BEFORE THE BOARD OF COUNTY COMMISSIONERS OF MARION COUNTY, STATE OF OREGON  NO. 20139  Int the Matter of the Application of TaniaMargsez Garcia  Fora a recommendation regarding the application to the Oregon Liquor Control Commission for  Change ofownership RECOMMENDATION  This matter coming before the Board of County Commissioners on the application of  /ania/ Marquez Garcin  for a recommendation to the Oregon  Liquor Control Commission under the provisions of ORS 471.166; and the Board having referred said application to the Sheriff of Marion County, Oregon, and having the report of said Sheriff that the applicant has not been convicted of a crime involving a violation oft the liquor control laws, or the gambling laws, or of crimes involving moral turpi-tude, and that the applicant is of good moral character, a citizen of the United States of America, and otherwise qualified to bel licensed under ITIS, THEREFORE RECOMMENDED TO THE OREGON LIQUOR CONTROL COMMISSION  the Oregon Liquor Control Act;  that the application of the above be refused Dated at Salem, Marion County, Oregon this  granted day of  20_  County Commissioner County Commissioner County Commissioner  Approved y  County Sheriff   S/2r/2024    LIQUOR LICENSE APPLICATION Check the appropriate license request option: Select the license type you are applying for.  Page 1 of4  New Outlet Change of Ownership I D Greater Privilege I D Additional Privilege  More information about all license types is available online.  Full On-Premises Commercial OCaterer  LOCAL GOVERNMENT USE ONLY LOCAL GOVERNMENT After providing your recommendation, return this form to the applicant WITH ther recommendation marked below Name of City OR County (not! both)  OPublic Passenger Carrier DOther Public Location DFor Profit Private Club Nonprofit Private Club Aprimaryl location  Marion  Pleaser makes suret ther name ofthel Local Govemment is printedk legibiy. or stampedk below  Winery  Date applicationrerelved: Optional: Date Stamp Received Below  Additional locations: D2nd [3rd 04th 05th  Brewery  23 E Bo 5   Primary location Additional locations: Brewery-PublicHouse Primary location Additional locations: D2nd C3rd Grower Sales Privilege Primary location  0 E 8 a  D2nd D3rd  Recommend this license be granted Recommend this license be denied No Recommendation/Neutra:  Additional locations: 02nd 03rd  Distillery  Primary location uimited On-Premises D Off Premises Warehouse  Additional tasting locations: (Use thel DISTT form HERE)  Printed Name  Date  Signature  V Wholesale Malt Beverage: and Wine  Trade Name  OLCC Liquor License Application (Rev. 10.25.23)    Qo  oLcc OREGON LIQUOR & CANNABIS COMMISSION  LIQUOR LICENSE APPLICATION  MMISSIO Instructions  1. Complete and sign this application.  2. Prior to submitting this application to the OLCC, send the completed application to the local government  for the premises address to obtain a recommendation.  Ifthe premises street address is within a city's limits, the local government is the city. Ifthe premises street address is not within a city's limits, the local government is the county. 1. You have WRITTEN documentation showing the date the local government received the application or;  3. You can submit the application to the OLCC if:  2. The local government has provided you their recommendation.  ALL forms and documents must be a PDF attachment  4. Email the PDF application that contains the local government recommendation or proof of submission 5, Do noti include any license fees with your application packet (fees will be collected at a later time). When it's time to pay the license fee you must pay thej fully yearly feej for the current license year (the license fee will not be prorated). lfyou pay in the last quarter ofy your license year you must also pay the yearly fee for the next license year. License Request Options - Please. see the general definitions of the license request options below: New Outlet: The licensing of al business that does not currently hold an active liquor license. Change of Ownership: The request to completely change the licensee of record at al licensed business. Greater Privilege: The request to change from an Off-Premises to al Limited or Full On-Premises Sales license OR Additional Privilege: The licensee currently holds an active liquor license at the premises and that same licensee would like to request to add an additional different liquor license type at that same premises location.  