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Home My WebLink About05/17/2006 Blue Sheet Oldfather Inn Change Agent Liquor License TOWN COUNCIL MEETING INFORMATION TOWN OF MARANA MEETING DATE May 17, 2006 AGENDA ITEM: I. 6 TO: MAYOR AND COUNCIL FROM: Jocelyn C. Bronson, Town Clerk SUBJECT: LiQuor License: Chane:e Ae:ent for Oldfather Inn DISCUSSION Staff is presenting the application for agent change on behalf of Brian Gerard Bouffard for the premises known as the Old Father Inn located at 4080 W. Ina Road. The liquor license for these premises is currently held by Marsha D. Silverman. Arizona Revised Statutes ~ 4-203.F requires that if a person other than those persons originally licensed acquires control over a license or licensee, the person shall file notice of the acquisition with the Director of the Arizona Department of Liquor Licenses & Control within 15 business days after such acquisition of control and a list of officers, directors or other controlling persons. All officers, directors or other controlling persons shall meet the qualifications for licensure as prescribed by statute. The Director shall conduct a preinvestigation prior to the assignment, sale or transfer of control of a license or licensee to determine whether the qualifications for licensure are met. The preinvestigation includes forwarding a copy of the application for agent change to the local governing body having jurisdiction over the premises subject to the acquisition. The local governing body may protest the acquisition within 60 days based on the capability, reliability and qualification of the person acquiring control. If the Director does not receive any protests, the transfer shall be approved within 105 days of the filing of the notice of acquisition and control. A TT ACHMENTS Application of Brian Gerard Bouffard for agent change for the premises known as the Old Father Inn, located at 4080 W. Ina Road. RECOMMENDATION If Council has no objection to the agent change for the premises known as the Old Father Inn, staff requests approval. SUGGESTED MOTION Council's pleasure. JCB/05/10/2006/5:01 PM ARIZONA DEPARTMENT OF LIQUOR LICENSES & CONTROL fV\.O.A.OALtL- 800 W W h' t 5th FI 400 W Congress #521 . as Ing on oor Tucson AZ 85701-1352 Phoenix AZ 85007-2934 ,., (602) 542-5141 (5.:.0) 628-6595 l~.ENT CHANGE~~~rr!.ON OF CONTROL - RESTRUCTURI; Che.ck . Pi" Ii^'t -I 0 2. SLt ~ Innb j,PH \ 8 A 1: 5Lt ADproooate . T.1.1f.'~('\~ I V;liC in' Uij ~. Sox . I \ Q . ~~rf( 'e,'nGlf1'ge' Acquisition O..f Control . I Restructure - om Sections 1.2.3.4.6 Comple19 Sections 1.2. (3,.~\tl~iQQ~~b'N fomplete ~J.rS ~fcn,~R) .5.6 (See Note 1 on back) I l.Q.J1\_ t-' I. I U (Settl'tOlll.2 blMck\. I SECTION 1 (COMPLETE THIS SECTION FOR AGENT CHANGE, ACQUISITION OF CONTROL OR RESTRUCTURE)t) t'D J O{)O \ 1. Name (INDIVIDUAL OR EXISTING AGENT (if no agent change) OR NEW AGENT OR CORPORATE OFFICER OR L.L.C. CONTROLL~ MEMBER) JS ~ '-.