher Ground on 4/24/2014. Let me know if ok. Laura v4or are Laura Kimball Deputy City Clerk City of South Burlington 575 Dorset Street South Burlington,Vt. 05403 lkimball@sburl.com Notice-Under Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared for use in matters concerning City business,concerning a City official or staff,or containing information relating to City business are likely to be regarded as public records which may be inspected by any person upon request,unless otherwise made confidential by law.If you have received this message in error,please notify us immediately by return email Thank you for your cooperation. 1 Laura From: Trevor Whipple [twhipple@sbpdvt.org] Sent: Tuesday, March 25, 2014 10:42 AM To: Laura Subject: RE: permitslent licenses No issues. Approved. Trevor S.Whipple Chief of Police,City of South Burlington 19 Gregory Drive,South Burlington,VT 05403-6047 802-846-4155 twhipple@sbpdvt.org Notice•Under Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared for use in matters concerning City business,concerning a City official or staff,or containing information relating to City business are likely to be regarded as public records which may be inspected by any person upon request,unless otherwise made confidential by law.If you have received this message in error,please notify us immediately by return email,Thank you for your cooperation. From: Laura [mailto:laura@sburl.com] Sent: Tuesday, March 25, 2014 10:37 AM To: Trevor Whipple; Terry Francis; ray; Justin Rabidoux Subject: permits/ent licenses Hello- Attached are two 2014 annual entertainment licenses for Sheraton & Franny O's.also one for another taste testing event at Higher Ground on 4/24/2014. Let me know if ok. Laura van ic,E0 er Laura Kimball Deputy City Clerk City of South Burlington 575 Dorset Street South Burlington,Vt. 05403 lkimballt sburl.com Notice-Under Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared for use in matters concerning City business,concerning a City official or staff,or containing information relating to City business are likely to be regarded as public records which may be inspected by any person upon request,unless otherwise made confidential by law.If you have received this message in error,please notify us immediately by return email.Thank you for your cooperation. 1 Laura From: Terry Francis Sent: Tuesday, March 25, 2014 4:01 PM To: Laura Subject: RE: permits/ent licenses Both Ok from FMO From: Laura Sent: Tuesday, March 25, 2014 10:37 AM To:Trevor Whipple; Terry Francis; ray; Justin Rabidoux Subject: permits/ent licenses Hello- Attached are two 2014 annual entertainment licenses for Sheraton& Franny O's.also one for another taste testing event at Higher Ground on 4/24/2014. Let me know if ok. Laura rVit sr Laura Kimball Deputy City Clerk City of South Burlington 575 Dorset Street South Burlington,Vt. 05403 lkimball@sburl.com Notice-Under Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared for use in matters concerning City business,concerning a City official or staff,or containing information relating to City business are likely to be regarded as public records which may be inspected by any person upon request,unless otherwise made confidential by law.If you have received this message in error,please notify us immediately by return email. Thank you for your cooperation 1 City ,of South Burlington ��� � City Clerk's Office Donna Kinville, City Clerk SPECIAL EVENT(ENTERTAINMENT) OR CATERING PERMIT �u�T 1-1 FULL NAME OF PERSON, PARTNERSHIP OR CORPORATION: ino►-�' i r '� 111 in er CONTACT PHONE NUMBER OR E-MAIL: ADDRESS: DATE RECEIVED BY CLERK'S OFFICE: • POLICE APPROVED: DATE: FIRE AP PROVED: t/7 DATE: 3 -,R4 "/2-A ZONING APPROVED: O‘K DATE: 3 A i4 RECREATION APPROVED: DATE: � J� if HIGHWAY/HEALTH DEPT APPROVED: C1 1 ' DATE: CITY COUNCIL DATE: / DATE SENT TO MONTPELIER: STATE OF VERMONT DEPARTMENT OF LIQUOR CONTROL 13 Green Mountain Drive Montpelier,VT 05602 APPLICATION FOR SPECIAL EVENT PERMIT Fee: $35.00 Check payable to Vermont Department of Liquor Control must accompany this application Licensee name Vermont Spirits Distilling Company dPo/a Vermont Spirits Address: 5573 Woodstock Rd Town/City: Quechee Zip 05059 Manufacturer's License No: 4417-001-MFSL-01 Email: mimi@vermontspirits.com 1. Describe the special event: VT Restaurant Week"Sweet Start Smackdown" 2. Location(specify defined area,include address of event): tasting will take place at an a t table inside Higher Ground Higher Ground Ballroom, 1214 Williston Road, S. Burlington. 