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STATE OF I'4ARYLAND
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(MONTGOMTRY COUNTY) rr.
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APPLICATION FOR RENEWAL OT ALCOHOL]C BEVERAGT LICTNSI

N3Tt: -nts app-Itcatlon must oe frled oetween 2/)-/95 ano 3/3I/95 wltn lhe 0ffrce of tne Board of
Lrcense Commisstoners for Montgomerv Countv, 16650 Craobs Brancn I{av, Rockvil}e,
Marvlano, otnerwtss Ltcensees ftling late applications during the monlh of Apri-l mav be
frneO an amount not to exceeO $50.00 for eacn Oav tne app.Iication ls late.
For the Use 0f: (CIRCLE gNE) Indivtoual Partnersnip Corporation Unincorporated Assn.

CIass of Current Lrcense: C 6/,:'i't-?. - ) I

Nunoe r :

Crrcle 0ne: Beer Wrne Beer & Wine Beer, Wine & Liouor (Cluos , H/1,1, H/R, Countrv CJ-uo)

Circ.l-e One: 0n Sale 0nlv Off Sale 0n1y 0n/0ff Sale .Consumptr on

TO THE BOARD OF LICENSE COMMISSIONERS FOR MONTGOMERY COUNTY:

is made oy the unoersigned under the provrsions of Article 28 of the Annotateo

Application
Code of Maryland, as amended, for a renewal of the license now held, and the applicant(s)
suDmit(s) and certify(ies) to tne following information reouired thereby:
(1) Applfcant(s): Give name(s) ano residence(s): If corporation, Iist all officers. PLEASE PRINT
President
a. Rohert E. Sullivan 620 Ashton Road, Ashton, MC. 2C861 ( 301 ) 774-699a
(Name & Trtle) (Residence & Zip Code) (Home Telepnone ii )
Vice President
b. Marilyn Goerg 7i32 Dew Wood F.d., Derwood, Md. 20855 (301) 899-3787
S e c::et-a ry
c. Elizabet-h L'Heureux J-4\12 Chq4ryLgE La.r Bqqkville, Md. _2!!93 , t3011 ,871-e13'.
(Name & Title) (Resioence &. Zip Code) (Home Telepnone #)

Q) of Corporation (IF APPLICABLE):

Name land Clubhouse Service
rz\ Trade Name: R o ssW{,/a,n ut*1a16 7.'/ t
Busi nes s

(4) Stocxnolders: C/O I,EISURE WORI,D COMMUNITY CORP. TRUSTEE

a. Name & Address Wallace V. Cunnen 3701 Rossmoor B1vd. SS, MD

Shares 0wne0: -
:

c/o,
D. Name & Ad0ress Rohert_J"j1e: Shares 0wneo: r

CIO LE]SURE TY CORP.

c. Name & Aooress John J - Hrnes Shares 0wned: 1

Name & Adoress Leisure World Foundation 3701 Rossmoor BIvd. Ss, MD Shafes 0wneoz 497

Name & Address Shares 0wneo:

(5) Aooress of Licenseo Premises: 3700 Rossmoor B1vd. S.S., Md. 20906

-r-
(5) i,rl= ^,=:eDV ano information set fortn
certlfV tnat tne facts in the apptrcailon upon wnlcn tne
Drese^: ircense was lssued are uncnanoeo: YES ( x) N0 ( ) If no, fXPLAIf'l on a
se33:a:e sneer of PaPer.
(7) Answer yES or N0. If answer:.s Y[S, on a separate sneet of paper. Durrno tne current
EXPLAIN
l.rcense vear, nas tne applrcant(s) oeen convtcteo of anv of tne fo-Ilowinq:
(4.) Vrolatron of Llouor Laws No (o) Violation of Gamol-ing Laws No

