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STATE OF T\4ARYLAND
(MONTGOMERY COUN1Y,J|

A p p Lt cATt oN FoR RENEWA.L OF ALCOHOLIb B EVEITAG

,r-O, E Li,Q-ErySE
t-,., ^, *.
NOTE: Tnis application must be filed between 211196 and 3i31196 with the Ofice of the Board of
License Commissioners for Montgomery County, 16650 Crabbs Branch Way, Rockville,
lr4aryland, otherwise Licensees filing late applications during the month of April may
be fined an amount not to exceed $50 for each day the appllcation is late.

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

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Class of Current License: Current License #: Qgttlt d&OA I
Circle One: Beer Wine Beer & Wine

Circle One: On Sale Only Off Sale Only On/Otf Sale Consumption

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 certity(ies)
to the fcllcwing infcrmaticn requireC thereby:

i
if Arplicant(s): Give name(s) and residence(s): lf corporation, list all officers. PLEASE PRINT.
President
2.. Roberc E. Sullivan 620 Ashton Rd. Ashton. Md. 20861 (301t 774-6990 _
(l'iame & Title) (Home Address/Zip Code) (Home Telephone #)
Vice President
3. Marilvn Goers 7732 Derwood Rd. Derwood Md. 20855 (301t 8oq-3287
(l'Jame & Title) (Home AddressiZip Code) (Home Telephone r1
Secretary
o. Elizabeth L"Heureux 14112 Chadwick La. Rockvil le. Md - 208\3 87'l -R] 37
(Name & Ti'rie) (Home Acjdress/Zip Code) (Home Telephcne
=,

(2) Name of Corporation (lF APPLICABLE): Mar]rland Clubhouse Services, rnc

,
(s) Trade Name: ru la
?iL'-ti\u't!\
(4) stockholders: c/o LErsuRE woRLD coMMUNrry coRp. TRUSTEE

a. Name/Address Wallace
V. n 3701 Shares Orvned: t
/o
LErsuRE woRLD COMMUNTTY CORP.
b. Name/AddleSS Rnherr .T Kpnnariy 370I _Rossmoor B't,d.. S. S. ].1;S:a-es O'^,'^e::__f_
C/O LEISURE WORLD COMMUN]TY CORP.
Name/Address John J. Hines 3701 Rossmoor Blvd. S.S. 1"1d. S^a-es,i,.,'red: 1

-,<^1ES l'*ned:49l
Leisure World Eoundation 3701 Rossmoor Bi-.'c. ):
A
l',iameiAocresS

(5) Acldressof Licensedpremises: 3700 Rossmoor Blvd. S.S. IId. __:-a

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^:-33i' oerifv that the facts and infoi'mation set iorth in the apciicaticn upon which the present
rssued ai'e unchanged: YES ( x ) No ( ) lf no, EXPLAIN on a separate piece of

-^3'"'3' :'IS cr NO: lf answer is YES, EXPLAIN on a separate piece of paper. During the current
year. has the appticant(s) been convicted of any of the following:

,?r 'i'iciaircn of Liquor Laws NO (b) Violation of Gambling Laws NO

tc) Ccmmission of a Felony NO (d) Violation of Rules/Regulations of Board NO

(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 seryants 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:

(9) 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, otner person or corporation in any way financially interested in the license applied for, or in the
business to be conducted thereunder? LWCC as Trustee owns fee to licensed premises.

ALL APPLTCANTS 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 (di IN ADDITION TO SIGNING AS AN APPLICANT
UNDER SECTION (a). (b). OR (c).

>t onature of icant)

Ro. :t "E. Sull

(b) *
i

,' (Sionature of Applicant)

izabEth L'Heui-eux

(o) {Uzz,W
*!Bgl g'H: "Jfi??'.?81,.'
Pge s io e nt)
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,:IiJD'COUNTY OF Montgomerv : SS:

*:- S l==TiFiFS that on this 21th day of March , 1996, before the subscriber, a
i.i::a-'=,.'.,ic,ineSiateofMar}zland,personallyappeared@
D-^
I - =: --',-,^--
-i=r-- , Marilyn Georg, Vice Pres. , Elizabeth L'Heureux, Sec.
the apriicantis) named in this renewal apptication, 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.

