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STATE OF MARYLANT)
(MONTGOMERY COUNTY)

"{s 'f1:
APPLICATION FOR RENEWAL OF ALCOHOLIC BEVERAGE LICEI']SE

NOTE: This application must be filed between 2/l/g3 and 3/31/91 with the Office of the
License'Commissioners for Montgomery County, 16650 Crabbs Branch l,fay, Rockville,
Maryland, otherwise Licensees fil
fined an amount not to e .00 for ea cation is ]ate.
For the Use Individual
0f: (CIRCLE 0NE) Partnership Corporation Unincorporated Assn.

Class of Current, License: ( , Current License Number t (.8 AQDO

Circ1e One: Beer Wine Beer & Wine Beer, Wine & Liquor (01ubs, H/M, H/R, Country Club)

Circle One: 0n SaIe 0n1y Off Sale 0n1y 0n/0ff Sale Consumption

TO THE BOARD OF LICENSE COMMISSIONERS FOR MONTGOMERY COUI'ITY:

is made by the undersigned under the provisions of Articl-e ZB of the Annotated

Application
Code of Maryland, as amended, for a renewal of the license now he1d, and the applicant(s)
submit(s) and certify(ies) to the following information required thereby:
(1) Applicant(s): Give name(s) and residence(s): If corporation, list all officers. PLEASE PRINT
Pre s ident
a,
\lice Pre s ident
b. Mar_i_Iyn Goerg* _
-* ____J_732 Dew l^lood Rd. Derwood MD. 20gI!__(!._Q_11_899-3787
Se cr e tary
c.
ffi
ELLzabeth *@20853 (301)
L'Heureux 14112 Chadwick La. Rockville MD. 871-8137

{2} Name of corporation (rF APPLTCABIE): _Mar^yland_clrrhhouse Servr'ess _ - ____*_ -

(3) Trade Name: Business Phone: _5gg-1000 _
(4) Stockholders:
CIO Suburban Trust Co. Trustee
Name & AddressWallgce_ Y. Cuqle Bl.i.rd. S_.S. *U. thares 0wned: _ 1
--
A/A Suburban Trust, Co. Trustee
L
U. Name & AddressBp[grt J*_Ken_ae.d.rr .37-_L_Rcssmoor BIvd- *S-S..-Md- Shares 0wned:
C/0 tsuburban Trust Co. Trustee
--J -
c. Name & Address.rohn .r _ gine* * 4 j _Rnqsmcu.rr B,l_\zd.*S.S_ Md,_ Shares 0wned: l _
Name & AddressLeisure World Foundation 3701 Rossmoor Blvd. Shares 0wned: 491
s.s" Md" 20906
Name & Address Shares Owned:

(5) Address of Licensed Premises: 3700 Rossmoor Blvd. SLl--Sp_L...Md. 20406

 o
i."'io. h.roF'
''.-*: ^e:t:fy that the facts and information set forth in the application upon which Lhe
J-=:: ':^^^S3 was i-ssued are unchanged: YtS ( x ) ttO ( ) If no, EXPLAIN on a
- --L=rl
separa'"e sheetof paper.
(7) Answei YES or N0. If answer is Y[S, EXPLAIN on a separale sheet of paper. During the current
Iicense year, has the applicant(s) been convicted of any of the following:
(a) Violation of Liquor Laws N+ (b) Violation of Gambling Laws tlq
(c) Commissions of a Felony _L{_O__
(d) Violation of Ru1es & Regulations of the Board NO

(e) 0ffense against Laws of l''ld. NO (f) 0ffense against Laws of U.S. NO

(8) During the current l-icense year, have there been any convictions of any of the clerks, agents,
employees or servants of the licensee for violations of the Alcoholic Beverage Laws of the
State of Maryland or Montgomery County on the licensed premises? Answer YES ( ) or tlO ( x ):
If YES, EXPLAIN:

slT-ave -InTHe-EGI
Iicense? Appljc+q! ij a sUbq -Fhe mana&emenl_ELgen! foJ f e_e _evmer _
of licensed propertv"
(l-3) Is any other person or corporalion in any way financially interested in the license applied
.fcr, or.inpremises.
-llcensed the.business to be conducted thereunder? T.wcc as Trrrsrpp ora;rns foe En _-

**+****** ALL APPLICANTS MUST SIGN UNDER SECTIONS a. b Of C BEL0W *********

r'l0TE: iF FII-ED AS A C0RPORATE APPLICATI0N THE PRESIDENT 0R VICE
_IT-TDDTTT6NM

(a)
ature of ica
erft' E" Su _LV
(b)
Signature eant
Elizabe 'Heureux
(c)

(
(d)
ure o )s t or Vice
Robert E Sullivan
*****ALL APPLLCAUTS STATEQ__LN sEC_rr0t_LI) MUSr PE$s*qIAU-y AtpqARl1Erqlq A NorgFyjuBLrc*T:

STATE 0F MARYLAND/COUIITY 0F Monrsomerv . >5.

