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srATE oF MARYLAND
lrnll?|^atrrrn\/
(MONTGOMERY AnIrrrrr,\
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!,! /..r- . :
COUNTY) "'

APPLICATION FOR RENEITAL OF ALCOHOLIC BEVERAGE LI,CdIf,Sy9

NOTE: This application must be fileo between ?/7/94 and 3/71/g4 with the office of
Ljcense Commissioners.for Montgomery County, 16650 Crabbs Branch the Board of
t^/ay, Rockville,
Marylano, otherwise Licensees iiling late ;pplicatio]rs during ine'montn of
fined an amount not Aoril may be

For the Use 0f: (CIRCLE 0NE) Individual Partnership Corporation Unincorporated Assn.
Class of Current License: C Current License Number: CBWLCCOO1
Circle One: Beer Wine Beer & Wine Beer. Wine & Liouor (Clubs_ H/M, H/R, Countrv Club)
CjrcLe 0ne: 0n SaIe 0nJ-y Off Sale 0n1y 0n/0ff 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

code.of Maryland, as amended, for a renewal of the license now held, Annotateo
and
submit(s) and certify(ies) to the following information required thereby: the applicant(s)

(1) Applicant(s): Give name(s) ano residence(s): rf corporation, list

alr officers. pLEASE pRrNT
a. Robert E. sullivan 620 Ashron Road Ashron, MD 20861 (301) 774-6990
Vice President
b. ril 7732 Dei,! Wood Bd. Derwood MD. 20855 (301) ggg-37g7
(Name TitfE
& sidence & Zip Code
Secretary
c. ick La. Bpckville MD. 20853
Name & Title Residence & ZIp
301 ) 871-8137
Home Te ephone
(2) Name of Corporation (IF AppLICABLE). Maryland Clubhouse Service
(3) Trade Name: N/a Business phone. 598-1000
(4) Stockholders:
c/o LEISURE WORLD CoMMUNTTY CORP. TRUSTEE
a. Name & Adoress Wallace V. Cunnen 3701 Rossmoor Blvd. SS MD. -r"nrjdr"rE'"'
Shartrq .snod.
b. 3707 Rossmoor BIvd. SS. MD. Shares Ownec: L
TRUSTEE
rrleur!!
c. Name & Adoress John J. Hines 3701 Rossmoor Blvd. _SS. MD. Shares Ownec: I

Name & Adoress shares Cwned: 497

Name & Address ss. Md. 20906
Shares Owneo:
(5) AOdress of Licensed premises: 3700 Rossmoor Rlvci. S. S. lvlD. 20a06

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(6) 7/Wq hereby certify that the facts and information set forth in the application upon which the
present license was issued are unchanged: YES ( x ) NO ( ) If no, EXPLAIN on a
separate sheet of paper.
(7) Answer YES or N0. If answer is YES, EXPLAIN on a separate sheet of paper. During the current
license year, has the applicant(s) been convicted of any of the following:
(a) Violatron of Liquor Laws N0 (b) Violation of Gambling Laws NO
(c) Commissions of a Felony N0 (d) Violation of Rules & Regulations of the Boaro N0
/p) 0ffense against Laws of Md. ttO (f) offense against Laws of U.S.f.i N0
(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 ljcensed premiseso Answer YES ( ) or t.tO ( X ):
If YES, EXPLAIN:

(9)Whatfinancia]intereStdoestheapp1icant(s)have
license? Applicr.rt is a sub"i
of licensed propertlz.
(10) Is any other person or corporation in any way financially interested in the license applieo
r

for, or in the business to be conducted thereunder? LWCC as Trustee owrls fee to

ALL APPLICANTS MUST SIGN UNDER SECTIONS a Of C BELoW *********

NOTE: IF FILED AS A CORPORATE APPLICATION THE PRESIDENT OR VICE
TALSO S]GN UNDER SECTION (d) IN ADDIT]ON
SIGNING AS AN APPLICANT UNDER SECTION (a), (b), oT (c

(a)
gnatuie
lvan
(b)
gna ture
Elizabet L'Heureux
(c)
ure App
lyn
(d)
gnature o res dent or Vice resi dent
Robert E" Sullivan
*****ALL APPLICANTS STATED IN SECTION (]) MUST PERSONALLY APPEAR BEFORE A NOTARY PUBLIC*****

STATE OF MARYLAND/COUNTY OF Montgomery

THIS CERTIFIES thAt ON the 25 oay of February , 1994, before the

a
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subscriber, a Notary Public of the State of Maryland , personally appeared
Boherl
. E. Fr+1livan, Pr-gs ., Maf ilvr"r abeth L'Iieuleux, sec .
the applicant(s) named in tnis re
matters and facts contained in said application are true and correct.

|I/ITNESS my harrd and official seal.