}... ~ ;':A-~ (?H,2 I A-N G- -e f 0.. r 0\ () b I 'Z) ~ \~ .s- Last .... . I. First . \ MIddle ~ iQ \ l d\ ~ liquor license # 2.'VfCorporation Ol.L.C. ON/AS N()s ~ DE.\ \ ANO""'CA-~)~.3Corp.File#: o~~':i999~ /""\ (Exactly as it appears on Al~es of Inc. or Artldes of arg.) 3. Business Name: D'l yJ ~t-\:-\-~ -:+=-NN B 101 \~u d- u 0 .-.-~ \.^ d~adly ~s itappears on license) ./') 0..::--, 4 I 4. Business Address: -=r \J ~ c::. w,- -H '" T-r {f::.JJ --r-v (.... ..$L:)f'\.\ r i- M Pr 6 '-' -L _ .. (00 not use P.O. Box Number) Clty COUNTY Zip 5. Is the business located within the incorporated limits of the above city or town? ~s DNo 6. MailingAddress: ~a2-~ ~ ,,:r:..NA: Rd --ru<-~i~ ~L- ~S--74L City te Zip 7. Business Phone: (~) I L~ Lt - \ J.. G G Residence Phone: l5J<J) J Y Y- - ~ ~ ~3 8. Does this transaction involve the sale of any portion of the corporate stock? 1Z\YES 0 NO 0 N/A If yes, submit a certified copy of minutes. . 9. Has there been any change of officers? 13..VES DNO ON/A If yes, submit a certified copy of minutes. . SECTION 2 (COMPLETE THIS SECTION FOR AGENT CHANGE, ACQUISITION OF CONTROL OR RESTRUCTURE) Each person listed in Section II must submit a personal questionnaire (Fonn L1C0101) and a Department approved fingerprint card which may be obtained at the Dept A person appearing in both lists need only submit one questionnaire and fingerprint caret. 1. List individual owner or partners or all directors, officers in corp.. members in LLC: Last First MIddle Title Residence Address > , " ~ 'I . ;, ': .I .. ) 185~ (ATTACH ADDITiONAL SHEET(S) IF NECESSARY) 2. list stockholders or controlling members owning 10% or more of CorpJLLC: Last First Middle % Owned Residence Address .- '(O..c-d UCOl02 09r.!005 1__ ~~c. CSR f~ ~o ~1 ", SECTION 3 (COMPLETE llilS SECTION FOR AGENT CHANGE) 1. If tho corp.oraflonlL.LC. Is owned by another entity, ATTACH AU OWNERSHIP AND DCRECTOR I OFFICER I MEMBER ~~b9SURe for the parent entity. Attach additional sheets 2zS necessary In order to disclose real people. :-\5 sn }\gejlt. will you be physically present and orrerating the licen5ed premises? );Q:YES 0 NO If you ansvlOreG YES, you must provide proof of attendance of a Department appro'o-ed Liquor Law Training Course within the la!rtRvG yealS Jl!tcf! '''2.Yl:...~.p..n!Ication for ~el..tt9~n ~~ $ubmltted. If "no" ~_n~!flagfJr wtth 3ooroved ~ralmn9.n~~.g S1.!.~ubmJtted. ...._"";!:--~ .... ~. ""t::~':'~ ~~~."~ ~ ,____... _:----.-......-.. .......... SECTION 4 (COMPLETl: THiS SECTION Fl:iR AG6t!lA!.C'1.fiI1GE~ P 2: 5 LI lobe completed by the INDMDUAJ.. OR EXISTING AGENT oW~R~bRAtE OFFICER OR L.LC. CONTROLliNG MEMBER: 1. license Number: 06/ OO/,;?) L10. DEP-raf:Ut,~~newaI:13 0.- (7. . rt'"~ L-/ Il- '/:- 2. Current Licensee or Agent: VII (ExaGtly as It appears on lloense) last First Middle I, m 4-'K.sJ-I..A. D i ~)z. S. \ V ~../).')A-N , hereby consent to the agent appointment named herein and (Print full name) agree to immediately assign a new agent in the event of the death, resignation, or discharge of this agent. I also understand that if the background report shows that I, the corporation, or any officer, director, member. or stockholder have been convicted of a felony in the past five (5) years, I Vv'ill immediately surrender the license to the Arizona Department of Liquor Licenses and Control and hereby waiv~ all ri9hZl:tQJ8 ,al such actiOf). f'\ . ;). ''/' - JJ . 