ORD NO 37-2022 CITY OF VAN BUREN,ARKANSAS
ORDINANCE NO.37 -2022
BE IT ENACTED BY THE CITY COUNCIL, FOR THE CITY OF VAN BUREN,
ARKANSAS, AN ORDINANCE TO BE ENTITLED:
AN ORDINANCE AUTHORIZING JASON COLLINS TO FILE AN
APPLICATION FOR A PRIVATE CLUB PERMIT,PURSUANT TO
A.C.A. 3-9-222 WITH THE ALCOHOLIC BEVERAGE CONTROL
DIVISION,AND FOR OTHER PURPOSES.
WHEREAS, Jason Collins has presented to the City of Van Buren, Arkansas, for consideration
an application for a Private Club Permit for a business to be known as "Doomsday
Coffee and Roasterie of Van Buren"; and
WHEREAS, the City Council of the City of Van Buren, Arkansas, believes it is in the best
interest of the citizens of the City of Van Buren,Arkansas to authorize Jason Collins
to proceed with such petition before the Alcoholic Beverage Control Division.
NOW,THEREFORE,BE IT ORDAINED BY THE CITY COUNCIL OF THE CITY
OF VAN BUREN,ARKANSAS,THAT: '
SECTION 1: The application submitted by Jason Collins for his Private Club Permit is hereby
approved to be submitted to the Alcoholic Beverage Control Division.
IN WITNESS WHEREOF, the City of Van Buren, Arkansas, by its City Council, did
pass, approve, and adopt, by a vote of -q- for and Q against, the foregoing Ordinance at its
regular meeting held on the 241h day of October 2022.
J e h . H st
Mayor
ATTESTED: Zaco
TjFORM:.,_
Ph hs Thomas Dwell
City Clerk/Treasurer City Attorney
10/19/2022
Mayor Joseph Hurst&City Council
1003 Broadway
Van Buren,AR 72956
SUBJECT: CITY OF VAN BUREN REQUEST FOR PRIVATE CLUB
PERMIT
I,Jason Collins,owner of Doomsday Coffee,.ask for the City of Van Buren to approve our
request for a Private club permit that would allow us to serve alcoholic beverage with
Crawford County,City limits of Van Buren.We will be conducting operations under the
name,"Doomsday Coffee and Roasterie of Van Buren"at 600 Main Street,Van Buren,
Doomsday is a coffee roastary/full service restaurant that focuses on customer
experience and the manufacturing of specialty coffee imported from all parts of the world.
We believe,Doomsday will be a great asset to the city of Van Buren.On the weekends,our
locations host between 400 to 600 customers.We hope,we can achieve the same success in
The Greater Downtown of Van Buren area.We are excited to see the additions of`The Vault'
and`Pointer Brewery'.The new investments in downtown lead us to believe there will
tremendous economic growth in the future.We wish to be a small part of that growth.The
Private Club Permit is a just a tool to help us to perpetuate our success.
We will be operating from 7am-7pm,Thursday-Sunday,if traffic permits,we will increase
our store hours to 7 clays a week,We wish to serve alcoholic beverages during these
business hours.As required,we are requesting approval to move forward with our
application for a Private Club Permit
Thank you for your consideration.
Rega4ds, �.
Jason Co lins
NEWSCHA0102 SCHEDULE A- INDXVIDUAL'S PERSONAL 011STORY
Application filled by Applicant- A, Stockholder/Partner- S
I submit answers to the following questions under oath:
1. Name �J�i c � l Gf 11�i7 f SeSx Date of Birth
2. Home Address . O f'�-e C J)e )e �Cy 12 c� eve/(e Phone No. :02 y�
Street City Zip �Z74L(
3. Are you a person of good moral character and reputation in your community? L ..'a S
4. Are you (CITIZEN.)4r (PERMAN RESIDENT ALIEN) of the United States? CIRCLE ONE
Social Sec(y No. � � Green Card No.
5. Are you a resident of the county in which application has been made? ()
If not, do you live within 35 miles of the premises to be permitted. r'S'
6. Have you ever been convicted of a felony? YES_-- IMO.\-/ _if so, give full information
7. Have you been convicted of any violation of any law relat7-1-10
alcoholic beverages within the
five (.5)years proceeding this application? APES �,,�,_ MO If so, give full information
8. Have you had any alcohol! beverage permit issued to you revolted within the five (5) years proceeding
this-application? VET NO If so, give full information
9. Do you presently hold or have you ever held an alcoholic beverage permit(s)? If so, give name,
pl ce, j
per .t umber(s
2c� l s �,,, s 1 C�c�e1 j
I �- l � ,1 ort-tom, #�
1 . Have you applied and been refused a permit at the pplied for location within the last 12 months?
