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� �- �.� `�. <br />Whoever s�al� knowing�y and wi�l�ul�y �a�s�fy the ans�v�rs to the follov�i�g ��esiiannaire shal� <br />be deem�d g�ilty of �erjury ancl sha�1 b� punished accordingly. �very questior� mus� be <br />answered. <br />(Licensi�g Period: January l, 20i0 through December 31, 20�0� <br />Business Name <br />�'remise Address <br />�'�-emise Sq. ft. <br />2(��0- <br />On Saie <br />Sur�day <br />1 r�ves#igation $ � 5�.00 <br />flff sale $200.00 <br />�'otal Fee <br />Rece� pt #: � <br />Date Pai� <br />r en i s, _ <br />Phone 651.792,7800 * �ax 651.634.5134 <br />��T H:IL�S <br />CI�Y �F A��N HIL�S <br />� 245 West Highvvay 96 <br />A d H'l� �N 55112 5794 <br />Hal i da Stati o�stores ��c. d b a�ol i da S�at� or�stor� #�b8 <br />1920 H��hwa� 96 <br />Arde� Hi � 3 s, M!� 5�112 <br />�,001 <br />A�plication: I�l Nevv <br />License Types Ap�ly for: <br />❑ �Zenevval � Transfer <br />� �n-Sale <br />� (�ff-Sale <br />� Wine On�y (�nc�udes strong beer) <br />� 3.2 �eer <br />�] 1VIa�t Bev�rag� <br />t� S�ecial Sunday (�n-Sale <br />