THIS CERTIFIES that on the 24-_ day of -Fehf:rafy-_ , 1993, before the
 o
s-:bscr:-5er, a Notary PubIic of the State of MarlzljLnd , personally appeared
.1 Mari'l vn Gogrg. V.Pres. ,
,

S renewal application, and made oath

matters and facts contained in said application are true and correct.

i^IITNESS my hand and official sea1.

(Seal)

frrrmrst,
f,fu ,s'* /'/-fr
STtTEMENT q: 0WNER 0F_ PREMTSLS

Required in connection with Alcoholic Beverage Laws of Maryland: (Not required if licensee has a
lease on the entire building in which the facility is located for not less than the term of the
renewal license (Apri1 30, 1994). HoLeveL, the attached statejnent of licensee must be completed
if lhis secliofr is not signed.
I/wE lhat
HEREBY CERIJTY- r the owner(s) of property known as 3700 Rossmoor Blvd'
Alvt/f{E ARE
5L-. >:r. iio' zuYvo named in the aforegoing renewal application made by Yarvland
to the Board of ticenie Commissioners.
wsoflr,lary}and:ThatI/WEassenttothegrantingof+"he
l:-:ense applied for, that I/WE hereby authorize the State Comptroller, his duly authortzed
iec,:!ies, inspectors and clerks, the Board of License Cormnissioners for Montgomery County, its
3'-.tj-y authorized agents and employees, and any peace officers of said county to lnspect ani search,
rtir'hour. warrant, the premises upon which the business is to be conducted, and any and aLl parts of
:uilding in which said business is to be conducted, at any and a1r hours.

wITNESS, Td.u'/Zrogt -- ( Owner )

(Res
oarc: 3*l - ?Z * _

( 0wner )
(ResidenCe)

Extract From Section 91 of Article 28 of the Annotated Code of Maryland: If any sig^o1;:::erne.rr-,
affiCavit or oalh required under the provisions of this Act sha1l contain any false sirlor3^1'-, r-h3
orender sha1l be deemed guilty of perjury, and upon indictment and conviction therecr;^a.l be
subject to the penalties provided by 1aw for that crime.

: i9,z
 STATEMENT OF LICENSEE

Da:e: Februarv 24 7993

(I, We) hereby certify that (I, I{e) have a lease with Le
(Property u r
expiring no expiration datQor the property in the aforegoing renewal application F3 r
named

Alcoholic Beverage License made by Maryland Clubhouse Services, Inc

( Applicant )
to the Board of License Commissioners and that (I, We) hereby authorize the State Comptroller, hls
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.

Signa re
Roberr E" Sullivan
STATE OF I.IARYLAND
SS:
COUNTY OF MONTGOMERY

This certifies, that on fie --?4 day of E9::::t - , D9:_, berore the subscriber, a
FlAUiEBb"lt: iqtf}q_JflA tg"shtt?rggd county aforesaicl,.personally appears6
Rob_ert- E" Sul_l_ivan
S:t'i"--,
-- "" - , the applicant(s) named in this renewal application, and made oath in
due form of the law that the matters and facts contained in said application are true and correct.

l{itness my hand and official seal:

( SEAL )

i{y Conmission Expires: tr- / - V 3

ElLzabeth A" LlHeureux
I' ',he holder of an Alcoholic Beverage License
nct less lhan the term of the renewal license, it is not necessary to obtain the property
3/rnerrs signature on the renewal application, however, lJF appEq.atl LuqL sgoplqlgjlte
Sarr
 t
ETECTION OF OFFICERS FORM

I, Robert E.
(Name)
lU!_f iygl hereby certify that the

following named individuals are the present off icers e1Maryland Clubhouse Ser. Inc.

Robert E. Sullivan President

(Name)

Marilyn Goerg Vice-President

ffi
EI izaberh L ''Heureux Secretary
( Name )

Treasurer
(Name)

Name)Robert E.

President
TTIIIE--
 cL ASS _2, qEs, l,,rlE . AUp _L r quoR L r CENSET_.!10TEL / LE_SI AURW

I/we hereby attest, under the penalty of perjury, that the gross receipts
from the sale of alcoholic beverages in the hotel/mote} for the twelve month period
immediately preceding the application for renewal did not exeed the gross receipts
from the sale of food.

ed Sarton
Food Service Director
Title Maryland__@ Inc.

***** I * * * ** * *** ** ****** ******.t( *** ***** i* lt* +

State of Maryland
55.
County of _M?llgegely

THIS CERT]FIES thal on The 2! day of February ,

too
-'t_,
3

before the subscriber, a Notary of the Stale of f,laryIand, personally appeared,

Ted Barton , the applicant named rn this food to
alcoholic beverage ralio statement, and made oath in due form of Law that the
matters and facts contained in said statement are true anC correct.
l{itness my hand and seal:

( SEAL )
c Elizabeth L ' Heu:: e::i
My Commission Expires:
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Techniques ol Alcohol Management
CERTIFICATION CARD
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Ilaurice D. Chqrnbers
2/12/91 - ilontgomery

Association