1/ State of D(\ TU{\ v, County of ,\ 1"'0 ~ X/ I L.~ y2 4~K-j The foregoing instrument was acknowledged before me this (Slgna~OfINDMOUAU~2~~~~~ft.~~-'" ()\:Y\ ~ (:~'l'Q;'\ La!; ,-,'nn Hancock Os day of ,:;;~.'!u,lf;.:.!';:,\ 'I (\, '.'\1 "ub!:c-Anzona Y ~-''''''''''-'''''iI ...... My commission axpi . ~'''"'.'3:' !~"'a Cc~nty ~J:;-;/ \!v r"., "'<"'l'" ...;~,;-~s ,:/l.*uu9 . - .,;\.. - ,~~~., .~~~~'''":;~.!_-.':,:.':~~~:: :~:.:.:~:~~--~~ SECTION 5 (COMPLETE THIS SECTION FOR RESTRUCTURE) Is there more than one licensed premises involved? paid for each Iicensellocation. Type of current ownership: o J.T.W.R.O.S. o INDIVIDU AL o PARTNERSHIP BCORPORATlON o LIMITED LlABILllY CO. o TRUST o OTHER Explain o YES .~'NO If yes, SEPARATE APPUCA 110NS must be filed and fees Type of new ownership: o J.rw.R.o.s. o INDIVIDUAL o PARTNERSHIP ~ORPORATlON o LIMITED LIABlLlW CO. o TRUST o OlliER Explain SECTION 6 (COMPLETe THIS SECTION FOR AGENT CHANGE, ACQUISITION OF CONTROL OR RESTRUCTURE) To be comp~ by INOMDUAL OR EXlSnNG AGENT (It no agent change) OR NEW AGENT OR CORPORATE OFFICER OR L.L.c. CONTROWNG MEMBER as listed In Question 1 ~ 1: / I, III! 126/1.1} V. 0 I '; t.,;'f/ J111l /1 , hereby declare that I am the APPLICANT filing this application. (Print full name) have read the application and ~ntents and all statements are true, correct and complete. , \/}. .. ~ (), ,.t'/! ~ State of M\{'~[,'.Y\ County of (:\(Y\~ ~_ ~ /:;:/ :.LJA- {,.t(.l~ The foregoing instrument was acknowledged before me this (Signatu'e of 1~~~~ClAt<S~~0?-\; f\ .'\ ,,,<-- r " \ ,.., . ;-'.;(.:))_v:;~'" r:- '- c: n" S1::v d f ' \ If;f..~,,;::.~ i~, Lon lyn~ !ian,cock (~ Oa Morrtl:l \! ?!~,;.~ NO::~i PUOhc-Anzona.~. y .- My commission e ",. ~:~~ P,ma Count'~ ~ rL_ '--/ .::~J;~.,:':'::;:~~~~Y72;'~~c:~~~~~%:; ,P,~!~~bA of NOT Y PUBLIC) NOTE 1: The fee for an agent change MUST be submitted with this appli application and $50.00 for each additional application, not to exceed $1,000.00. (A.R.S. 4-209.H) NOTE 2: The $100.00 fee for restructure MUST be submitted with this application (A.R.S.4-209.A) . , SECTION 3 (COMPLETE THIS SECTION FOR AGENT CHANGE) . 1, lfth~ corporation/L.L.C. Is owned by another entity, AITACH AN OWNERSHIP AND DIRECTOR I OFFICER I MEMBER DISCLOSURE_ for the: parent entity. Attach additional sheets as necessary in order to disclose real people. As nr. Agent, will you be physically present and operating the licensed premises? DYES 0 NO IfY:Jij answered YES, you must provide proof of atiendao.ce of a Department approved. Liquor Law T~nil),Q ~t.lrse wit11in the last five years before your application for Agept can be submitted. If "no" ;j~riUQ\rv.ithJmpf6v~ training .must be submitted. SECTION 4 (COMPLETE