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STATE OF MARYLAND
(MONTGOMERY COUNTY)
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APPLICATION FOR RENEWAL OF ALCOHOLIC BEVERAGE LICENSE

NOTE: This application must be filed between 2l1to1and 3/31/01 with 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 Current License: C Current License #: cnwr.ceoor

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

TO THE BOARD OF LICENSE COMMISSIONERS FOR MONTGOMERY COUNTY:

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 ) Applicant(s): Give name(s) and residence(s): PLEASE PRINT.

Pre s ident
Robert E. Sullivan 620 Ashton Rd. Ashton, Md. 2086L (301-77 4-699A
(Name) (Home Address/Zip Code) (Home Telephone #)
Vice President
b. M.,rill'n co^.g 773^ no-,nood Rd. nesrreod IvId. 20855 (301-899-3787
(Name) (Home Address/Zip Code) (Home Telephone #)
S ecre tary

c. Elizabeth L'Heureux l4ll2 Chadwick ln. Rockville, Md. 20853 (301-B7l-8137

(Name) (Home Address/Zip Code) (Home Telephone #)

(2) Name Of BUSineSg Maryland Clubhouse Services, Inc.

(Business Telephone r)
(3) Address of Licensed premiSeS: 3700 Rossmoor B1vd. Sil. Spr. Md. 20906
(4) Name of Corporation (lF APPLICABLE): Maryland Clubhouse Services, Inc.

(a) Stockholders:

Name/AddfeSS Wallace V. Cunnen 370I Rossmoor B1vd. S.S. Md. .Shares Owned: I
c/o LEISURE l,lORLD COIMUNITY CORP.
Name/AddfeSS Robert L. Kenndev 3701 Rossmoor B1vd. S.S. Md. Shares Owned: i
c/o LEISURE WORLD CO}0{UNITY CORP.
Name/AddIeSS John Hines 3701 Rossmoor Blvd. s.S. Md. Shares Owned: r

Name/AddfeSS T,oi qrrre Wnrt rt Forrnrlari on j70l Rossmoor Blvrl . S. S. Md. Shares Owned:+gu
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(5 r Name of Ltd. Liability Co.(lF APPLICAB LE): /q/t
(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:_
facts and information set forth in the application upon which the cresen:
lAlVe hereby certify that the
license was issued are unchanged: YES ( x )No ( )
lf no, EXPLAIN on a separate piece o:
paper.

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

(b) Violation of Gambling Laws

(a) Violation of Liquor Laws
#
(c) Commission of a Felony NO (d) Violation of Rules/Regulations of Board

(e) Offense against Laws of Md.lqo (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 licensed premises? Answer YES ( )NO ( x ):

If YES, EXPLAIN:
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ig What financial interest does the applicant(s) have in the business conducted under the present
;:erse? -lpplicant is a subsidiarv of the ma

(10) ls any other person, corporation, partnership, or limited liability company in any way financially
interested in the license applied for, or in the business to be coriducted thereunder? YES NO
lf the answer is yes, explain on a separate piece of paper.
LhtlC as Trustee oro-ns f ee to llcensed premises.

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

IF FTLED AS A CORPORATE APPLICATION THE PRESIDENT OR VICE PRESIDENT

Sionature {pplicant)
RoEert E. I-L1Van

Marilyn

of Applicant)
Elizabeth LrHeureux

(Signature of President or Vice President)

Robert E. Su1l1van, President
MONTGOMERY
STATE OF MARYLAND/COUNTY OF : SS:

THIS CERTIFIES that on this 21r:" day of MarnL ,2001, before the subscriber, a Notary
Public of the State of Marlzland , personally appeared:
(g) Robert E. Su11ivan, Pres. , ([) Marilyn Georg, Vice Pres.
(c) slirabeth L'H.ure 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.

Public Elizabeth LrHeureux

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STATEMENT OF OWNER OF PREMISES

R.equired 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 2001
- April 2002) lf this section is not completed, the attached Statement of Licensee must be completed.

IAIVE HEREBY CERTIFY that I/VVE are the owner(s) of the property known dS ?7oo Rnss-oo. irrzd-
Silver spring, Md. named in the aforegoing renewal application made by Maryland
c r,hho,ce Se^ri ces - rnr- - to the Board of License Commissioners.
Under the Alcoholic Beverage Laws of Maryland: That lAlVe assent to the granting of the license
applied for, that l/VVe hereby authorize the State Comptroller, his duly authorized deputies, inspectors and
c erks. the Board of License Commissioners for Montgomery County, its duly authorized agents and
ernployees, and any peace officers of said county to inspect and search, without warrant, the premises
-ccn which the business is to be conducted, at any and all hours.

(Residence
Date: LWCC Trustee of Facliities
Comm.
(ReSidenCe ) 3701 Rossl,oor B1vd. S - S. rld. 20q06

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.
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ELECTION OF OFFICERS FORM

GORPORATE MINUTES

l, Robert E. Sullivan hereby certify that the following

(Name)

named individuals are the present officers of Maryland cluhhouse services, rnc.
(Corp. Name)

President Pnlrarf I' Qrrllirrqn

(Name)

Vice-President Marivln Geore

(Name)

Secretary Elizabeth A. LrHeureux

(Name)

Treasurer
(Name)

of Applicant

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

lffie 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.

(Signature of Applicant)

Rnhari F. Srrllirr:n
(Title) President

State of Maryland

County of Montgomery

This certifies that on the ztth day of M:rch ,2001, before the
subscriber, a Notary of the State of Maryland, personally appeared, Robert E. Sullivan
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)

PUbllC Elizabeth L'Heureux

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AFFIDAVIT OF STATE TAX OBLIGATIONS

lAtVe hereby agree to keep current all state and localtax obligations

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

missions taxes.

MD srArE sALEs rAx AccouNr NUMBER , OJ 0 e { O fr

Signature of Licensee

Printed Name of Licensee

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State of Maryland
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County of Montgomery ,
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Subscirbed and sworn to before me, a Notary Public, tnis ?i 5' day of
-'
,ti,l: ,2001'

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(Seal)
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