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Attachment A <br />"08 10A6 FROII-D'Amico Accounting 6, 12113 17 4'2 12 T-856 P002/009 F-171 <br />10-08- i 9 <br />Minnesota Dopartmirmt of Public Sakty <br />ALCOHOL AND GAMBLING ENFORCMENT DIVISION <br />444 Cedar St... Suite 1533k St. Paull, MIN 55101-5133 <br />(651) 201-7507 FAX (650,2197-5255 TTY (6151) 282-6555 <br />WWWDP&STATEM-MUS <br />APPLICATION FOR COUNTY/CITY ON-SALt WINE LICENSE <br />of to exceed 14% of alcohol by, volume) <br />EVERY QVE'S TION MUST' BE A,NSWFRED. If a corporation, an officcr sha,ll', cxzacutc' this application. if -a pantiership, L1, C, a partner <br />shail cxeoulc this applicallon. <br />Workers c oraptrisation insurance comp any. N i A Pol i Cy <br />11 <br />L ICENISE 8 9 MN'S ALPS & USE TAX I' ) w OpPly fbr-MNI SalosTfmg call (651)',7,96-6181. <br />LICENSE-IR'S FED1P.4W, TA,)( 113 ti <br />Appli-eWitSIName (SuSiae$S, Partnership, Corporation) TrAde., Name or DBA <br />Busirliess Addrcss C-N. Applicant's Home Phorlo <br />C County State Zip Code <br />bN� <br />Is this appl'ication If a transfee, give name of -form.-cr owz.jer <br />w or, a 0 Tan�sfer License period <br />e r <br />I Vro M To <br />If a cry rporat ion, Ejivc Imme, f1t1c2 address a,rd date of birth of each ofriecr. Ii rtnctsbip, LLg.,.8jLq name, Address and date of birth of each. 3rin r <br />'Plantic;r/Offlicer Naw and title- Address Social Sj�e. urity'O DOB <br />Partnt:r/10ifficer NI c and Title A&.rcss S06a] S�CUTITY 4 DOB <br />Flarwer/Officer one aild, "*Pitle <br />Address <br />Social Security -N <br />DOB <br />Parintr/Officer Nam�r, and T)"Itic <br />Address <br />So; ial sectiz-fty 9 <br />DOB <br />)e4io6be the pzvmists to b-e di n's <br />f f.k� tesiAtirant, it inn Conj'UfldiOn wilh All( v busirmss, (resort W.), dtscribc business <br />NO LICENSEWILL 13 E PP ED OR RELEASEI) UNTIL THE $20 11ETAf UR 0 CAP11D F E) IS RECEIVZI) 13Y AC;:ED <br />