STATE OF MARYLAND

o
(MONTGOMERY COUNTY)

APPLICATION FOR RENEWAL OF ALGOHOLIC BEVERAGE LICENSE

NOTE: This application must be filed between 211198 and 3/31/98 with the Office of the Board of
License Commissioners for Montgomery County, 16650 Crabbs Branch Way, Rockville,
Maryland, othenr,rise Licensees filing late applications during the month of April may
be fined an amount not to exceed $50 for each day the application is Iate.

For the Use of: (Circle One) lndividual Partnership Corporation Unincorp. Assn.

Class of Current License: Current License g. CBWLCC001

Circle Beer Wine

One: Beer & Wine Beer, Wine & Liquor (Chrhs, H/M, H/R, Cnrtntry Club)
Circle One: On Sale Only Off Sale Only On/Off Sale Consumption

TO THE BOARD OF LICENSE COMMISSIONERS FOR MONTGOMERY COUNTY:

Application is made by the undersigned under the provisions of Article 28 ofthe 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) Applicant(s): Give name(s) and residence(s): lf corporation, list all officers. PLEASE PRINT.
President
a. BoberE E.-Srrllivnn 6?O Achtnn Rd. Achtnn, Md. ?OR6l (?O1) 774-699O
(Name & Title) (Home Address/Zip Code) (Home Telephone #)
Vice Presldent
Ilarilyn Georg 7732 Derwood Rd. Derwood, Md. 20855 (301) 899-3787
(Name & Title) (Home Address/Zip Code) (Home Telephone #)
Secretary
Ellzabeth LrHeureux L4LLZ Chadwick La. Rockville, Md. 20853 (30r1- 871-8t37
(Name & Title) (Home Address/Zip Code) (Home Telephone #)

(2\ Name of Corporation (lF APPLICABLE): Maryland Clubhouse Services, Inc.

(3) Trade Name:

(Business Telephone #)
(4) Stockholders: C/O LEISURE WORLD CO}O{UNITY CORP. TRUSTEE

a. Name/Address Wallace V. Cunnen 3701 Rossmoor Blvd. S.S. Md. Shares Owned: t
C/O LEISURE WORLD COIO{UNITY CORP.

b. Name/AddfeSS Robert .1. Kennedv 3 701 Rossmoor B1vd. S. S. Md - Shares Owned: r

C/O LEISURE WORLD CO}O{UNITY CORP.

C. Name/Address Tnhn T Tlinpq ?7Ol Rnqqmnnr Rlrrrl q q M,l Shares Owned: 1

d Name/Address Leisure World Foundatlon 3701 Rossmoor B1vd. S.S. Md. Shares Owned:497
(5) Address of LicenseO Pr"*ij ?7OO Pnce-nnr Rlrrl q q M.l ) oqo6
a
ltuVe hereby certify that the facts and information set forth in the application upon which the present
license.was issued are unchanged: YES ( x) No ( )
lf no, EXPLAIN on a separate piece of
paper.

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

(a) Violation of Liquor Laws (b) Violation of Gambling Laws

(c) Commission of a Felony No (d) Violation of Rules/Regulations of Board

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

(8) During the current license 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 iicensecj prei'nises? Answer YES wC 1 ): ( ) x
If YES, EXPLAIN:

(g) What financial interest does the applicant(s) have in the business conducted under the present
liCenSe? Applicant is a subsidiary of the management agent for fee owner of licensed property.

(10) ls any other person or corporation in anywayfinancially interested in the license applied for, or in
the business to be conducted thereunder?
n.Ue6--:-s--jlrrt.to^ n*nc fea i-

ALL APPLICANTS MUST SIGN UNDER SECTIONS a. b. or c BELOW

NOTE: IF FILED AS A CORPORATE APPLICATION THE PRESIDENT OR VICE PRESIDENT

MUST ALSO SIGN UNDER SECTION (d) IN ADDITION TO SIGNING AS AN APPLICANT
UNDER SECTION (a). (b). OR (c).

