,; STATE OF MARYLAND C

!' (MONTGOMERY COUNTY)

APPLICATION FOR RENEWAL OF ALCOHOLIC BEVERAGE LICENSE

NOTE r This application must be filed between 2l1l0o and 3131100 y.,ith the Office of the Board of
License Commissioners for Montgomery County, 16650 Crabbs Branch Way, Rockville,
Maryland, otherwise Licensees filing late applications during the month of April may
be fined an amount not to exceed $50 for each day the application is late.

For the Use of: (Circle One) lndividual Partnership Corporation Ltd. Liability Co. (LLC)

Class of Cunent License: c Current License g. CBhT.CCOOl

Circle One: Beer Wine Beer & Wine Beer, Wine & Liquor

TO THE BOARD OF LICENSE COMMISSIONERS FOR MONTGOMERY COUNW:

Application is made by the undersigned under the provisions of Article 28 of the Annotated Code of
Maryland, as amended, for a renewal of the license now held, and the applicant(s) submit(s) and certify(ies)
to the following information required thereby:

(1) Appiicant(s): Give name(s) and residence(s): PLEASE PRINT.

Pre s id ent
d. E 20 Ashton Rd. Ashton,Md 20861 (sor;774-6990
(Name) (Home Address/Zip Code) (Home Telephone #)
Vice President
h Haril Ge or 7732 Derwood Rd. Derwood, Md 20855 (301) 899-3787
(Name) (Home AddressZip Code) (Home Telephone #)

u. fft;af;grx L,Heureux l4LL2 Chadwick La. Rockville, Md. 20853 (301) 871-8137
(Name) (Home AddressZip Code) (Home Telephone #)

(2) Name of Business Maryland Clubhouse Services, Inc.

3,:

(3) Address of Licensed Premisest 3700 Rossmoor Blvd. S.S. Md . 20906

(4) Name of Corporation (lF APPLICABLE): Maryland clubhouse servj-ces. rnc.

(a) Stockholders:

Name/AddIeSS Wallace V. Ljunnen 3701 Rossmoor Blvd.

Cunnen 3/UI BIvd. S.S. Md.
Md. ShafgS OWned:

Name/Addfess Roberr L. Kenndev 3701 Rossmoor B1vd. S.S. Md. Shares Owned: 1
c/o LEISURE WORLD COMMUNITY CORP.
Name/Addless John Hines 3701 Rossmoor B1vd. s.s. Md. _shares Owned: 1
c/o LEISUns WoiiD
NameiAddISS t,eis.re worlrl Foundarion 3701 Rossmoor Blvd. s.S. Mc1. Shares Owned:492
 (5) Name of LLC (lF APPLICABLE):

(a) Percentage ownership interest of entire LLC:

Name/Address Percentage:

Name/Address Percentage:

Name/Address .Percentage:.

Name/Address Percentage:

(6) Name of Partnership (lF APPLICABLE):

(a) Percentage ownership interest of each partner:

Name/Address Percentage:

Name/Address Percentage:

Name/Address Percentage:

Name/Address Percentage:

lAlVe hereby certifu that the facts and information set forth in the application upon which the present
license was issued are unchanged: YES 1 x ) No ( ) lf no, EXPLAIN on a separate piece of
paper.

(7) Answer YES or NO: lf answer is YES, EXPLAIN on a separate piece of paper. During the cunent
license year, has the applicant(s) been convicted of any of the following:

ia) Violation of Liquor Laws No (b) Violation of Gambling Laws NO

(c) Commission of a Felony uo (d) Violation of Rules/Regulations of Board N0

re) Offense against Laws of Md. No (f) Offense against Laws of U.S. No

(8) During the cunent license year, have there been any convictions of any of the clerks, agents,
employees or seryants of the licensee for violations of the Alcoholic Beverage Laws of the State of Maryland
cr Montgomery County on the licensed premises? Answer YES ( ) NO ( x ):

f YES EXPLAIN:

o
 z+szrrloT PAGE E2

g) urrder the preserrt

what ftnancial inlere.st does the applicant(s) have in the business conducted
zApplicant is a subsidiary of the_ manqg,ement- ?qent..f o
icense? - ,':fy":1':1- prope

or limited liability company in any way financially

10) ts any other persofl, corpo_ration, partnership, to be conducted thereundet? YEs No
nterested in the ricense applied for, or in the business
paper'
f the answer i3 yes, oxplain on a $eparate piece of
LWMC as Tiustee owns fee to l"icen

ALL SIGN UNDER SECI1OHS a, b, or c EFLOW

rpoRATE AFPLICATE_@oR vlcE PBESJ?EI'IT _

IIOTE: IF FILED
MUST i oR (c).
lc_ruLT

(Signature of
bert E. Su

yn _ Georg

of
izabeth

ffintorvice President)
Robert E. Sul1ivan, President

STATE OF IIIARYLAND/COUNTY OF - _ Yq]YTGq!4EBI- -, - .: S5:

before the subscnber' a Nctar'r

this 22!9day of
THIS CERTIFIES that on ' 2000'
appeared:
;ffi#ir',;'d;J"H'-";";;;"F --- "..1;personaitv
ta) -.,, nouS.rf..e-
(b
application,
)I{
,f !
\ ,---*
L.LLZaPe LlMlEuIgUA,
.#
gEUY. _+'
.--*-
trre apPlican(s) named in this
^*.J facts'contgined in said application
sr-+r AA6+drnar't tr't E,lt.! iar-lt)lrt are true and
and made oath in due fonfl of law that the rnatters and
correut.