to: OLCC.LiquorLicenseApplicationQoregon.gov.  from a Limited to Full On-Premises Sales license.  Additional Information  Applicant Identification: Please review OAR 845-006-0301 for the definitions of "applicant" and "licensee" and OAR 845-005-0311 to confirm that alli individuals or entities with an ownership interest (other than a waivable ownership interest, per OAR 845-005-03116)) ini the business have been identified as license applicants on this document. If you have a question about whether an individual or entity needs to be listed as an applicant for the license, discuss this with the OLCC staff person assigned to your application. Premises Address: This is the physical location oft the business and where the liquor license will be posted. Applicant Signature(s): Each individual listed ini the applicant information box on page 2 (entity or Ifa an applicant listed ini the applicant information box on page 2 is an entity (such as a corporation or limited liability company), at least one member or officer of the entity must sign the application. Applicant/licensee Representativels): In order to make changes to a license or application or to receive information about a license or application by someone other than the applicant/licensee you must:  individuals applying for the license) must sign the application.  -"Complete the Authorized Representative-: and submit with the application.  For help with" this application or any related documents or processes, email olc.alcoholicensing@oregon.goy,    LIQUOR LICENSE APPLICATION  Page 2of4  APPLICANT INFORMATION  Identify the applicants applying for the license. This is the entity (example: corporation or LLC) ori individual(s) applying for the license. Please add an additional page if more space is needed.  Name of entity or individual applicant #1: Bicacdo Lizaola r. Name of entity ori individual applicant #3: Pedo Olaldé  Name of entity or individual applicant #2: lania Maxcocz Garcia Name of entity ori individual applicant #4:  BUSINESS INFORMATION  Trade Name oft the Business (name customers will: see):  AJ's Mexicon tood.  Premises street address(The physical location oft the business and where thel liquor license willl be posted):  3862  Centel st Zip Code:  Salem OR  City: Salew Business phone number:  County:  97301  Businessemail.  192155  Business mailing address (where wev will send any items by mail as descridedi in FARBAF00A-0S5I1):  3862 City: Salem.  Center st. Salem OR  State: 97301  Zip Code: 9730]  Does the business address currently have an OLCC Does the business address currently have an OLCC  liquor license? Dyes'KNo  marijuana license? Cyes No  APPLICATION CONTACT INFORMATON - Provide the point of contact for this application. If thisi individual is not an applicant or licensee, the Authorized. Representative Form must be completed and submitted withi this application.  Application Contact Name: Onla Phonenumber:  Marquez Gorcia.  Email:  Please note: liquorl license applications are publicrecords.  OLCC Liquorl License Application (Rev. 10.25.23)    LIQUOR LICENSE APPLICATION  Page 30 of4 TERMS  e"Real property" means the real estate. (land) and generally whatever is erected or affixed to the land "Common area" is a privately owned area where two or more parties (property tenants) have permission to use the area in common. Examples include the walking areas between stores at a shopping center, lobbies, hallways, patios, parking lots, etc. An area's designation as a "common area"  (for example, the building) at the business address.  ist typically identified in the lease or rental agreement.  ATTESTATION - OWNERSHIP AND CONTROLOF THE BUSINESS AND PREMISES Each applicant listed in the "Application Information" section of this form has read and understands 1. At least one applicant listed in the "Application Information" section of this form has the legal right to occupy and control the real property proposed tol be licensed as shown by a property deed, lease, 2. No person not listed as an applicant ini the "Application Information" section of this form has an ownership interest in the business proposed to be licensed, unless the person qualifies to have that  OAR 845-005-0311 and attests that:  rental agreement, or similar document.  