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Minnesota Del)artinent of 11ttblic Safety ��TL4
<br />LIQU O R.CONTRO L DIVISION
<br />144 Cedar St Sufic 100 L. S1. Paui, NM 55 10 1 -2 156 ������ 19.
<br />{ .ti a� (612)296 -64:10 '1-'1 1 -
<br />APPLICATION FOR OFF SALE INTOXICATING LIQUOR LICENSE
<br />o I icon se %i- ill be ap p rove d o r mleased u nt11 the $20 Rot atiile r ID Ca rd fee is receive d by M[ Liquo r Cont rul.
<br />Work- crs compensation ru S1Lr ante c oni any . N ►uiie ti �'e�
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<br />II �tN S�~'S SAI,Ir S & U SI" TAX I # To app ' for sales tax ff. call 296-06 181 or 1-900-657-3777
<br />If a corporation, are offlqg.,,§haL1 execute this application If a partnership, a partner shall execute this application.
<br />i . icon sce Name {Itxd iv idii .-ryl gor-p oral ion} 13 arinL -rslr ip)
<br />D013
<br />Trade N anzc or D13A
<br />shares
<br />Address, C'j) -, �C:tic, 7 in rr,rij%
<br />-s
<br />1 -it le
<br />Sli arcs
<br />Mir" cc rily �� Ri�A- -r s,ly Cr`odc
<br />I . iceti se Location ( Strect A ddret s & Block No.)
<br />D 013
<br />License Period
<br />AL
<br />A p l icy cw i s I Ionic l'l i mic
<br />r -
<br />Address, C ilyR, State, Zit) Code
<br />I
<br />i, ar(m,, on icer 0' it sl . ni idd [0 l asi)
<br />D013
<br />[` rout_ -�_
<br />fug -•-
<br />_
<br />DOB
<br />Title
<br />J
<br />Address, City, Stale. Zip Code
<br />Coll Ily
<br />State
<br />Zip Code
<br />5 5
<br />{t,ile or Store Manager Business Phone l nniber DOB (ndividttal AI)l3licaLit)
<br />rW
<br />IF a corp oration, state nark date of birth, address, title, and shares held by each officer.
<br />names,, address and date of birth of each partner.
<br />I f a partnership, state
<br />I'(irtjier Nicer 0` irsl, middle, Iasi)
<br />D013
<br />Title
<br />shares
<br />Address, C'j) -, �C:tic, 7 in rr,rij%
<br />1 -it le
<br />Sli arcs
<br />Mir" cc rily �� Ri�A- -r s,ly Cr`odc
<br />P eu -in of Off1cer (Firs-, m iddlc ,11s-t)
<br />D 013
<br />' /r +
<br />r � • L! {Y L •
<br />AL
<br />r -
<br />Address, C ilyR, State, Zit) Code
<br />I
<br />i, ar(m,, on icer 0' it sl . ni idd [0 l asi)
<br />D013
<br />l'it le
<br />Sli arcs
<br />P arl n or Officer 0i lrst , Pal addle, la st)
<br />DOB
<br />Title
<br />Sli arcs
<br />Address, City, Stale. Zip Code
<br />1. If a coq)oraf ion, date of incorporation 1---1. —r ?--.state iueorp orated in , mnoun t paid iii �.
<br />capital r : ', '" , . If a subsidiary or any other corporation. so state azrd arc purpose of
<br />corporation _� +f =� { /1'
<br />_ '- � ._ - - If incorp orated tuad the laws of mioth r state, is corporation
<br />autboriZed to do business in the sfaic of h innesota? ❑ Yes ❑ No
<br />. Describe prerrtiscs to ihich license applies; such as try floor v hoof, b asoneut, ctc.) or if entire buildia . so st atc.
<br />. Is establishment located near any slate unimersity, state hos-p it al, training school, reforni atory or prison's ❑ Ycs r XNo Ii' yes
<br />st atc ap�ro� unate distance. - r
<br />rY�: drss building ol��acr : L!�Xi [ �- } L 1, 6
<br />1-4 ti Has oxvn r of building any connection, directly or indirect y, with appfi6ant? ❑ Yes J'No
<br />5. I s app lieaut or any of the associaics in tb is application, a member of the govern in g boo of the niun icip ality in %vhich thi s iiceu
<br />isle be issticd? ❑ des loo Ii'yes, �t what c ryp acity? .
<br />6. Stale whc1her any person outer that applicants has ww rioil. title or hitere.4 in the funtiture, i"t�t,tre� �,� ��� ����, �, � for, ��rlt ieb
<br />license is applied and if so, &c n.-me and de-tails. 7. ff inre applicants- any inicrest wh aisoever, directly or indirectly, in any other liquor esi ablisluueat in the state of Minnesota?
<br />�Irs CJ No Lf yes, give n ague and address of cst ab lWnu eut . ,,,,. ......
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