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Attachment A
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<br />.A Minnesota Department of Public Safety
<br />ALCOHOL AND GAN181JNG ENFORCEMENT DIVISION
<br />444 Cedar St., Suite 222, St. Paul, MN 55101-513
<br />(651) 201 -7507 FAX (651)297-5259 T-y' 1 -6555
<br />W W W..ST.T *,M r 1�
<br />APPLICATION FOROFF SALE INTOXICATING I IQUOR LICENSE
<br />Workers compensation insurance company. Dame Travelers propeftyi a u lty Company of Arnerisa Poliq �YJUB 46 A1651
<br />Licensee is Sales and Ise 'Fax ID # 3129949 To app ot• a MN sales and vse = I , call 1 296 -6151
<br />Licensee's Federal Tara 11) 0 4- 3105002
<br />ira c . U an onieer shau execute tars ti atLo
<br />11 a Irtne" a
<br />Licensee ensee fame Individual, Corporation, Partnership,1A,C)
<br />Social Security ##
<br />Minnesota Fire Wines & Spirits, LLC
<br />N/
<br />License Location (Street Address & Block o. )
<br />License Period
<br />2401 Fairview enu N, Suite 105
<br />From wre Opanirioro
<br />City
<br />Roseville
<br />Trade Name or DBA
<br />Total Wine & More
<br />Applicant's Home Phone
<br />Zip Cade
<br />55113
<br />Name of Store Manager Business Phone Number DOB (Individual Applicant
<br />If a corporation or LLC state name, date of birth, Social Security N address, title, and shares held by each oI` icer. If a partnership, state
<br />names, address and date ofbirth of each partner.
<br />Partner Officer r 'ir'st, : . � ; 1�i i" �• � � ►t S S Title Shares ddr� , City, Same, Zip ;ode
<br />See e9 1
<br />Partner Officer (First, middle, last) E DOB I SS# [.title I Shares I Address, City, State, Zip Code
<br />f tner #' o r (First, riddle, last) I C I SS# t �'itl I Shares I Address, City, State, Zip Code
<br />113'artner Officer (First, middle, last) I DOB SS �itle I Slims I Address, City, State, Zip "ode
<br />Lk_
<br />If a r ate; date `$r eor oration 612811 , state incorporated in Minnesota t , amount paid in
<br />capital _ If a subsidiary off* any other corporation, o state / and give purpose of
<br />corporation retail liquor sales �.. �. �...... ....._y..._._..� ..............� • If incorp prat d under the la ►s of another state, is corporati on
<br />authorized to do business in the stag of Minnesota! []Yes NO NIA
<br />Describe prernises to which license applies; such as first floor, second floor-, basement, etc.) or if entire building, so state.
<br />First floor in shopping oent r
<br />3. Is es:Wbli hrn nt located near any state university, stag hospital, training school, r fo,rmatory or prison; des Bl o I fyes stag,
<br />approximate distance.
<br />. Name and address of buildin ownen Rosedale Mark tpla Associates, LP �._._�_.�,..,.. . _...Y...�.�...
<br />/o Tahurb Developments Inc., 10 King Street East, Suite 800, Toronto, Ontario MSC 3-C3 CANADA
<br />Hai vii 6, o 5i rn any on Iron irec.11, y or rtr � t vat app i a� . Cs �"
<br />5. Is app] ieant or any of the associates in this application, a member of the governing body of thQ innoi ip l ity in which thi license is
<br />t b i ued El es S o Ify s3 ire hat capacity`s
<br />6. S tate whetht;r any person Whet- than app Iicants ha any right, title or interest in the furn iturc, fixtures or e uiptn nt for which license
<br />is applied and i-Cso, givename and details.
<br />17, !•-lave app I i ants any interest whatsoev er, dir etly or indirectly, in any other liquor estabi i hment 1n the state oFMinnesota'?
<br />o If yes. give: naine and address of establishment Total �Mn More, , 4260 Jest 78th Street, Bloomington, N 55435
<br />_._ _.__. _ _._._.�.� Y. HrynN. H_ .w. ry..� nwH.w.w.H .. x m w . ...... ... ...........- ......... .
<br />Does 43960937
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