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10i-08-'08 10:16 F'ROi M-,D'Armco Accounting 6123174229 T-856 P002/009 F-171 <br />Attachment A <br />Minnesota Department of Public Safety <br />ALCOHOL AND GAMBLING ]ENFORC)EMIENT)DIVISION <br />444 Cedar St., Suite 1332 St- Paul MN 55101-5133 <br />(651) 201-7507 FAX (651) 2197-5259 TTY (651) 282-6555 <br />WWW.DPS.STATE.MN.US <br />APPLICATION FOR COUNTY/C,IT'Y ON-$AUE WINE LICENSE <br />of to exceed 14% of alcohol by volume) <br />If'a corpratim, give n4tnie, fitle,i address and date of birth of each officer. It a <br />Partner/Officer Name and tltic <br />Partner/Officer Namd and Title <br />Plartner/Officer Name and Ti <br />Partner/Officer Name and Title <br />ntrsbip., LLB Ety�q liame, address and date of birth of each parnner. <br />Address S0691 Security # DOB <br />Address Social secutity # DOD. <br />Address Social Security # D013 <br />Address social security # 00B <br />D00 Of'] UorpOralion state of inCOVrAtiOn. Ccrlificalt Purnbo-r ICZ corporation authorized to do bositiess in Mirin%om? <br />Xy-es 0 No <br />If a s,ubsidiiry of anoilher corporation,, give h=6 and,$MNSS of parent WrpOraliOn <br />0 <br />BUILDING AND RESTAURANT <br />01mon'be thla pr mu to be 11 *enwd- <br />, �Tvz 4-0i�;v-\V��CJF <br />If 1he resminnt it in onilonction, with another business (rtzort etc.), describe business <br />R <br />N <br />