Laserfiche WebLink
<br />Incorporation Date: 0 7 - tJ 5 - 19 ? 9 <br />List of Directors: f'e t1 n e JI1 {:' 1/1+ IV 0 e Il 8 e e.. i(' <br />J U KC m l/fhraL/l ~P(~/{ <br />List of Stockholders: S F1 yY"\..Jl <br /> <br />- <br />PERSONAL INFORMATION (if sole proprietor): <br />Applicant's Name: <br /> <br />Applicant's Address: <br /> <br />[City] <br /> <br />[State] <br /> <br />[Zip] <br /> <br />Home Telephone Number: <br /> <br />Social Security Number: <br /> <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 /> <br />-~-_._----------below;--- ----------- <br /> <br /> <br />.f'p 11 n e-r4 F (J ~JJ.?-ell. lJ ~ e. J~ <br />, <br />J U L I ~ (VI V AtJ~(l-ee.l<- <br />Addresses: ~ B 9' ~ C 8/Jrefl UIl-Le- ~O <br />Cenre~ V/C"LB rnrJ ~5c)3a <br /> <br />Assumed or Tmde Names, if any: <br /> <br />Business Telephone Number: I.t:S 1- (,f 'l- J 0"7 7 Home Telephone Number: (;, 51, (.,) J - I) Cj J <br />Has any person named in the application ever been convicted of a felony? 0 Yes ~ No <br /> <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 />Federal Tax Identification Number: <br /> <br />'-/60:1970 <br />L/ 1- i95()7:J'--I <br /> <br />Minnesota Tax Identification Number: <br /> <br />If a Minnesota Tax Identification Number is not required, please explain on the reverse side. <br /> <br />Signature~~ P<>sition (Office, Partner. etc.): Iff;, es I a- <9,,-r- <br /> <br />PrintName: f;lJllell-t F Date: / () - Z 5-- 2." O!) <br />V It "" oer Bet: 1<" <br /> <br />//9 <br />