(a)
(Signature of licani)
bert E.

re of
Geo
(c)
(Signature of Applicant)
Elizabeth L'Heureux
o {L.Ltq-fu( s i
s v,':S" i de nt)
HHJ:."[ 1',3:iq??13 i ?ies

THESE SIGNATURES MUST ALL BE NOTARIZED ON THE NEXT PAGE

 o
STATE OF MARYLAND/COUNTY OF MONTGOMERY :SS

THIS CERTIFIES that on this 2rd day of March 1998, before the subscriber, a
Notarv Public of the State of Marvland personally appeared Roberr Sul1ivan,
D-oairlanf
, Marilyn Georg, Vice President Elizabeth LrHeureux, SecY.

the applicant(s) named in this renewal application, and made oath in due form of law that the matters and
facts contained in said application are true and correct.

WITNESS my hand and official seal.

!) jy
Ce rt r rlt 6s/o i E?' P'*f -L-or-^-llfl Public Elizabeth A. LrHeureux

STATEMENT OF OWNER OF PREMISES

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, May 1998
- April 1999) !f this section is not completed, the attached Statement of Licensee must be completed.

lA/r/E HEREBY CERTIFY that lA//E are the owner(s) of the property known ss 3700, RsesnooB'B&vd.
Silwer Snrins. Md- named in the aforegoing renewal application made praryt end b!
Clubhouse Service, Inc. to the Board of License Commissioners.
Under the Alcoholic Beverage Laws of Maryland: That l/We assent to the granting of the license
applied for, that lA/Ve 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, at any and all hours.

wrtness /bta*di' lz {/,:zzzt-t ro*n"rl e=:)l-^. (-^* * r-

(Residence) ARTilt-tt? - rc'v'st-t-
s- L -q/ (OWfle[) l,ulcc Trrr stpe nf _l(oom.--Iacll i t i es
(Residence) 3701 Rossmoor B1vd. S.s. Md. 20906

Extract from Section 16-501 of Article 28 of the Annotated Code of Maryland: lf any signed statement,
affidavit or oath required under the provisions of this Act shall contain any false statement, the offender
shall be deemed guilty of perjury, and upon indictment and conviction thereof, shall be subject to the
penalties provided by law for that crime.
 o
AFFIDAVIT OF STATE TAX OBLIGATIONS

l/We 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.

,{L,1, : !,
Signature of Licensee
"

Robert E. Sullivan
Maryland Clubhouse Services, Inc.

Printed Name of Licensee

March 2 . 1998
Date

State of Maryland Maryland

SS.
County of Montgomery Montgomery

Subscirbed and sworn to before me, a Notary Public, this z day of

l'[rrnh 1 998

Public Elizabeth A.
t
L Heureux
Co-mmission expires on 8-t-0 i

(Seal)
 o
ELECTION OF OFFICERS FORM
CORPORATE MINUTES

Robert E. Sullivan _ hereby certify that the following

(Name)

named individuals are the present officers of Maryland Clubhouse Services, Inc.
(Corp. Name)

President Robert E. Sullivan

(Name,1

Vice-President Marilyn Georg

(Name)

Secretary Elizabeth A. LtHeureux

(Name)

Treasurer
(Name)

President
Title
 o
RATIO AFF!DAVIT
BEER. WINE & LIQUOR LICENSE. CLASS B. ON SALE ONLY
HOTEL/RESTAURANT . HOTEL/MOTEL

lA//e hereby attest, under the penalty of perjury, that the gross 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.

(si of Applicant)
Ted Barton
Food Services Director
(Title)

State of Maryland '.

County of Montgomery :

This certifies thai on the 2 day of March 1998 before the

subscriber. a Notary of the State of Maryland, personally appeard, Jsi-Brrr-o.n
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)

ry Public Elizabeth A. L'Heureux

Mv Commission expires 8- 1- ii I
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