If so, give full information
11. Marital Status: Single ( ) Married (�) Divorced ( ) Separated ( } Other ( )
12. Furnish complete information regarding members of immediate family:
Relationship n� Full Name (l Address Occupation
I�-�-2 1 ur c.. 1�1i71�c�1��3c�z�� 4�J �
165
e�� I'
-------------
NEWSCHA0202
(a) Are any of the above to be connected with the operation of the outlet? — �"�S
(b) If so, who and in what capacity? ��lr�Yf ��� C �) - 01,J_� ir'
13. Give your home address (city or town) and.dates at each for the past five (5) years: /
uu ^o
14. Covering the past five (5) years, give in detail the following:
Your Business or Occupation j Name &Address gf Em�yer Dates of Em llooyment
����%t✓rsd o.l, �y�-Fc•Q, 3 t^]f s/-�tNti �v_1�_ S' 1% z. -f 4n,
I hereby state on oath that I will not violate any law of this State or any regulation of the Alcoholic Beverage
Control Division, nor will any agent or employee be allowed to 'olate any law or regulation. It is hereby
consented that the licensed premises and its books and records a be open at all times to all law enforcement
officials without warrant or other legal process.
Appiicant's Signature
STATE OF ARKANSAS
MOF �n&nan
1n , being first duly sworn on oath deposes and says that he/she has
read each of the questions to which he/she has made answer, and that his/her said answers in each instance are
true and correct.
Subscribed and sworn to before me this day of
Nota Pu lic
My Commission Expires: _
BROOKLYNN FLORY
Notary Public-Arkansas
Washington County
Commission#12717498
My Commission Expires Nov 17,2031
DIII �ad � '�IIII
STATE OF ARKANSAS
ALCOHOLIC BEVERAGE CONTROL DIVISION
APPLICATION FOR PRIVATE CLUB PERMIT
Private Club
Permit No.
We hereby make applications for permits to serve alcoholic boverages.on our premises to the clubs adult
members,members of their families over the age of 21, and duly qualified guests.
�nr�wja s r . d- 1- r-_ - 0P 0:41 FAIN *Z-0 7 q L/1-3
Non-Profit Corporation .��
APPLICANT ON BEHALF OF CLUBS
First f
Middle Last
HOME ADDRESS I O 5 O A e Ua bJurLr '
Str t City Zip County
BUSINESS NAME S
BUSINESS ADDRESS dL- 1 -:5 4p
Street City Zip County
Is proposed location inside or outside city limits?
Does the club own the premises? y1 U � If leased,dive name and address of owner:
Is your establishment primarily engaged in the business of serving food for consumption on
the premises? - 0 s
Under which system of dispensing alcoholic beverages will the club operate?
Pool/Revolving Locker
Does anyone now hold an alcoholic beverage permit a this location? ( eS If so, give
name, address and permit no, (s) Pdllr�x-
Amount of Dues$ G °`U ANNUAL?f MONTHLY()
Give names and addresses of all officers/directors of the non-profit organization:
NAME TITLE ADDRESS
Has any member of the club's board of directors or other governing body, or any
c►rlrb officer, been under the sentence, whether suspended or otherwise, of any court
for the conviction of a felony Within ewo (2) years preceding the date of this
application? YES NO:-)L H yes, please explalirn._____
Signed this day of
I ,ature of Applic:antjManaging Agent
Official Title -
f
Subscribed and sworn to before me this day of_D_f� 21-?1
Notary Pu lic
My Commission Expires:
BROOKLYNN FLORY
Notary Public-Arkansas 3!15J1 Cx
Washington county
commission#12717498
My commission Expires Nov 17,2031
1
i 1
AUTHORITY TO RELEASE INFORMATION
Application filled by Applicant - A, Stockholder/Partner - S
TO WHOM 1T MAY CONCERN:
I understand that the Alcoholic. Beverage Control Enforcement Division will conduct a thorough
investigation before a final decision is made regarding my eligibility to hold an alcoholic beverage
permit. This investigation may include inquiries as to my character, reputation, and the location and
feasibility of a permit being issued at the applied for location.
To facilitate this investigation, I do hereby give my consent and authority for any public utility or
police agency to furnish information from their records to the Alcoholic Beverage Control Enforcement
Division and the Alcoholic Beverage Control Poard.
Mar►U �Mi����S-�z��
Signature - Full Name
Date
(Gt:-0 Reed VQI.,IN P( .
