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<br />miunesota i ')epartniet or public safety
<br />LIQUOR,CoNr!" ROL DIVISION ,
<br />44 Ce -flay St., %he 100 i.., SA. Paul, W 55101-2156 �
<br />(612)296-6430 "1 °1-Y(612)282 -6555 ,
<br />APPLICATION FOR OFF SALE INTOXICATING LIQUOR LICENSE
<br />No license will be approved or released unt if the S20 Ref at1er ED Card fee Ia remlved by MN Liquor Coat r oL
<br />Workers compcttsat ion insurance company . Nmne.
<br />I. I CEN ST- TE' S SA.I,L S & 11 SE TAX ID #
<br />PolMy#
<br />To apply for sales ism #t call 296-06 119 1 or 1-8 00-657-3777
<br />If a cor Drat ion. an officer shall execute this aaalicat iort If a nartnershim a vartner shall execute this aDDlication.
<br />I Acen see Name (hidiv idual, Corporation, ParineTship) Trade Name or DB
<br />ER B. XIONG & CHUE MOUA G &C LTQUOR
<br />I.icensc 1 {ocation (,fitrcet Address & block No.) Ucenm P rind �Apylieant's Flank Phone
<br />1740 LEXINGTON AVE
<br />I+ ron� To
<br />Ci t }' Coi1zxt�� .ate Zip Code
<br />R��E�ILLE RAI+f�EY MN X511 3
<br />Name of Store Manager wesi Phone Number DOB (Ludividual Appliewit)
<br />CHUE MOUA NONE
<br />If a corporation,, state name, date of hirtha address, title, and shares held by each officer. If a partnership., st at e
<br />names,, address and date ofhlfih of each partner.
<br />P artner Ofliccr ('irsi, r i fiddle, Iasi) DOB Titic Shares Address, City, Stale, Zip Codc
<br />F r-;�T n,r�►
<br />GER B. ION
<br />Parwcr Officer (Fy irbi, . middle., last) DOB Tit lc Shan cs Address, City, St atc. Zip Codc
<br />CHUE MOUA
<br />Partner Officer (First. middle, Iasi) 1) OB J`itic Shares Address, City, State, dip bode
<br />NA
<br />1' arl n er Officer (First, rn iddle, last) DOB Title %arcs Address, City, State, Zip Cede
<br />1. Ira corporation, date of incorporation RZA - } state incorporated in , amount paid iii
<br />capital . If a subsidimy of any other corporation, so state _ od eve purpose of
<br />corporation . If incorporated umdcr the laws of anothcr state., is corporation
<br />authorized to do business in the state of Mi nesot a? 0 Yes IR No
<br />2. Describe prernises to which license applies; such as (first floor-, second floor, basmneut, etc.) or if cutire building, so state.
<br />Flrst Floor
<br />3, Is estab lishment located near any state university, state hose ital, trainin g wdhool, reformatory or prison? 0 Yes J0 No If yes
<br />state approximate distance. -
<br />4 . N adze and address of building owner : .
<br />Has owner of building any conaectien, dkeetly or indict , with apPlicant? I? Yes El No
<br />5. Is applicant or any of the associates in this application, a mmnber of the gavcrning body of the municipality in which tbLq License
<br />is to be issned? M Yes 0 No lfyes, hi what capacity?
<br />6. State whether any person other than applicants has any rioit, title or hit=s in the f umiture, fps or equipment for which
<br />liven is applied and if so, give name and details.
<br />7. Unre applicants any intcrest whatsoever, directly or indirectly, hi any other liquor establishment in the state of Minnesota?
<br />0 Yes ( No I!'yes, give umue and address of establi.4unent.
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