(Seai)
Utvt, 74 ; (-/-7; Elizabeth E. L'Heureux
-Y(/
STATEMENT OF OWNER OF PREMISES

Required in connection with Alcoholic Beverage Laws of Maryland. (Not required if licensee has a lease for
the licensed premises which covers the 1996/1997 license year (May 1996 - April 1997) lf thls section is
not completed, the attached Statement of Licensee must be completed.

HEREBY CERTIFY that I/VVE are the owner(s) of the property known as3700 Rossmoor B1vd.
l,ryVE
Silver Spring, Md. 20906amed in the aforegoing renewal application made by Maryland
Cl rrhhorrsp Spr - , Tnr. tO the BOafd Of LiCenSe COmmiSSioners.
Uncjer the Aicohoiic Beverage Laws of Maryland: That l/We assent to the granting of the license
seeiied for, that l/We hereby authorize the State Comptroller, his duly authorized deputies, inspectors and
cie.r,s, the tsoard of License Commissioners for Montgomery County, its duly authorized agents and
?rDic'rees, and any peace officers of said county to inspect and search, without warrant, the prernises
-.::c: r^,'hich the business is to be conducted, at any and all hours.

'i^v/ilness fr{"/- f (Owner) &4h

(Residence) . Leslie Hurt
c, /"4
Date: ,1-4/- ?6 (Owner) LWCC Trustee of Comm. Facilities
(Residence) 3701 Rossmoor Blvd. S. S. Md . 20975

Extraci from Section 16-501 of Article 28 at 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, cf perjury, and upcn incjictment and conviciicn therecf . shall be subject to the
penaliies provicied by iaw for that crime.
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STATEMENT OF LICENSEE

Date: March 2L.. 1996

l/}Ve hereby certify that l/VVe have a lease with Leisure WorId Community Corp.
(Property Owner)
expiring no expi r.ari nn rl.ere for the property named in the aforegoing renewal application for

Alcohotic Beverage License made [y Maryland Clubhouse Services , Inc. to the Board
(Appticant)
of License Commissioners and that l/YVe 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.

Q^.,lutL / or'
(Signature of Appiicant)
.

Robert E. Sullivan
STATE OF MARYLAND
ec'
COUNTY OF I\4ONTGOMERY

This ceriifies that on this 2L day of March ,

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JJV,
ha{nrc i\c

suc-scriber, a No_taiy- Public in and for the State and County aforesaid, personally appeared
R:bert E. Suflivan, Pres.
)farvland Clubhouse Services. Inc , an applicant named in this renewal applicaiic: a^:
,.naie oath in due form of law that the matters and facts contained in said application are true and co:;-e::.

Witness My Hand and Official Seal:

(sEAL)

L'Heureux
Ytly lo u/t/ / t d/ o,'i
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 RATIO AFFIDAVIT
BEER. WINE & LIQUOR LICENSE, CLASS B, ON SALE ONLY
HOTEL/RESTAU RANT . HOTEL/MOTEL

l/We 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)
Ted Barton
Food Service DZrector
(Titte)

State of Maryland

Ccunty of Montgomery

This cei-iifies that on the 2ltb- day of March '1 OQA hofn:a 1::

subscriber, a Notary of the State of Maryland, personally appeared, Ted Barton

the applicant named in this foqd 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:

r. l- -:

(sEAL") :^..
)"1

Elizabeth L'Heureux
f,7 /erurtuen,D EuP,,e\,
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AFFIDAVIT OF STATE TA.X OBLIGA,TIONS

l/VVe hereby agree to keep current all state and local tax obtigations

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

missions taxes.

Robert E. Sullivan, Pres.

Maryland Clubhouse Services, Inc.
Prinied Name of Licensee

Mets!_aL we6
Date

State of tv4aryland Maryland

: SS:
County of Montgomery Montgomery

Subscirbed and sworn to before me, a Notary Public, this 22th clay of

March ,1996.

Elizabeth A. L'Heureux
My Commission Expires 8-l-97
(Seai)
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T*lrr$$m ol AloohC llrnrgrmrm

CEHTIFICATION CAHB

f,rur{ca E Gbrrbcre
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Ltlzlgl - IontSortry
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ELECTION OF OFFICERS FORM

r, Robert E. Sullivan hereDv certify that tne

--GemO-
following nemeo individuals are the present officers 'land CIu Inc,
,l't1r" .-., 'i. 1'' . ''r;i.1.!i 1ra.!1

Robert E. Sullivan President

(Name)

Vi ce-Presi oent

Secretarv

Treasure r
tNamsl