Home Address
F,-) A*�)t�e t��. Z�64
City State Zip
Mailing Address
City State Zip
T13--Z 14-1-04','D q9 - I(9--7101
Contact Phone Business Phone
�cun �c�Uy,co{e eCgmc'i cairn
E-Mail Address
Sworn and subscribed before me this day of
No r Public
BROOKLYNN FLORY
Notary Public-Arkansas
My Commission Expires: Washington County
Commission 9 12717498
(Revised 3/08) My Commission Expires Nov 17,2031
i
i
AUTHORITY TO RELEASE INFORMATION
Application filled by Applicant - A, Stockholder/Partner - S
TO WHOM IT MAY CONCERN:
I understand that the Alcoholic. Beverage Control Enforcement Division will conduct a thorough
investigation before a final decision is made regarding my eligibility to hold an alcoholic beverage
permit. This investigation may include inquiries as to my character, reputation, and the location and
feasibility of a permit being issued at the applied for location.
To facilitate this investigation, I do hereby give my consent and authority for any public utility or
police agency to furnish information fro heir records to the and
Beverage Control Enforcement
Division and the Alcoholic.Beverage C ntr Bo
Signature - Full Name
10 Z
Date
10�0 Rf0yclll�'� PKI
Home Address
Tb`(ai F'U A i t Ap, 4?;10 4-
City State Zip
lacjo QeF2ed
Mailing Address
City State Zip
Tn_ OZ-4Z95 419"31b-7lG�
Contact Phone Business Phone
J'Mlmssvy, co
E-Mail Address
Sworn and subscribed before me this day of ,aC7',CLN .
t y Public k,..r...
BROOKLYNN FLO
Notary Public-Ark
My Commission Expires: Washington Coun
Commission#127174987
(Revised 3/08) My Commission Expires N
NEWSCHA011J2 SCHEDULE A- XiMDXQ XDUAL'S PERSONAL HISTORY
i
Application filled.by Applicant- A, Stockholder/Partner - S
I submit answers to the
pfollowing questions under oath:
1. Name MQYIG M0y-01(e-S—tC7)Q 0 ----Sex r Date of Birth Q3 Gt 01G
ca�50 RMd Valle Rd Envi �(e
2. Home Address y y �l27(Phone No.
Street City T Zip
3. Are you a person of good moral character and reputation in your community? �e S
4. Are you a ITYZ�E r (PERMANENT RESIDENT ALIEN) of the United States? CIRCLE ONE
Social Security No. Green Card No.
5. Are you a resident of the county in which application has been made? Y)U
If not, do you live within 35 miles of the premises to be permitted? ye-S
/ T—
b. Have you ever been convicted of a felony? YES.. .._NO?�_,-If so, give full information
7.. Have you been convicted of any violation of any law re(ating,to alcoholic beverages within the
five (5)years preceeding this application? YES--_ No— If so, give full information
8. Have you had any alcoholic beverage permit issued to you revoked within the five (5) years preceeding
this application? VET NO V If so, give full information
9. Do you presently hold or have yo eve► eld an I o (ic v e r►xr't(s)? e�5 a�ag, give name,
Ac-, �.-o 14�,� ��r• ��� � �y h Z
place, arid permit numker(s) � � �
- U COU - AGQSf fl ej � Zl(09-vl I2D t jjwy+ ?-12 SIIco—NSp rl
10. Have you applied and been refused a permit at the applied for location within the last 12 months?
rP If so, give.full information
11. Marital Status: Single ( ) Married (�'J ) Divorced ( ) Separated ( ) Other ( )
12. Furnish complete information regarding members of immediate family:
Relationship Full Name Address Occupation
&S'iyie Pwn-Q l,--
y�C i(1�t,r �G f(Gl CG(L 1
S+"oje r, ---
NEN%[HA0202
(a) Are any of the above to be connected with the operation of the outlet?
(b) If so, who andin what capacity? C` \
13. Give your home address (city or town) and dates at each for the past five (5) years:
(05[) /\"tr| \ /".\\-e 7(9\[^
� � �- - - - 'r-----------'---------' '-----
14. Covering the past five (5) years, give in detail the following:
Your Business or,Occupation Name &Addre.5.� of Em-p-1gygr Dates of Fmployment
VVI
I hereby state on oath that I will not violate any law of this State or any regulation of the Alcoholic Beverage
Control Division, nor will any agent or employee be allowed to violate any /avv or regulation. It is hereby
consented that the licensed premises and its books and records shall be open at all t[rney to all law enforcement
officials without warrant or other legal process.
Applicant's Sig"rTature
STATE {}FARKANSAS
COUNTY OF
Mkw� mbyxvs,, being first duly sworn on.oath deposes and says that he/she has
neOU each of the questions to which he/she has made answer, and that his/her said answers in each instance are
true and correc±.