(c) Commissions of a Fei.onv NO (o) Vtolation of Rules & Regulations of the Board No_
(e) 0ffense aqainst Laws of Md. NO (f) of U.S. No
Offense asarnst Laws
(B) During tne current ficense vear, nave tnere been anv convictions of anv of the clerks, aoents,
emplovees or servants of tne lrcensee for violations of the Alconolic Beverage Laws of tne
Stale of Marvland or Montoomerv Countv on tne ficensed premises? Answer YES ( ) or N0 ( x ):
II YES, EXPLAIN:

hcense? Applicant is a subsidiary of the management agent for fee owner

of licensed
(L0) Is any other person or corporation in anv way financrallv interested in the license applied
for, or in tne business to be conducted tnereunoer? twcc as lrustee owns fee to

********* ALL APPLICANTS MUST SIGN UNDER SECTIoNS a, O or c BEL0W

NOTE: IF FILED AS A CORPORATE APPLICAT]ON THE PRESIDENT OR VICE

or (c).

Maril

(d)
gnature of President or Vice

--&ebe-qt--E.-S-sl-r.;-yas,--P-rs-s-rdcEr!----
*****ALL APPLICANTS STATED IN SECTION (I) MUST PERSONALLY APPEAR BEFORE A NOTARY PUBLIC*****

STATE OF MARYLAND/COUNTY OF Mont-qomerY . 55.

THIS CERTIFIES tnat on the zo day of March , L995, Defore the

-2-
 I

'.1--::v PuoIrc of tne State of Maryland , persona.Ilv appeareo

t
:ne , ano made oatn ln oue
il 5
- -=-: ano facts containeo in saio appllcation are true and correct.

;" I -',ISS nanc ano cffrcral seal.

'. l,eG J )

beth A.

STATEMENT OF O|IINER OF PREM]SES

Reouired in connection with Alcoholic Beverage Laws of Marv.Iand: (Not reouired if licensee has a
lease on tne enttre building in which tne facilrtv is located for not less tnan tne term of the
renewal license (Rpri )" 70, L996). However, the attacheo statement of licensee must be completed
if this section is not signed.
I/WE HEREBY CERTIFY the owner(s) of propertv known as 370o Rossmonr nr,a.
tnat I AM/WE ARE
silver spring, Md. 20906 named in the aforegoing renewal application made bv {aryland
to tne Board of License Conrnissioners
wsofMary1and:ThatI/l./Eassenttothegrantingoftne
l-icense applieo for, tnat I/WE nereby authorize the State ComptrolJ.er, nis oul-v authorized
oeputres, inspectors and clerks, tne Board of License Commissioners for Montgomerv Countv, its
dul-v autnorized agents and employees, and any peace officers of said counlv to rnspect and search,
without warrant, the premises upon which the business is to be conducteo, and anv ano alL parts of
DuiLding in which said business is to be conoucted, at anv and aLl hours.
/I
WITNESS: ff;\:d,'du *r {,, Ig:r:]
(Resi dence
DATE:

(0wner) - ""zv'u
Zvtu .
(ResioencEJ

Extract From Section 9l of Article 28 of the Annotated Code of Marvl-ano: If anv signeo statement,
affidavit or oath reourreo under tne provisions of this Act sha1l contain any false statement, the
offender shall be deemed guilty of perjurv, ano upon inoictment and convictton thereof sna11 oe
suDject to tne penalties provioed by law for tnat crime.

L /94
 o o

STATTMINT OF LICTNSTE

r.r- y^L .)n

l_995

i:, i,e) neieDv cerltfv tnat (I, We) have a lease wrtn Leisure wor:Id Community Corp.
expirino no exoiration <iarefor tne propertv nameo in the aforegoing renewal applicatton for
Alconolrc Beverage Ltcense maoe bV Maryland Clubhouse Services, rnc.
cant
to tne Boaro of License Commissioners and tnat (I, We) nerebv authorize tne State Comptroj-ler, his
ou-Lv autnorrzeo Oeputies, tnspectors and clerxs; tne Boaro of Ljcense Commissioners for MontqomerY
county, lts ouly authorlzed aoents and emplovees, ano anv peace officers of said countv to j.nspect
and searcn, without warrant, tne premises upon which the business is to De conducted, ancl anv ano
a1J- parts of the buildinq in which said business is to De conducted, at anv and all hours.

