Laserfiche WebLink
<br />Incorporation Date: ~ -~ I S- I? 19 <br />List of Directors: j':>"7/lern-+ ~ {J/lV0I'4/?-RP'/C.. <br />JULie In lJ/hJ~/?~/( <br /> <br />List of Stockholders: S /T'p.....Jl <br /> <br />PERSONAL INFORMATION (d'sole proprietor): <br />keT? n ",--y-}.} F [/ fhJ (lfJ te '/l.tJsz ~ <br />Applicant's Address: b ;y 9 J.. C'- 8-/lrc r vi L( ~ e.o <br />Ce JJrrerj/11 L e tJJ ~ <br />[City] [State] <br /> <br />Applicant's Name: <br /> <br />::550'33 <br />[Zip] <br /> <br />Home Telephone Number: <br /> <br />Social Security Number: <br />ALL APPLICANTS: <br /> <br />List all persons or entities with either a direct or indirect interest in the applicant or the applicant's business <br />to be conducted under the license for which this application is made and describe their interest in detail <br />below. <br /> <br />luo /J C <br />, <br /> <br />Addresses: <br /> <br />Assumed or Trade Names, if any: <br /> <br />BusinessTelephoneNumber:Wj-h5'?--!O-71 HomeTelephoneNumber: C::s'J- 653-1 J89 <br />Has any person named in the application ever been convicted of a felony? 0 Yes ~ No <br />If yes, set forth the offense, date, county and stated of conviction: <br /> <br />Applicant agrees that any manager employed in the licensed premises will have all qualifications of a <br />licensee and that the manager will not violate any city or state laws. <br /> <br />Minnesota Tax Identification Number: q 5" 0 J c.,. 7 0 <br /> <br />Federal Tax Identification Number: 4 I ' I q:; 0 '7 3 4 <br /> <br /> <br />Si <br /> <br />Identification Number is not required, please explain on the reverse side. <br />Position (Office, Partner, etc.): f Itsl p.; /")ir-- <br />10-25--00 <br /> <br />Date: <br /> <br />Print Name: ~n n e /1+ <br />V IhJ ()R~'Bee:.,)L <br /> <br />S9 <br />