ownership interest waived under OAR 845-005-0311. a. Does not include any common areas; or  3. The licensed premises at the premises street address proposed to be licensed either:  b. Does include one or more common areas; however, only the applicant(s) have the exclusive right to engage in alcohol sales and service in the area to be included as part oft the licensed premises. Int this circumstancé, the applicant(s) acknowledges responsibility for ensuring compliance with liquor laws within and in the immediate vicinity of the licensed premises, including in portions of the premises that are situated in "common areas" and that this requirement  applies at all times; even when the business is closed.  4. The licensed premises at the premises street address either:  a. Has no area on property controlled by a public entity (like a city, county, or state); or b. Has one or more areas on property controlled by a public entity (like a city, county, or state) and the public entity has given at least one of the applicant(s) permission to exercise the privileges of  the license int the area.  OLCCI Liquor License Application (Rev. 10.25.23)    LIQUOR LICENSE APPLICATION  Page 4 of4  Applicant Signature(s): Each individual listed in the applicant information box on page 2 (entity or Ifa an applicant listed in the applicant information box on page 2i is an entity (such as a corporation or limited liability company), at least one member or officer oft the entity must sign the application.  individuals applying for the license) must sign the application.  eEach applicant listed in the "Application Information" section of this form has read and understands 1. Upon licensure, each licensee is responsible for the conduct of others on the licensed premises, 2. The licensed premises willl be controlled to promote public safety and prevent problems and violations, with particular emphasis on preventing minors from obtaining or consuming alcoholic beverages, preventing over-service of alcoholic beverages, preventing open containers of alcoholic beverages from leaving the licensed premises unless allowed by OLCC rules, and preventing noisy, lattest that all answers on all forms and documents, and all information provided toi the OLCC as a part  OAR 845-006-0362 and attests that: including in outdoor areas.  disorderly, and unlawful activity on the licensed premises.  of this application, are true and complete.  Licordo Lzac S R  Applicantr name Hania Applicantname Tabro Ohls Applilcant name Applicant name  CH/10/2024  Signature  Date Date Date Date  04/1012024 QH/10/2024  Magur2.6 E  Tesro olals 1422  Signature Signature  Applicant/licensee Representativels): If you would like to designate a person/entity to act on your behalf you must complete the Authorized Representative Form. You may submit the form with the application or anytime thereafter. The form must be received by the OLCC before the representative  can receive or submit information for the applicant.  Please note that applicants/lcensees are responsible. for all information, provided, eveni if an authorized. representative submits additional forms on behalf of the applicant.  OLCC Liquor License Application (Rev. 10.25.23)    OREGON LIQUOR & CANNABIS COMMISSION BUSINESS INFORMATION  OLcc  Please Print or Type Applicant Name: Tania marquez Trade Name (dba):. JJs Mexican food Business Location Address: 3862 center st ne  Phone:  City: Salem  ZIP Code: 97301  DAYS AND HOURS OF OPERATION  Business Hours: Sunday. 7:00am Monday 7oM to 1dn Tuesday 7:00 Wednesday 7m to1:00 Thursday 7 m to1 1:00 Friday Saturday 7:00 to 2:00  Outdoor Area Hours: A  The outdoor area is used for: D Food service Hours Alcohol service Hours: Enclosed, how.  to. :00am to 1:An  Sunday. Monday Tuesday Wednesday, Thursday Friday Saturday  to to to to. to to to.  IR  The exterior, area is adequately viewed and/or supervised by Service Permittees.  7:00 to 2:00  (Investigator's Initials)  Seasonal Variations: D Yes D No If yes, explain: Seasowjal  ENTERTAINMENT Live Music Recorded Music DJ Music Dancing Live Entertainment Minor Entertainers approval from the OLCC SEATING COUNT Restaurant: X Banquet:  Check ALL that apply: Karaoke  DAYS & HOURS OF LIVE OR DJ MUSICI  Sunday Monday Tuesday Wednesday Thursday Friday Saturday  to. ID4m 2pm to to to to  Coin-operated Games Video Lottery Machines Pool Tables Other:  Nude Dancing Social Gaming  to LAA - AvI  Am  EPm  *Minor Entertainers in an area prohibited to minors need prior  OLCCUSE ONLY  Investigator Verified Seating: (Y) (N)  Outdoor: Other (explain):  Lounge: Total Seating: 49  Investigator Initials: Date:  lunderstand if my answers are not true and complete, the OLCC may deny my license application.  - Rev: 2.1.23  Applicant Signature:  Date:  5  www.oregon.gowolce  CH16b024    PRINT FORM RESET, FORM  Oregon Liquor & Cannabis Commission  (oucci) LIMITED LIABILITY COMPANY (LLC) QUESTIONNAIRE  LLC Name ania Manquez Garca  Trade Name of Business (Name Customers Will See). The LLC named int this document is a (see page 11 for definitions):  1's. Mrxicn Focc  Manager-Managed LLC  Member-Managed LLC  This section is ONLY for a manager-managed LLC. (Directions on page 1. You mayi include information on a separate sheet.)  Name of Managing Member (please print)  Name of Managing Member (please print)  This section is for BOTHar manager-managed LLC and a member-managed LLC. (Directions on page 1. Your may include information  ona separate sheet.)  Name of Member (please print)  Percentage ofi issued membership held 7o0am to Y:o0rm  Taksa Olalde  Towio  MCNeNez Gordo H0gpn - .a0em  Ricivco Lizocda  H-opn - 00p  This section is ONLY for an LLC with the listed officers. (Directions on page 1. You mayi include information on a separate sheet.)  Title  Name (please print)  President Secretary Treasurer  Vice president with responsibility over the operation of thel business SERVER EDUCATION DESIGNEE (Directions on page 1)  Name (please print)  Date of Birth  SIGNATURE (Directions on page 1) NAME of Signing Person (please type or print). SIGNATURE of signing person (nay electronically sign)  ania 5  Gxaa 04/19/2023.  -  Mague DATE  This box for OLCC use ONLY  Does the entity hold, or hasi ite ever held, an OLCC-issued liquor license?  Rev: 2.1.23 Page 2of2    Oregon Liquor & Cannabis Commission (OLCC) LIMITED LIABILITY COMPANY (LLC) FORM INSTRUCTIONS  OLcC MISS>  Definitions  Manager-Managed LLC" means an LLC where one or more individuals or entities have the responsibility to run the LLC, "Managing member" means an individual or entity who has been named to run a manager-managed LLC. Amanaging member is not required to own or hold membership in the LLC. - Amanager of the business is not required to be a member or managing member oft the LLC. Member-Managed LLC" means an LLC where all members have the responsibility to run the LLC, and as such, no "Member" means an individual or entity who owns membership in the LLC. "Entity" means an association, corporation, limited liability company, partnership, trust, or any similar entity that has legal standing under the laws of Oregon or another state within the United States.  and as such, have been named as a' "managing member."  managing member has been named.  "Individual" means an individual human being. When does the OLCC require this form to be submitted?  The LLC is listed as an applicant in the Applicant Information" section of the Liquor License Application form; The LLC has 20% or more ownership in an entity applicant listed ini the' Applicant Information" section of the Liquor  Liçense Application; Registered with the Oregon Secretary of State (SOS) Section 1 Section 2 Section 3  The OLCC believes obtaining this information may help the OLCC in its investigation.  Manager-Managed LLC  Member-Managed LLC The OLCC does not require registration in Oregon with the Oregon Secretary of State. Not Applicable.  The OLCC does not require registration in Oregon with the Oregon Secretary of State. Must complete this section. a List allr managing members (may be one or more individuals or entities) Must complete this section.  . List all members with 20% or more membership (may be one or more individuals or entities). . An LLC with the following officers must complete this section: president, secretary, treasurer, and vice president (with responsibility over the operation of the business). Alli individuals who are a managing member, member with 20% or more membership, ora The OLCC has determined that the LLC has provided proof to the OLCC that it is listed on an exchange registered with the U.S. Securities and Exchange Commission; or The OLCC has determined that the LLC has provided written documentation to the OLCC sufficient to show that control of the day-to-day operation oft the business has been relinquished by the individual through a written management agreement, or similar written agreement, to one or more parties who are an applicant or licensee for the same license at the same premises. Relinquishing control over the day-to-day operation of the business includes not managing or controlling the sale or service of alcohol or directly supervising any person . If the application is for al liquor license that allows customers to consume alcohol at the business, an individual must be listed who has completed, or will complete, an OLCC approved Alcohol Server Education class, and has passed the test. This individual must have the authority to set standards and policies for alcohol servers at the business. Ift the application is not for al liquor license that allows customers to consume alcohol at the One of the listed members or managing members must sign and date this form.  . An LLC with no officers should skip this section.  Individual History form The following individuals must submit an Individual History form unless an exception applies:  listed officer. Exceptions:  who sells or serves alcoholic beverages  Section 4  business, this section may be left blank.  Section 5 Rev: 21.23 Page 1of2    PRINT FORM RESETFORM  OREGON LIQUOR & CANNABIS COMMISSION INDIVIDUAL HISTORY FORM  (oLcc) MISS1O  1.N Name (Print):  Gonca  Tahia First  Last  Middle No  Marquez  2. Other names used (maiden, other): Ify yes, your mustl list your SSN:  3.[ Do you have a Social Security Number/SNlisued bythe United States Social Security Administration? Yes  SOCIAL: SECURITY NUMBER DISCLOSURE: As part of your application for ani initial or renewal license, Federal and State laws require yout to provide your Social Security Number (SSN) to the Oregon Liquor Control Commission (OLCC) for child support enforcement purposes (42 USCS 666(a)(13)& ORS 25.785). Ify you: are an applicant orl licensee and fail to provide your SSN, the OLCCI may refuse to process your application. Your SSN willl be Based on our authority under ORS 471.311 and OAR 845-005-0312(6), we are requesting your voluntary consent to use your SSN for1 thet following administrative purposes only: to matchy your license application to your Alcohol Server Education records (where applicable), and to ensure your identity for criminalr records checks. OLCC will not deny you any rights, benefits or privileges otherwise provided byl lawi if you do not consent to use  used onlyf for child support enforcement purposes unless youi indicate below.  of your SSN for these administrative purposes (SUSCS 552(a).  4. Do you consent to the OLCC's use of my SSN as described above? Check this box:  5. Date of Birth (DOB): 6. Driver License or State ID#: 8. Contact Phone: 9. E-mail Address: 10. Mailing Address:  (mm)  (dd)  (vyyy) CPegon  7.State  Number and Street)  (City)  (State)  (Zip Code)  11. In the past 10 years, have youl been convicted ofat felony or a misdemeanor in a U.S. state outside of Oregon?  No A Yes  (Ify yes, explain in the space provided, below) Unsure,  Choose this option and provide an explanation if,  for example: you were arrested or went to court, but are unsure of whether there was a conviction; you paid ai fine or served probation or parole, but are unsure of whether there was a conviction; or ify you know you had a conviction, buty you are unsure of  whether the conviction has been removed from your record, etc.  Rev. 2.1.23  Page 2of3    (ouc! 519  OREGON LIQUOR & CANNABIS COMMISSION INDIVIDUAL HISTORY FORM  WHOI MUST COMPLETE THIS FORM? You must complete this form if: License. Application form.  Yourr name is listed as an applicant in the "Entity or Individuals applying for the license" section oft the Liquor Acorporation is listed as an applicant in the "Entity or Individuals applying for the license" section of the Liquor President, a' Vice President with responsibility over the operation of the business, Secretary, or Treasurer,  License Application form and you are:  AD Director.  Ani individual who owns 20% or more of issued stock. section of the Liquor License. Application form and you are: the same individual designated to manage the business). AN Member who owns 20% or more of the membership.  Al limited liability company (LLC) is listed as an applicant int the "Entity or Individuals applying for the license" AM Managing Member of the LLC (this is an individual designated to manage the LLC; it may or may not be An Officer (such as al President or Secretary) with responsibilities over the operation of the business. Part of an entity other than a corporation or LLC that is listed as an applicant in the "Entity or Individuals Part of an entity that owns 10% or more of an entity listed as an applicant in the "Entity or Individuals IN_ADDITION. THE OLCC MAY REQUIRE OTHERI PEOPLEIOCOMPLEIE THIS FORM WHEN THERE IS  You must work with the OLCC to determine who must complete this form if you are: applying for the license" section of the Liquor License. Application form, or applying for the license" section of the Liquor License Application form. REASON TO BELIEVE ITI MAY HELP THE OLCCI INITSINVESTIGATION.  