THIS SECTION FOR AGENT CHANGE) L I O. 0 E P T. T U C SOH To be completed by the INDIVIDUAL OR EXISTING AGENT OR CORPORATE OFFICER OR L.L.C. CONTROLLING MEMBER: 1. License Number: Date of last renewal: 2. Current Licensee or Agent: (Exactly as it appears on license) Last First Middle I, , hereby consent to the agent appointment named herein and (Print full name) agree to immediately assign a new agent in the event of the death, resignation, or discharge of this agent. I also understand that if the background report shows that I, the corporation, or any officer, director, member, or stockholder have been convicted of a felony in the past five (5) years, I will immediately surrender the license to the Arizona Department of Liquor Licenses and Control and hereby waive all rights to appeal such action. State of County of X The foregoing instrument was acknowledged before me this (Signature of INDIVIDUAU CORPORA TElCLUB OFFICERlMEM8ER) My commission expires on: ..,.. ., ~ '.' . 'J , ,~.!< Month Year . r4~ it. . ~~ ~ ~~t<~:, (COMPLETE THI~ I '.tJiFQRJ:{ES~R6cTJ~~)' ~~$ {J 4 . !J ~~ .~i;;:<;~ ~ ,.~;,' ,'-? Is there more than one licensed premises involved? 0 YES 0 NO If yes, SEPARATE APPLICATIONS must be filed and fees paid for each license/location. TYPE: of current ownership: (~ignature of NOTARY PUBLIC) SECTION 5 ~\ Type of new ownership: D J.T.W.R.O.S. D INDIVIDU AL D PARTNERSHIP o CORPORATION o LIMITED L1ABILllY CO. o TRUST o OTHER Explain o J.TW.R.O.S. o INDIVIDUAL o PARTNERSHIP D CORPORATION o LIMITED L1ABILllY CO. o TRUST o OTHER Explain My commission expires on: SECTION 6 (COMPLETE THIS SECTION FOR AGENT CHANGE, ACQUISITION OF CONTROL OR RESTRUCTURE) To be completed by INDIVIDUAL OR EXISTING AGENT (if no agent change) OR NEW AGENT OR CORPORATE OFFICER OR L.L.C. CONTROLLING MEMBER as listed In Question 1 Section 1: I, t3K / ,~N GM f+-R j, ~ ~~~~, , hereby declare that I am the APPLICANT filing this application. (Prinimii name) ~ ~ have read the application and the contents and all statements are true, IT t and complete. : tVl /i {) ---- r&J A /J ~\.. -112 /'Jtate of County of I ~ ./ X ~OfIN~A~~.~ #ThefOr go ginst entw~s..~~ owIedgedbefO~ ' ~,u,-y CI 1-,,:..., 'j dav of ~ it~' JO/.',\JE L. . \ , J ~ NO',"'"[ ee .o'.^. Day onth Year ~~c:mmIS&IOn ~~~esc~._ ~ ; ::JJ7 ;~ (Sig ature of NOTARY PUBLIC) I/cati n: $100.00 for the first ap NOTE 1: The fee for an agent change MUST be submitted with this ap for each additional application, not to exceed $1,000.00. (A.R.S. 4-209.H) NOTE 2: The $100.00 fee for restructure MUST be submitted with this application (A.R.S.4-209.A) nd $50.00 Brian G. Bouffard Offence: DUI 100b H~'t - \ P 2: S5 Agency: Pima County Sheriff department L10. DEPT. TUCSON Date: 5\17\03 lU~b ~.PR \ 8 A F S 5 UO. OEPT. TUCSON Arrested for DUI on May 17th 2003 stopped at the scene of an accident. 1 year unsupervised probation 1\7\04 to 1 \7\05. 35221 ARIZONA DEPARTMEJ\TT OF LIQUOR LICENSES & CONTROL ,.~~ 800 \V V.fashington 5th Floor I,. ~~~~ Phoenix AZ 85007-2934 \..:~t~~}W (602\ 542-5141 ~.