ignature c
Sullivan
STATE OF MARYLAND
SS:
COUNTY OF MONTGOMERY

Tnis certifies, that on the ^o dav of , 1995 , before tne suDscrjDer,

Notary Publrc in and for the State and County aforesaid, personally appeafEd Roh"rr r' -c..' : r --.-
President, Maryland Clubhouse
services, Tnc. t the applicant(s) named in thrs renewal application, ano maoe oa:. Ln

oue form of the law that the matters and facts contained in said application are true am cornBct.

Witness nty hanil arid official seal:

(SEAL)

My Commission Expires: y-/-q 7

c
a-fn-4.
4. L'Heureux
U rrrr
4ugull

Note: If the holder of an Alconolic Beverage License has a lease upon the entire builcjing for
not less than the term of the renewal license, it is not necessary to obtain the property
ownerrs signature on the renewal application, however, the applicant must complete this
form.
 o

ELECT]ON OF OFFICERS FORM

I, Robert E. Sullivan hereDv certifv that tne

----fNmEI

followrng nameo i noi vi oua1s are the present officers Of Maryland CLubhouse Services, fne.
. ..4)

Robert E. Sullivan President

lXemEr
Marilyn Go"rL Vice-Presioent
TN'ame)"-
m Elizabeth A. L'Heureux Secretarv

Treasurer
( Name )

,fl 4-/5 f{'

( Name )
Robert- E. Sullrr-an -.
Preqi dcrri
(Title)
 ---e- - t
Hts F P WINE AND LIQU0R LICINSE, H0TEL/RTSTAURANT AND H0rEL/f'4OTtL

'^ h^-eDv
--. /w= ;tei attest, unoer tne penaltv of per.iurv, t.nat tne gross receipts
':c-:r= S3,E ol alconol-tc oeveraoes in tne notel-/motel for tne twe-l-ve montn perloo
tmrr3l-a',elv DreCeOlnQ tne appliCation for renewal did not ecxee0 tne OroSS recerpts
from tne sale of fooo.

/'/ /; /l ..;)
'/e& --4
fu^/-ro"-
Ted Barton
Rood Serrz i op l-t i ron1-or
Tr tle

++* * ** * * ** ** ** ** ** * * * ** ** + * ** * ** ** ** * * * * * * *

State of fiaryland
55.
CountV gfontgomery

20 'lOO
THIS CERTIFIES thAt ON thE dav of March , L//
c
J t

oefore tne subscriDer, a Notarv of the State of Marvland, personal-lv appeareo,

Tar:l E: r{-an , the applicant named in this fooo to
alcoholic beverage ratio statement, and made oath in due form of Jaw tnat ihe
matters lnd facts contained in said statement are true and correct.
ftitness ;nrl hood and sea-l:

( srei- I
1C
Elizabeth A. L'Heureux
My Commrssion Expires:
y_/_{r
 13

i'{l'i Trchniquo o I Alcohol ttrnrgrmcnt

cEnrrFlcArroN cAFo
EI
f,rurica IL Cberbcrs
2/12/gl - f,ontsorcry
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AT.TIqAY.I]

I nereoy agree to keep current a.L1 state and local tax ooligations incluoing,
not llmiteo to, state sales and use tax, witnholoing tax, and admissions tax.

gn-ature of Licensee
Robert E. Sullivan, President
Marvland Clubhouse Services, Inc.
Printed Name of Licensee

Date: March 23, 1995

State of Maryland * Maryland

* ss:
County of Mont. * Montgomery

Subscribed and suorn to before a Notary Public this 23rd day of

March ,1995,

Elizabeth A. L'H.eureux

-SEAL- My Corrnission Expires 8-1-97