WITNESS mY hand and offfcial seal'

(Seal) L'Heureux
*,=:, 11:53 2487771L
t PAGE 83

STATEiIIEHT OF OWNER OF FRETITISEE

Laws of Maryland, (Not required if licensee has a laase c

Required in conrrection with Alcoholic Beverage
less than the term of the renewal license, May 200
the entire building in which the facitity is located for not
- Aprit 2001) tf thl+ ssction is nst completed,
thc attsehcd statement of LicansEE r-lqsllB-qqrfllFtc

t/vvE HEREBY CERTIFy that I^^/E sre the ownB(s) of

the prcperty known ns :zoo nossmpor,.BJ.vd.
SilVer Spring' MD namM in the afuregolng rgnewalapplicatlon rnade bY *.r'rarrlana-
CLubhouse
--S
ffito the Board of license Comrrtlssioner5i"
Under
ut ]t re ,AtcohodE*#ierage Laws of
ttJE[ the
Maryland: That lrue assent to the q*,nti11"lll:^l::T:
EtPPIlgLr for,
applied tllBr lAffa
lvl r that vI herEbv authorize the State Comptroller' I:.t^Iy
#Hfii*L'"tf:;I^'l-*;:ono 'no
the Board of Lic*n=" commlssioners for MontgornBry county, iE dury a'thorized agents a1{
crerks,
I'#,'JiilH]ft ;;;;;"fil;;i;;il *untv to iispect and selrch, without warrant, the premises
and all hours
ihA ntsaffiiE

upon whlch the business is to be conducted, at any

Witness:
ffii*A,
(ResidenCe) -:ui -a:j::j '
{Owrle!') - Lwcc Tr:lst ee o: c::-:- . : ::- -::;-:--
=

(Residence) 37o 1-iro s sroor' 1;:.-

l,

code of Maryland: lf any signed staiemer'--

Extract from $estion 1F501 0f Article ?ts of the Annotated
contain any false statement' the ofie:rcs s-
affidavit or oath rrqrir"d ,nderttie provisions of this Act shall
and eonviction thereof, ghall be subiect to Lhe
penaltro*s
be deemsd guilty of perjury, and upon lndictment
provkJed by law for that crime.
 o

ELECTION OF OFFICERS FORM

CORPORATE MINUTES

l, nohort F. Srrl I irran hereby certify that the following

(Name)

named individuals are the present officers of I4aryland -Glubhouse Services, Inc.
(Corp. Name)

President Robert E. Su111van

(Name)

Vice-President Mari-lyn Georg

(Name)

Secretary E-l izehpfh A- T,tHerrreux

(Name)

Treasurer
(Name)

Signature of Applicant Robert E. sull ivan

President
Title
 luecrlddvJo alnlBu6ts
(auep)
uosiod pozrJoqlnv
(aueN)
uosJod poztJor-llnv
(eurep)
uosJad paztJor.llnv
(auep {ueduuo3 &ltqett pailurll)
jo sNosu=d cfzluoHlnv aql orB slenpt^tput paurBu
(auep)
6urmo;1o; aql leql &lpec fqa.laq ,l
NOtJ.nloSSU -rVNO|I\Z|NV9UO
ANVd1'[O3 AUltEVt] OIIIT'u!'I
 o

RATIO AFFIDAVIT
BEER, WINE & LIQUOR LICENSE, CLASS B, ON SALE ONLY
HOTEURESTAURANT . HOTEUMOTEL

l/We hereby attest, under the penalty of perjury, that the gro.g. receipts from the sale of alcoholic
beverages in the hotel/restaurant - hotel/motel for the twelve month period immediately preceding the
application for renewal did not exceed the gross receipts from the sale of food.

(Signature of Ap pi ica nt)

Ted Barton
Food Service D.lecto:
(Tifle)

\
**********rr******i.********

State of Maryland MaryLdnd

' qq' Montgomery

County of Montgomery

This certifies that on the 6th dav of March 2000, befcre tlie
subscrrber. a Notary of the State of Maryland, personally appeared, Ted Barron
the applicant named in this food to alcoholic beverage ratio statement, and made oath in due form of law
that the matters and facts contained in said statement are true and correct.