~j~('r"!?- \ J ._ ~ '~~ MA.~ I f) '). I: C 1- __.__....1.1:' , -~........ ,,,,"'=-bJ.,.==-="'--'-'---o'---'~ . . - ..- -.... - ~. "'~. ..--.--. ~lJ-~ - - . - .. . . . .. -- .-:~.lX-r"" 1\\~b ~~\'\ \ 0 ' CtfflIBto/r!lfJJtS1ar.fOMPLETED ALCOHOL TRAINING PROGRAM(S) OH OBTAIN ORIGINALS OF THIS FORM ~ROM OLLC-DO NOT PI-'OTOCOPY, DOCUMENT IS COMPUTER SCANNED. TYk \Q fl . 4CO Vv Congress #150 Tucsi)!1 AZ 85701-1352 (520) 628-6595 r I ALCOHOL TRAINING PROGRAM INDIVIDUAL INFORMATION T OF TRA:NING COMPLETED TRAINER MUST CHE<;K YES OR NO FOR EACH TYPE \ 2- \ ;3 05 Date Training Completed J&I YES 0 NO BASIC ~ YES 0 NO MANAGEMENT ~ YES 0 NO BOTH ~ YES 0 NO ON SALE IZI YES 0 NO OFF SALE DYES 0 NO OTHER IF TRAINEE IS EMPLOYED BY A LICENSEE: aiD 1=-Pr-r~T"\t-~ NAME OF THE LICENSEE BUSINESS NAME LIQUOR LICENSE NUMBER [ALCOHOL TRAINING PROGRAM PROVIDER INFORMATION I Arizona Business Council for Alcohol Education (ABC) Company or Individual Name 500 East Thomas Road # 100 Address Phoenix, C;ty Arizona 85012 (602) 285-1396 State .Zip Phone I Certify the above named individual has successfully completed the specified program(s). T. J. Kuhn l z.. t.3 DS- Date in give original of completed form to trainee, photocopy and maintain completed document for your records. Mandatory Liquor Law Training for all new applications submitted after Nov. 1, 1997. A.R.S. Section 4-112(G}(2). Completion of the Liquor License Training Courses is required at the issuance of a license. The person(s} required to attend both the Basic Liquor Law and Management Training. (either on-sale or off-sale), will indude all of the following: owner(s}, licensee/agent or manager(s) WHO ARE ACTIVELY INVOLVED IN THE DAY TO DAY OPERATION OF THE BUSINESS. Proof of attendance within the last five years for the required courses must be submitted to the Department before the license application is considered complete.' . .... Before acceptance of a Manager's Questionnaire and/or Agent Change for an existing license, proof of attendance for the Basic Uquor Law and Management Training (either on-sale or off-sale) will. be required. we 1021 1012001 Disabled individuals fe'luiring special accommodations please call (602) 542.9051 LyneH J. K~nworthy Arrc::;tcd d0mestic violence 7-6-2000. lOub I-iA Y -. I P 2: S Ll ZOCb WR. I 8 A 1: 55 Pima county justice courts LlO. DEPT. TUCSON L10. OEPT. TUCSON Involved in a dispute which both parties were arrested it was self defence. Offered diversion and was dismissed without prejudice 09-16-2001 r, J csV ^ Vl.t . v~ IN. ~ ~ .~) ~-(h~tt C1LcQ 354 '1 9 ARIZONA DEPARTMENT OF LIQUOR LICENSES & CONTROL 300" W Washington 5th Floer .,"".~ . 400 W Congress #150 Phoenix AZ 85007-2934 ~~. .~-;~/ Tucson AZ 85701-1352 (602) 542-514I ~~;/ (520) 628-6595 ?ni,,, $; \' __ t D '/: .:.:;:: =--:=-=--~~"-== I = =~.