Laserfiche WebLink
<br /> <br />e <br /> <br />e'.' <br />, " <br />, . <br />, . <br />.. . <br />~, ,.. .- <br />'"../ . <br /> <br />1 <br /> <br />Minnesota Department of Public SIIfcty <br />ALCOHOL AND GAMBLING ENFORCEMENT DMSION <br />444 Cedar St., Suite 133, Sl Paul, MN 55101-5133 <br />(651) 201-7507 FAX (6S1)297-52S9 ITY(6S1)282-65S5 <br />WWW.DPS.STATE..MN.US <br /> <br />APPUCATJON FOR OFF SALE INTOXICATING UQOOR UCENSE <br />No ~ will be alllllOVed 01' ,1...... IUIllIlbe S20 Rtlder m CallI fie II ...... <br />Polk:ylt <br />Tollpply/DraMNMIk.t11Id""lla lPN. co1/(6JI) 19M,18} <br /> <br />rtJIer shaD encate tills . eatlo8. <br />Trade Name 01' DBA <br /> <br />j~D \ L U <br /> <br />Applicanl's Home Pbone # <br />12 5Z <br /> <br />OOB (Individual Applicant) <br />J , ,,;. 7 <br />Ila eorp0ntfe8 lIT LLC stale name. date ofblrtlt, Soelal SecIIrlty 1# addraa, tilIe, .... 1!Iam Wd by _h olficer. Ila parlUnblp, IDle <br />aames, addrao.. 4Ile of birdl of _h parl8er. <br />Partner Officer (Fim, middle, last) DOB <br />o ~ /rl t <br /> <br /> <br /> <br />_c.;. ritle <br /> <br />Partner Omcer (Fint, middl", last) <br /> <br />DOB <br /> <br />88# <br /> <br />tle <br /> <br />Shares Address, City, Stale. Zip Code <br /> <br />Partner Officer (Firsl, middle, last) <br /> <br />SS# <br /> <br />DOB <br /> <br />itIe <br /> <br />SIIoues Address, City, Stale. Zip Code <br /> <br />to <br /> <br />llaC<:llJlO'1llioo dllle ofi>""""",ation .~N[ ?M" ,Sl8lelncurp"utod in MINNfI,arA ,amount paid in <br />capilal , If a subsidiary of any oIiler corporation. so state and give purpoo;e of <br />cotpOnllion . If incorporated under the laws of 8lIOlIter state, is corporaIion <br />autOOrized to do busineu in the state ofMiDDesota? 1A Yes uNo <br />, <br /> <br />~'r;1i.~r;!jm~~suchas~~""fbmJn-.~2J~~re. <br /> <br />Is establishment 10000ed near any state university, state hospital, training school, refomurtory or prison? I 'Yes "No lfyes state <br />approximate distance. <br /> <br />2. <br /> <br />3. <br /> <br />4. <br /> <br />Name IIIld address of building owner:~LL <br /> <br />Has owner ofbuildillg any COIlIIection, dire<:lly or inditectly, willl appIicaDI? 0 Yes III No <br />Is applicant or any oftbe associates In this application. a member of tile _..;.." body oflbe mllllic;ipalily in wIlidI this U- is <br />tobelssued? ayes ~No Ifyes,inwhatcapacity'1 <br /> <br />s. <br /> <br />6. <br /> <br />Sfate whl:ther any person odt<<lhIn ~ba lIlY, right.1ilIe oriRlerelt in !he Iimritun:. fixlurcscrequipmClll for wbidlllceftse <br />is applied and if so, aM name and deIalls. a <br /> <br />7. <br /> <br />Have app!icanls any interesc wl1aIsoever, directly or iD<Iino:tIy, in.. other liquor esl8bIisbmalt in the Slate ofM'mnesolIl? <br />n yes "No IfYe&. give name and address ofesl8blishmClll. <br /> <br />t/J5 <br />