3. Date of event: Thursday April 24th 4. Hours of operation: Beginnin 6 Ending 9.30 pm Signed: Date 3-24-14 m u toter) (circle one) APPROVED DISAPPROVED Town/City Clerk signature Town/City Date Submit to Town/City at location of special event. After action by local control commissioners, this application will be forwarded to the Vermont Liquor Control Board at least 5 days prior to the date of the event. donna From: Trevor Whipple <twhipple@sbpdvt.org> Sent: Monday, March 24, 2014 3:38 PM To: donna Subject: RE: Special Event Permit Higher Ground No concerns. Approved. Trevor S.Whipple Chief of Police,City of South Burlington 19 Gregory Drive, South Burlington,VT 05403-6047 802-846-4155 twhipple ct sbpdvt.org Notice-Crider Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared for use in matters concerting City business,concerning a City official or staff;or containing information refitting to City business are likely'w be regarded as public l'eern its which may be inspected by any person upon request,unless otherwise made confidential by lays_If you have r eeeised this message in error,please notify us immediately by return email.Thank you for your cooperation. From: donna [mailto:dkinville@sburl.com] Sent: Monday, March 24, 2014 3:23 PM To: Trevor Whipple; Justin Rabidoux; ray;Terry Francis; Laura Subject: FW: Special Event Permit Higher Ground Attached is a special permit application. Could you please let me know if you approve or have issues with the event by Friday. Thanks. Donna Derma R'rrtuiete South Burlington City Clerk 802-846-4119 dkinville@sburl.com Notice-Under Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared for use in matters concerning City business,concerning a City official or staff,or containing information relating to City business are likely to be regarded as public records which may be inspected by any person upon request,unless otherwise made confidential by law.If you have received this message in error,please notify us immediately by return emaiL Thank you for your cooperation. From: Mimi Buttenheim [mailto:mimi@vermontspirits.com] Sent: Monday, March 24, 2014 2:52 PM To: donna Subject: Special Event Permit Higher Ground Dear Donna, donna From: Justin Rabidoux Sent: Monday, March 24, 2014 3:48 PM To: donna Subject: Re: Special Event Permit Higher Ground Attachments: image002jpg; image001 jpg Ok with me >On Mar 24,2014, at 3:23 PM,"donna"<dkinville@sburl.com>wrote: >Attached is a special permit application. Could you please let me know if you approve or have issues with the event by Friday. >Thanks. > Donna > Donna Kinville >South Burlington City Clerk >802-846-4119 >dkinville@sburl.com<mailto:dkinville@sburl.com> > [sb_clerk_logo_full_rgb] > Notice-Under Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared for use in matters concerning City business,concerning a City official or staff,or containing information relating to City business are likely to be regarded as public'ecords which may be inspected by any person upon request,unless otherwise made confidential by law. If you have received this message in error, please notify us immediately by return email.Thank you for your cooperation. > From: Mimi Buttenheim[mailto:mimi@vermor tspirits.com] ""1"!pK7Felbr.Or,V4M"t"r rhWMt ^!m;tf Pii�:;...w donna From: Trevor Whipple <twhipple@sbpdvt.org> Sent:. Monday, March 24, 2014 3:38 PM To: donna Subject: RE: Special Event Permit Higher Ground No concerns. Approved. Trevor S.Whipple Chief of Police,City of South Burlington 19 Gregory Drive,South Burlington,VT 05403-6047 802-846-4155 twhipple@sbpdvt.org sbpdvt.org Notice-lender Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of€ocuments received or prepared for use in matters - concerning City business,concerning a City official or staff,or containing information relating to(:its'business are likely to he regarded as public records which may be inspected by any person upon request,unless otherwise made confidential by law,If son have received this message in error,please notify us immediately by return email.Thank you fin-your cooperation. From: donna [mailto:dkinville@sburl.com] Sent: Monday, March 24, 2014 3:23 PM- To:Trevor Whipple; Justin Rabidoux; ray;Terry Francis; Laura Subject: FW: Special Event Permit Higher Ground Attached is a special permit application. Could you please let me know if you approve or have issues with the event by Friday. Thanks. Donna oytatet, R.4tuiete South Burlington City Clerk 802-846-4119 dkinville@sburl.com Notice-Under Vermont's Public Records.Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared for use in matters concerning City business,concerning a City official or staff,or containing information relating to City business are likely to be regarded as public records which may be inspected by any person upon request,unless otherwise made confidential by law.If you have received this message in error,please notify us immediately by return entail Thank you for your cooperation. From: Mimi Buttenheim [mailto:mimi©vermontspirits.com] Sent: Monday, March 24, 2014 2:52 PM To: donna Subject: Special Event Permit Higher Ground Dear Donna, i donna From: Justin Rabidoux Sent: Monday, March 24, 2014 3:48 PM To: donna Subject: Re: Special Event Permit Higher Ground Attachments: image002 jpg; image001 jpg Ok with me >On Mar 24,2014,at 3:23 PM, "donna"<dkinville@sburl.com>wrote: >Attached is a special permit application. Could you please let me know if you approve or have issues with the event by Friday. >Thanks. > Donna > Donna Kinville >South Burlington City Clerk >802-846-4119 >dkinville@sburl.com<mailto:dkinville@sburl.com> > > [sb_clerk_logo_full_rgb] > Notice- Under Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared for use in matters concerning City business,concerning a City official or staff,or containing information relating to City business are likely to be regarded as public records which may be inspected by any person upon request, unless otherwise made confidential by law. If you have received this message in error, please notify us immediately by return email.Thank you for your cooperation. > From: Mimi Buttenheim [mailto:mimi@vermontspirits.com] >Sent: Monday, March 24,2014 2:52 PM >To:donna • >Subject:Special Event Permit Higher Ground >Dear Donna, >Attached is a special event permit for the"Sweet Start Smackdown,"the first event to kick off Vermont Restaurant Week. > Details of the event here: http://www.vermontrestaurantweek.com/events/ >We are one of the sponsors of VT Restaurant Week and have been asked to provide a sampling booth for our spirits. >We have already sent a check to the DLC. If you approve the permit, please fax it to the DLC at 802-828-1031 or email to DLC-Enf.Lic@state.vt.us<mailto:DLC-Enf.Lic@state.vt.us>. > Please let me know if you have any questions. 1 donna From: ray Sent: Monday, March 24,2014 4:09 PM To: donna Subject: RE: Special Event Permit Higher Ground No zoning issues. Ray Belair Administrative Officer City of So. Burlington 575 Dorset Street So. Burlington, VT 05403 802-846-4106 www.sburl.com www.sbpathtosustainability.com Notice-Under Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared for use in matters concerning City business,concerning a City official or staff or containing information relating to City business are likely to be regarded as public records which may be inspected by any person upon request,unless otherwise made confidential by law.If you have received this message in error,please notify us immediately by return email. Thank you for your cooperation. From:donna Sent: Monday, March 24,2014 3:23 PM To:Trevor Whipple (twhipple@sbpdvt.org);Justin Rabidoux; ray;Terry Francis; Laura Subject: FW:Special Event Permit Higher Ground Attached is a special permit application. Could you please let me know if you approve or have issues with the event by Friday. Thanks. Donna Daoutet Rutesif'E'e South Burlington City Clerk 802-846-4119 dkinville@sburl.com Notice-Under Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared for use in matters concerning City business,concerning a City official or staff,or containing information relating to City business are likely to be regarded as public records which may be inspected by any person upon request,unless otherwise made confidential by law.If you have received this message in error,please notify us immediately by return email. Thank you for your cooperation. From: Mimi Buttenheim [mailto:mimi©vermontspirits.com] Sent: Monday, March 24, 2014 2:52 PM To: donna Subject: Special Event Permit Higher Ground 1 donna From: Terry Francis Sent: Monday, March 24, 2014 4:19 PM To: donna Subject: RE: Special Event Permit Higher Ground Ok from FMO • From: donna Sent: Monday, March 24, 2014 3:23 PM To:Trevor Whipple (twhipple(a sbpdvt.orq); Justin Rabidoux; ray;Terry Francis; Laura Subject: FW: Special Event Permit Higher Ground Attached is a special permit application. Could you please let me know if you approve or have issues with the event by Friday. Thanks. Donna nowt R'earg ee South Burlington City Clerk 802-846-4119 dkinville@sburl.com Notice-Under Vermont's Public Records Act,all e-mail,e-mail attachments as well as paper copies of documents received or prepared fir use in matters concerning City business,concerning a City official or staff,or containing information relating to City business are likely to be regarded as public records which may be inspected by any person upon request,unless otherwise made confidential by law.If you have received this message in error,please notify as immediately by return emaiL Thank you for your cooperation. From: Mimi Buttenheim [mailto:mimi©vermontspirits.com] Sent: Monday, March 24, 2014 2:52 PM To: donna Subject: Special Event Permit Higher Ground Dear Donna, Attached is a special event permit for the "Sweet Start Smackdown," the first event to kick off Vermont Restaurant Week. Details of the event here: http://www.vermontrestaurantweek.com/events/ We are one of the sponsors of VT Restaurant Week and have been asked to provide a sampling booth for our spirits. i