Rev: 2.1.23  Page 1of3    OREGON LIQUOR & CANNABIS COMMISSION INDIVIDUAL HISTORY FORM  oucc! s5i9  12. Doy you, or any entity that you are a part of, currently hold or have you previously held a recreational marijuana license in  Oregon? (Note: marijuana worker permits are not marijuana licenses.)  No KI Yes  Please list! licenses (and year(s) licensed) below Unsure  Please include an explanation:  13. Do you, or any entity thaty you are ap part of, hold an alcohol license in a U.S. state outside of Oregon?  No.  Yes  Please list licenses (and year(s) licensed) below Unsure  Please include an explanation:  14. Do you or any entity that you are a part of, have any other liquor license applications pending with the OLCC?  No  Yes  Please list applications below Unsure.  Please include an explanation:  Your must sign your own form (electronic signature acceptable). Another individual, such as your attorney or ani individual with Even iflreceive assistance in completing thist form, laffirm by my signature below, that my answers ont this form are true and complete. understand the OLCC will use the above information to check my records, including but not limited to my criminal history. lunderstand that if my answers are not true and complete, the OLCC may deny my license application.  power of attorney, may nots sign your form.  Affirmation  6acio  lanloy  Name (Print): Signature:  Marquez  Last  First  Middle  6  Date: 04/16/2023  This box for OLCC use ONLY Rev. 2.1-.23. 6  Does thei individual currently hold, or has thei individual previously held, an OLCC- issued liquor license?    Page 3of3    OREGON LIQUOR & CANNABIS COMMISSION  (oLcc)  FLOOR PLAN FORM  Your floor plan must besubmitted on this form  Tania Applicant Name  Ga  Aekicon  -  Name Trade (dba), 3 0 O M  focd bae  Mauquez  S  00 000  000 00  080  00 06  000 00    Rigislef.  00  080  Entrovce  OLCC USE ONLY. MINOR POSTING. ASSIGNMENT/S)  Date:  Initials:  frov na/22)    OREGON LIQUOR & CANNABIS COMMISSION  (OLcci  FLOOR PLAN  INSTRUCTIONS  1. Your floor plan MUST be submitted on the Floor Plan Form below  2. Use a separate Floor Plan Form for each level or floor of the building. The floor plan(s) must show the 3. Label areasi i.e. dining area, bar, lounge, lottery, outside patio and sidewalk cafe areas. 4. Food Counters should be, labeled as such, and not as a Bar. At a Food Counter, food servitce/Consumption ist the predominant activity. Ata Bar, alcohol service/consumption is the predominant activity. Please  specific areas of your premises.  label Food Counters and Bars accordingly. 5. Include all tables and chairs. (See Example below)  6. Ify you have an outdoor area, please show iti in reference to the licensed building. be served, where the seating will be and any other food carts that are in1 the pod.  7. If you! have sidewalk seating please contact your local government to see ifa permit is required for use. 8. Ift this isaF Food Cart Pod please label the floor plan where the alcohol willl be served from, where food will Please do not use complex architect drawings as your floor plan, unless they are clearly readable and  show all the tables and chairs.  RESTAURANT EXAMPLE OREGON LIQUOR & CANNABIS FLOOR PLANF FORM Your floor plann mustbes submittedo ont thislarm MyR RestaurantLLC  FOOD CART POD EXAMPLE OREGON LIQUOR & CANNABIS COMMISSION FLOOR PLAN FORM Yourt floor pianmustb bes subminedont thisf form Food Carts LLC war Food Cart Food Cart Food Food Cart &  My Restaurant  EverydayF Food CartPod Entrance 090 - -  Example:  D  Food Cart Food Cart Food Food Cart  000 000  000 0000000  88  D0400004  Les  OLCCI Liquorl License Floor Plan (Rev. 3.22)    MARION: COUNTY BILL BURGESS. MARION: COUNTY-CLERK  Reçeipt #: 24524: Station:3  Receipt Date: 05/10/2024: 03:53 PM Cashier; DMI,  Receipt Name: RICARDOLIZAOLA: JR  Comments!  Thank Youl  Miscellaneous Fees LIQUOR LICENSE FEE  BILL BURGESS, MARION COUNTYCLERK Please retain this receipt for your records.  YES  Receipt Total CREDIT CARD 181259982  $25.00 $25.00  Documents are recorded as submitted. The Marion County Clerk's, Office assumes no liability for sufficiency, validity, or accuracy.  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