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Licenscei MN SW69"ifustlTakmip 1;1 <br />if FL-C2Mr-at1on9­nn,*ffjew a min and we An LD t, =a (631) 29&618 1 <br />shan, execute a ea <br />RP <br />ap <br />FROSle V <br />j7 Littftli6_'PeTiod-- <br />A-w <br />6U, nty <br />Ua& Name or am <br />Applicanfs Home Phone # <br />r T state <br />Zip Code <br />. <br />Business Phon DOB (Individual App <br />Wioia_V�A' -T,cross- <br />6 <br />Ir 4, WrPorafiowor LLC- -sute--n 4qq I I <br />i 7ecuAty#sjd"si�tjtjej <br />InIddle, last) <br />%)Am Shares Addmsy Cit <br />Y11 StRte, Zip Code <br />P8rtner Officer (Arst, middle, last) <br />�/ <br />DOB SS#1 da" Shares Address, City, State., Zip Code' <br />Kart L <br />PaTtner Officer (Firgrqiddle, !as C 0 <br />Partner Officer- (FirA. middle., la'st): i7 9�. am Addras <br />SS <br />City, State, Zip Code <br />1. If a corporation, <br />of incorporation' <br />Copital inoorPorated inm V) 64A <br />po;aoqn, ti. <br />C he <br />0, rPomted under t laws of another� <br />authorized tDdo business in the' Ste of Mthniioiaf ci Yes' state, is cOrporation <br />2. Dcscn <br />4W ich license lies; as t Or, second.floor, basemc�% etc.) Or if entire building, so state, <br />Vositylo stai� hcmAtal, traffil. <br />RPProximate distance, ing school) refonridtory or plisOn? Dyes AND If yes state <br />Name and addrew.of.buildin,% VVV r3 rngj <br />�s V(O <br />W-A-M Sul f 2vo <br />Has owner" Wing any connection, <br />M appliewtion., -a Mbrnber of the governing body of the. muni <br />td be issued?"O Yes;-- XNO"If ycs.-in whatreapacity? cipality in which this lic <br />ense is <br />th' fumitUre, fixtures or equipment <br />ve name and deiihi. <br />Have applicants any inter=r whaft6dver, directly or indirectly, in y other liquor <br />0 yes establishtnent in the state of Minnesota? <br />)(No If Yes.. give name and addrm ofeftblishment, gm <br />