( Seal )

STATEI4ENT OF OWNER OF PREMISES

Required in connection with Alcoholic Beverage Laws of Maryrand: (Not reouired if licensee has a
Iease on the entjre building in which the ta-ltity is locaied for not less than the term of the
renewal license (April 30, L995). However, the aitached statement of licensee must be completed
if this section is not signed.
I/l{E HEREBY CERTIFY that I AM/WE ARE the owner(s) of property known as3700 Rossmoor Blvd.
sj1SrrMd^0Q06named.in-theaforegoingrenewa1app1icati@
ClrJ,bhbu"e Serrri cos. Tne to the Board of License Conmissioners.
Under the Alcoholic Beverage Laws of Maryland: That I/WE assent to the granting of the
license applied for, that I/WE hereby authorize the State Comptroller, his dJly authorized
oeputies, inspectors and clerks, the Board of License Conrnissioners for Montgomery County, its
duly authorized agents and employees, and any peace officers of saio county [o inipect and search,
IilftoYt wamant, the.premises upon which the business is to be conducted, ind any and a1I parts oi

wrtNess' ,*/ (owner)

(ResideiG
oaft:, lV4/-?y'
( 0wner )
(ResioenE)

Extract From Section 91 of Article 28 of the Annotated Code of Marylano: If any signed stateflieni,
affidavit or oath required under the provisions of this Act shal1 contain any filse statement, the
offender shall be deemed gurlty of perjury, and upon indictment and conviction thereof shal1 be
subject to the penalties provided by l_aw for that crime.

t/94
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STATEMENT OF LICENSEE

Date: Februnry ?5, 199L

(I, certify that (I., We) have a lease uith
We) hereby
rty
expiring Po expiration datefor the property named in the aforegoing renewal application f o r
Alcohouc Beverage License made by Maryland clubhouse Services, Inc.
ca
to the Board of License Conrnissioners and that (f,
fub) hereby authorize the State Comptroller, his
!|]x,3:'i::';:i"o:lilrii;"i"::::::":^:":-:l::si-ir-;?1il-;i
county, its duly authorized agents and employe"s,.and any peace[i""n'" conmjssjoners ror MontEomeiv
and search, without warrant, the premises'upon which the businessofficers of saio *rrl, H iilJ;;l
arl parts of the building in which said business is to be is to be conducted, and any and
at any and al1 hours.
"onor.i"o,

gna ure o

Robert E. Sullivan
STATE OF MARYLAND
SS:
COUNTY OF MONTGOMERY

This certifies, that on the 25 _day of Febru?ry 4 , before the subscriber, a

, r9g

Yit"?r5Eo"'i: uggt#a uf"Eh..E"and countv aforesaid, personally appeared Roberr E. Sullivan

Services, Inc.
, 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 apprication
are true and correct.

litrcss my hard and official seal:

(SEAL)

vy Conmi ssion Expires t_y-/ -77

Elizabeth A. L'Heureux
If the holder of an Alcoholic Beverage License has.a lease upon the entire building for
not less than the term of the renewal ricense, it is not. necessary to obtain the pioperty'
ownerfs signature on the renewal application, however, tne appricant musi comiretE-this
form.
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ELECTION OF OFFICERS FORM

Ir Roherf-Jl.-, Srrl 1 i rz.an hereby certify that ttre

followjng named individuals are the present officers op Maryland Clubhouse Se:. -::: .

11ivan Presi dent

Vi ce-Presi dent

Elizabeth A. L'Heureux Secretary

Treasurer

*-fl,LL
(Name, Robert E. S-:-- '.---:

Pre s ident

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CLASS B, BEER, I{INE AND LIQUOR LICENSE, HOTEL/RESTAURANT AND HOTEL/MOTEL

I/we hereby attest, under the penalty of perjury, that the gross receipts
from the sale of arcoholic beverages in the hoter/motel for the twel-ve month period
inmediately preceding the application for renewal did not ecxeed
ecxeed the gross receipts
from the sale of fooo.

ffi$ur-*,r^'tor
Food Service Direc
Title Maryland Clubhouse Senzlce1 Inc .

****rt*****************t****************{.****

State of Maryland
County of Mnntgomery

THIS CERTIFIES that on the 25 day of FebruarY , l99l+_,

before the subscriber, a Notary of the State of Marylano, personally appeared,
Ted Barton , the applicant named in r"h:s food to
alcoholic beverage ratio statement, and made oath in oue form o" law :na: the
matLers and facts contained in said statement are true and cor:ec:.
Witness my hano and seal:

( SEAL )

My Commission Expires:
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-.*-;-*-..
i-lEi Techniqucr ol Alcohol Managcment

mM cERrlFlcArloN oAFID

Maurice D- Charbers
2/12/91 - Hontgolery