<..t:._ _ [ 1~~b ~~R \ L1oS:8~p\flfOCTg'8~ OF COMPLETED ALCOHOL TRAINING PROGRAM(S) ~ OBTAIN ORIGiNALS OF THIS FORM FR~M DLLC.oO NOT PHOTOCOPY. DOCUMENT IS COMPUTER SCANNEO'w\'oe ALCOHOL TRAINING PROGRAM INDIVIDUAL INFORMATION L~'\\~\l /'-'~ TYPE OF TRAINING COMPLETED TRAINER MlJST CHECK YES OR NO FOR EACH TYPE \ --z.. \ ~ C> ::: Date Training Completed ~ YES 0 NO BASIC lXJ YES 0 NO MANAGEMENT !Xl YES 0 NO BOTH ~ YES 0 NO ON SALE [RJ YES 0 NO OFF SALE DYES 0 NO OTHER IF TRAINEE IS EMPLOYED BY A LICENSEE: $ l n\ ~ Q't" Q \ ::]:"(\ V"\.. NAME OF THE LICENSEE BUSINESS NAME LIQUOR LICENSE NUMBER I ALCOHOL TRAINING PROGRAM PROVIDER INFORMATION I Arizona Business Council for Alcohol Education (ABC) Company or Individual Name 500 East Thomas Road #100 Address Phoenix, City Arizona 85012 (602) 285-1396 State Zip Phone I Certify the above named individual has successfully completed the specified program(s). T. J. Kuhn \ 2)~C>S- Date in give original of completed form to trainee, photocopy and maintain completed document for your records. Mandatory Liquor Law Training for all new applications submitted after Nov. 1, 1997. A.R.S. Section 4-112(G)(2). Completion of the Liquor License Training Courses is required at the issuance of a license. The person(s) required to attend both the Basic Liquor Law and Management Training, (either on-sale or off-sale), will include all of the following: owner(s). licensee/agent or manager(s) WHO ARE ACTIVELY INVOLVED IN THE DAY TO DAY OPERA nON OF THE BUSINESS. Proof of attendance within the last five years for the required courses must be submitted to the Department before the license application is considered complete. Before acceptance of a Manager's Questionnaire andlor Agent Change for an existing license, proof of attendance for the Basic Liquor Law and Management Training (either on-sale or off-sale) will be required. we 1021 I0I2ll01 Disabled individuals lUluiring special accommodations please call (602) 542-9051 ~ '1 Paul W. Bouffard 3948 Estancia Dr. f). ~ SS Oceanside, Ca. 92054 200b 1\\A't - I P 2: 5 Lt N~\\ ~~\\ \ ~ J-o To: Arizona Department ofL'emr. ~~e~~ol Qt.?\. ,UCSQH 400 W. Congress #521 UCl. Tucson,~. 85701-1352 To whom it may concern, Questions number 15 & 16 are answered "Yes". This happened in 1997, in Orange County, California. The charge was misdemeanor possession of marijuana. I have no documentation of this. It happened 9 years ago and I through out all memories of it. Please check with the Orange County California Court. Thank You, Paul W. Bouffard y;JadCl/~___ 0/r/-cJ( Sharon M. Boutfard 3948 Esrancia Dr. Oceanside, Ca. 92054 10Gb i~AY -I P 2: S5 To; Arizona Department of Liquor Licenses & Control 400 W. Congress #521 L10. OEPT. TUCSON Tucson, AZ. 85701-1352 lGUb APR I 8 A 1: S. UG. DEPT. TUCSOH To whom it may concern, Questions number 15 & 16 are answered "Yes". This happened in 1997, in Orange County, California. The charge was possession of a controlled substance. Charge was dropped to a misdemeanor. I have no documentation of this. It happened 9 years ago and I through out all memories of it. Please check with the Orange County California Court. Thank You, Shh' M. Bouffard 4I1V!M~;J!. L(-! Lj- ()fJ