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r <br />CP % <br />a' <br />ICIuinesola I)q)aru uenl of Pub1rc Safcly <br />LI U OR,CONTROL DIVISION <br />- 444 Cedar ,St., 1LitC 100 L, S1. 11'sul} MN 55 lid 1-21)6 <br />. <br />•�~�� <br />•1- •i -Y(6 <br />+ (612)296-6430 6-6430 12)282 -6555 <br />APPLICATION FOR Off SALE INTOXICATING LIQUOR LICENSE <br />loo license ivHI be appraved or released until the $20 Retailer ID Card fee is mveive d by MN Liquor Cont rol. <br />Workers- coinpea s al ion in sisrance cons aay . Mund `#�� � � ` &a'&1"gAol1cy# <br />1. I C N SE 'S SAIX S & f 1 SE TAX Ili �� �' ,� �� j _ loo apply for sales ta.� N, call 296 l $ 1 or 1-900-657-3777 <br />If a eo oration, an offigLgmll execute this a2pl i cat ion If a p art nershi p, a p airtner shall execute t N s±2p Ii cat ion. <br />l . icen see Nnne (Individual l:orpi�ral ioa �P artncrsh ip) <br />Trade Name or D13A <br />l.ic ensc Location (Streel Address & Block No j <br />Licemse Period <br />pplicsitfs i lome I'Izone <br />Ah <br />From 0 To <br />colin ly <br />State <br />flip Code <br />J9 z F <br />Ai <br />rt <br />N.-ti i e of Store M au nger <br />I3ti suless Plkotie Numb er <br />DOB (IndiV sdU al App liemit ) <br />A,-4- kt-4- LJ <br />I ` a eo # ration state r�arne date `hxrih ad r ss title'. and shares held each officer. If a partnership, state <br />rF a <br />names, address and date of birth of each 2artner, <br />Partner Officer O'irsd, middle. lacsl) <br />Doll <br />T'itic <br />rarer <br />}address, City, .Male, fia bode <br />1 <br />P,-atner Of`f-iccr (First. in idd e, last) D 11 <br />■ <br />it lc <br />Shares Aclr1ress� �ltt�', State - � 1� ��rtir��+ <br />■ r r r <br />0 <br />P ari cr Officer ff irsi . tit iddle0 as-l) <br />DOB <br />1'it le <br />Slt ares <br />Address, €: ity, St ate, Zip Fade <br />P ari n sir Officer (First, ni iddle, last) <br />DOB <br />Title <br />Slares <br />Addre s} City, St ate, Zip Cede <br />1. If a corporation, date of incorporation -- . 1 _ , state iucarporated in , mnouat paid hi <br />_ <br />capital �•: i "� . If a subsidiary of any other corporation, so state -� and give purpose of <br />corpora, zan �� +� - zf incorporated and the l a %,%'s of smother state, is corporation <br />authorized to do business in the oic of Minnesota? ❑ Ye ❑ No <br />2. Dcscribe to Iiccnsc floor send floor, ba mcnt, cte.) or if cadre building. so state. <br />premi s which applies; such as first <br />3. Is establishment located near my state university, stale hospital, training school, reformaimy or prison? 0 Yes fi�No Ityes <br />t st at a app rax rtn ate distance. <br />_ <br />. ai in •i iiYsti i of building owner d' . f� *'� -+ s it •+ <br />� Has 01--4- of building any ronnection, directly or indirectly, with applicant? 0 Yes 33 No <br />5. Is applicant or only of the associates 10 this application, a member of the go -ve ing bo4 of the inunicipalily in which this lI I] se <br />11z In he icctied ? n T ne Nr W A If ve-e 111 yuh At t'`_an nn f '19 _ <br />- -- <br />6 . State whether any person other than applicants has apy ri ott, title or iittearest in the furniture, f rx ures or equipinent f0 which ti <br />license is a Iicd and if so am <br />pig a name and details. - <br />7. Have applicants any intcrest whatsoever, dircctly or indirectly, iii any other liquor establishment an the state orMinnesota? - <br />•. Ycs (J No Lryes, dive ngrne and address of est ab lishiu ent . <br />