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Minnesota Department of Public Safcty
<br /> ' LIQUOR,CONTROL DIVISION ,, � `
<br /> 444 Cedar St.. Suite 100 [.,St.Paul,MN 55 10 1-2 156
<br /> (612)290-6430 .I..tY(612)282-6555 ,
<br /> APPLICATION FOR OFF SALE INTOXICATING LIQUOR LICENSE
<br /> No license will be appnwed or released until the S20 Reta&r ID Card fee is received by MN Uquor Control
<br /> Workers compensation insurance company. Name Policy# ')/6 0 ; 7 33
<br /> LICENSEE'S SALES&u '• TAx iD# .5 "l 1_t' To apply for sales tax #, call 295-06 18 I or I-800-657-3777
<br /> If a co oration an officer shall execute this Rplication If a pannershi2, a pLnner shall execute this.application.
<br /> I.icen see Name(ludiv idu al, ozp oration P mtneursb ip) Trade Name or DBA
<br /> coo 4A(Ala &9%iA LLs ej e) rlarl or--.,k
<br /> F LeA t�,J.*kC.
<br /> M aor L4
<br /> License Location (Street Address&Block No.) Lictmse Period Applicant's Home Phone
<br /> 02 Lk) F, 0 ' From , To C 4`I C)) F9 3 _7 3 a(qa T)3-7
<br /> City C:o;luty State lip Code
<br /> �se �. A) 13
<br /> Nance of Store Manager Business Phone Number DOB(Individual Applicant)
<br /> n c t a.�a�.t Ca
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<br /> If a corporation, state name, date of birth, address, title, and shares held by each officer_ If a partnership, state
<br /> names, address and date of birth of each partner.
<br /> Partner-IFne (First,middle,last) U013 1'it a Mares Address,City, State,Zip Code re
<br /> kLAXr Cam .
<br /> CA 9 V-(a.D
<br /> lamer Officer(First'..middle,last) DOB Title Shares Address,City-,State.lip Code
<br /> 441L
<br /> jfir■ r �■_ ~
<br /> . y 6 a
<br /> Farther Officer(First,middle,last) DOB Title Shares Address,C:i 4 State,Zip Code
<br /> Q .sue
<br /> AR LOA 6P7_1��4_47xwo Trr CA 4y(a 6
<br /> Partuer Officer(First,middle,last] DOB Title Shares Address,City,State,lip Code
<br /> 1. If a corporation,date of incorporation I ,state incorporated in_ KALE` -mow.' „_,amount p aidui
<br /> capital If a subsidiary of any other Corporation,so state f 17 -- and give purpose of
<br /> corp orat ton . If incorporated under the laws of another state,is corp or at ion
<br /> authorized to do business in the state of Minnesota?VYes ❑ No
<br /> 2 Describe premises to which Iiccnse applies;such as (first floor, second floor, basement, etc.) or if entire building. so state.
<br /> 14+yc� 1. 6 19
<br /> Is establishment located near any state unn�ersy�s s#ate lac tt ,training school,reformatory or pro n? 3 Yes o If yes
<br /> state approximate distance.
<br /> 4 ICIi nne and address of building owner:An :A e ale .�'� 4 1 C9_Q -
<br /> Z;,%,± &4-A4 u Flas owner of building any conifedion,directly or 6directly, with applicant? 'u Yes ❑ No
<br /> 5 is " g g plicant or auy of the associates in this application, a member of the onrcnnin body of the municipality in which this license
<br /> is to be issued? [I Yes )4,No If yes, in what capacity?
<br /> 6 State whether any person other than applicants has any right, title or ittterct in the furniture,fixtures or equipment for which
<br /> license is applied and if so, give nmue and details. tlo/LQ.-
<br /> 7 Have applicants auy interest whatsoever, directly or indirectly,in anv other liquor eslablislunent in the state of Minnesota?
<br /> KYes i;No If yes, give name and address of establishment. __ ? �
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