Witness my Hand and Seal:

(sEAL)

Notary Public Elizabeth

My Commisslon expires on 8-0 1 -200 1
 -

foS" oil-PREllIsE SSN: 229-08-s083

rssued: 06/23/199S Expires: 06/15/2001
rD #: 8?93117 D.o.B.: 05/18/1962

}IARCIA GROVE

l{215-302 6RAll0 PRt R0A0

SILYER SPRIIIG, llD 20906

ll0 EXPIReIIoll IS: 06/15/2002

lillial Perez, 2{362, AB

frPs' ttu TIPS (Trainingfot hiefl"'bi

of
srccessfulcofipkt'dt
This cardindbotes
Pruce.tLrc') P'ogfifr

LT'ffiS"H'IL?JH;' ""'
Suite 1700
I lol Wrlson Boulevatd
eriingron. v'c 22209
TEL: ?01-524-1100
 o

AFFIDAVIT OF STATE TAX OBLIGATIONS

lAlVe hereby agree to keep current all state and local tax obligations

including, but not limited to, state sales and use taxes, withholding taxes, and ad-

missions taxes.

MD STATE SALES TAX ACCOUNT NUMBER; 02028080

'Qr', Lrli
Signature of Licensee

Robert E. Su11ir-an
Mar::l-aoC Clibhouse Ser.-lr.s --:
Printed Name of Licensee

I4arch 6. 2000
Date

State of Maryland Maryland

SS:
County of Montgomery Montgomery

Subscirbeci and sworn to before me, a Notary Public, this otrr day of

March 2000.

Notary Public Etizaberh A. LrHeureux

My Commlssion expi-res on 8-1-2001
 STATEMENT OF LICENSEE

l/VVe hereby cedify that lAlVe have a lease with

(Property Owner)
expiring for the property named in the aforegoing renewal application for

Alcoholic Beverage License made by to the Board

(Applicant)
of License Commissioners and that l/We hereby authorize the State Comptroller, his duly authorized
deputies, inspectors, and clerks; the Board of License Commissioners for Montgomery County, its duly
authorized agents and employees, and any peace officers of said County to inspect and search, without
warrant, the premises upon which the business is to be conducted, and any and all parts of the building in
which said business is to be conducted, at any and all hours.

(Signature of Applicant)

STATE OF MARYLAND :

SS:
COUNry OF MONTGOMERY :

This certifies that on this day of ,2000, before the

subscriber. a Notary Public in and for the State and County aforesaid, personally appeared

, an applicant named in this renewal applicaiio. a^:

rnade cath in cjue form of law that the matters and facts contained in said application are true anc :c--::".

Witness My Hand and Offic:a' Sea

..{d
000?
, edvu
, SEAL)
i

l!l
 a3l27l2Bag 85:86 24A777L 93:l- PAGE
o a
I:-T

EArc 4EfrDryll
WHE A UQUOR GITSS B, ON SIILE ONLY
HOTEURH$T - HOTEUMOTEL (,
!

lAr/e hereby atteet, under the penalty of perjury, that the grc:s receipts from the sale of alcoholic
preceding the
beverages in the hotel/restaurant - hotel/motel for the twelve month period immediatety
application for renewal did notplrqee$lthe gross receipts tom the sale of food-

Applicant) 1
{signature of
RoE,ERf E gtuur* tt
RFstoeilr
(Ti$j
... "..-

rti*********+ +++**+****rt**

State of Maryland :

I S8;

Sounty of Montgomery :

*.
This certlfles that on the J7 'ary of .. ///eru'y'--.-. -, 2000' beforelhe
I

subscriber, a Notary of the $tate of Maryland, personally appeared , Toqg.,,gf E:--fu+tffi--

:he applicant ngmed in this food to alcoholic beverage ratio statement,
and made oath in due forrrr of law

.hat the matters and facts corttained in said statement are true and correct-

Witness my Hand and Seal:

E/rr. Wrt I /'//eteEu/

p,1 bmttlostac /1ee6 {'/-a /
10039 MONTGOMERY COUNTY MD 0033770

Description lnvoice Account Amount

RENEWAL 03'1600 000'1-0100-6439-00c2

0001-0900-5 Bank of America TOTAL: $50.00

s
 a
Lei>ilre \\ :".-- . \ Ir:'i r:rnJ Cor?oration
, -,,,,,,,

March 6, 20OO

Board of License Commi_ssioners

16650 Crabbs Braneh h,ay
Rockville, Maryland ZbeSS
Gentlemen:
Enclosed is_ Maryland clubhouse services, rnc. application
renewal of our Alcoholic Beverage Li-cense and the for
g50'.bo p.o""ssing
fee' Also included is the statJment of owner of premises, Elect1on
of corporate officers form, Ratio affidavil -;"d
Awareness certification. ;;* of Ar-cohol
These documents fuIfi11 or. obligation
for application for renewal.

Sincerely,

Y?-*"t/tLPL
Robert E. Sullivan
General Manager

RES:pmp
enc1. check
 tltAT,2
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