Subscribed and sworn to before me this day of
Not
My Commission Expires: �
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NEWETDS0102 ,
DESCRIPTION OF BUSINESS AND ENTERTAINMENT ACTIVITIES
i
FOR.PRIVATE CLUB PERMIT
NAME OF OUTLET 401 L Il ,
CITY VGn Ereyi COUNTY D(CIW-b—rd
Arkansas Law requires that a private club must exist for some reason other than the consumption of
alcoholic beverages. On this sheet of paper, which is a part of your verified application,you are to describe,
in complete detail, what entertainment (live bands, dancers, food service, etc.), social functions, or other
recreational events will be available at the club for the members. If you are in doubt about whether to list
an item,you are urged to include it.
Under Section 1.34 of the ABC regulations, any permit issued by this agency is only valid for the
uses described in the original application. Any material change in the club's operation or entertainment,
other than originally listed in this application, without prior approval of the director, shall be grounds or
revocation of your permit.
On your floor plan, which is a separate -attachment, please mark the entrance to the private club, noting the
location of the guest book, and mark any major features of the private club area, including where specific
entertainment items will be located.
PLEASE PRINT OR TYPE YOUR RESPONSES BELOW. USE THE BACK OF FORM, OR AbDDITIONAL
SHEETS, IF NECESSARY.
ibis i�sftllshrnen+ wi l ) a,.rUe �� f��f , by-unch and
glqnq of.111 espect,.l, COVIC dvI n Ks , T lrle�t U 1 , J
bt live -goctQ ) avent"; Suck Cis bi-ln90 n.��ht j lylI VICI
o lq nt of lid M01 C bclnd at ot St 06 t mys I cin YJ
Appacat Pion for Criminal Hnisto ry Check
k
for Alcoholic Beverage Permit
A.0 .A 3-2-103
(See other side for instructions)
Full Name: -morolle -I,G2Gnd �/Ir��riea Oel Qoso►no
Yeast Name First Name Middle Name
All other names ever used (married names, maiden, shortened, etc)I ^
Date of Birth: 03 io 1 iq°),o State of Birth: C_k)kVQhtfp MexlCO
(Month/Day/Year)
Citizenship: US C��t'I`Zer� -- Race: ttftftn'Q, Sex: f
Eye Color: Ilai.r Color: DOTK aYQWrl'
Height: 5 3 _ lbo l�S
Weight: i
Social Security #: .. . Driver's License #: ��� A pl
State
Mailing Address: 1090 Reed V0111t-y.....(- ,.. �uW� .�I f I fCl2 12104-
Street city State ZIP
Day Time Phone:
I GIVE MY CONSENT FOR THE ARKANSAS STATE POLICE TO CONDUCT A CRIMINAL
RECORD SEARCH ON MYSELF AND RELEASE ANY RESULTS TO THE FOLLOWING
PERSON AND/OR ENTITY :
M000Q 01t) (ZGSQric� MriMl 'S-t07,CinO
Name: Phone:
Full Name of Person/Entity
Mailing Address: PCIG Re d VQ1►ey R__�\ie-tevlile A� 12�®4
Street _ City State ZIP
Signature: VkWU D _ � P Date: IP 10 2022
(First MI/Last Name) (Month/Day/Year)
For Official Use Only
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Application for Criminal History Check
for Alcoholic Beverage Permit
A. C.A 3-2-103
(See other side for instructions)
Full Name: 'h tit =_. Le-C
Last Dame First Name MiddleName
All other names ever used (married names, maiden, shortened, etc) '
Date of Birth: L/ 3-V-7 State of Birth: AG1 1',5S(,t U-V*,
(Month/Daly/Year)
Citizenship: � Race: �� Sex:
Y(-,4
Eye Color: 7-C t Hair Color:
Height: i t7 Weight: /6
Social Security #: <2, Driver's License #:
State
:. .Mailing Address: �� C) �_ . C'.C.l� �r��C� J�ct/ _ ( �� �� j, �( �'. ilZ `?w, 7&l
Street city T-State ZIP
Day Time.Phone: W� - i�()�--
I GIVE MY CONSENT FOR THE ARKANSAS STATE POLICE TO CONDUCT A CRIMINAL
RECORD SEARCH ON MYSELF AND RELEASE ANY RESULTS TO THE FOLLOWING
PERSON AND/OR ENTITY :
Name: '" (,, ) /��1 �L �C��, l d/ hone: �f 7/`-
Full Name of Person/Entity
'y �c)Cleo �Jg e e. ���Il f6
Mailing Address: A .50 ��E �k' ��� � � � � ���
tr �Idzeeet city State ZIP
Signature: i� Date: 1e2 � -2
(F' t/MI/Last Name) (Month/Day/Year)
For Official Use.Only
82005 Civil Record Check- 80019 FBI Record Check - 80006,FBI Record Check