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Attachment A <br />Minneso#a DeRartment of Public Sa�ty ��r�,mt �orn, � <br />� ' Alcahoi and Gambling Enforcemenfi Divisian <br />!� � <br />� 444 C�dar Street, Suite 2�2. St. Paui, MN ��101 <br />b5f-201-7�QOF�xfSi-29?-5xS3T�'Y'6SZ-282-6555 t�. <br />A�cano� ��a,nb��ng Eatorcemem �Pf.1CA710N FOR tt?UNTY/CITY O�M-SAL.E WIN� UCENSE `... <br />tNotto eacce�d 14*�i of akohai by volume} <br />�VERY QUE5T10N IIALIST BE ANSWER�D. Ifa tarpor�rtion, an officer shali e�cecute this application. if a partnership, L�C, a partner shalf <br />execute this appiicat�cn. To apply for Mh1 sales T'a�c � call t551-296-6] 8i <br />Worlcers compensation insurance compartiy name Travelers #�aticyl�umber UB-9DQ�47 &4 <br />Licensee's MN safes and tlse Tax li7 # 33471 i 5 Licensee's Federa! Tax iD # 80-04275�8 <br />Appticar�ts Name {Business, Partnerships. Corparation Trad� Name or pB�1 <br />Bry�nt Enterpr'ises inc. Wing Stop <br />2T00 5rteliiitg Ave. RI., �l66C <br />�Y <br />Roseviile <br />Is thEs appiication <br />X[] Neuv or a[) Transfer <br />If a corporation, give name, titt�„ ad <br />Partner/Qfficer Name and ti� <br />S�ann;an 8ryarrt <br />PartnerlUffirer Name� anc! tlt <br />Howard Bryant <br />'artner/QtF�er Narne a�d tit <br />bS1-270-9718 <br />Coe�nty <br />Ramsey <br />a trat�sfer, giv� name of former owner <br />!ss ar►d date of bkth af eactr a cer. if a partnershlp, LI.C, giv� narr►e. addi <br />Address <br />piicant's Ma�rne <br />1-q25-0328 <br />Mrv f ss� �� <br />From '��, <br />I date a� hirth af each paRaer. <br />Date of incorporatfar� State �rf incorporation �ertificate Num}�r is carpara#ian authQrized m do business in <br />May 24, 2[i13 Mlnnesata 67q12770QD29 Minnesota? []X Yes [� No <br />!� a subsidiary of ano#her corparaxion, give name and adcfress of parent corparai�on <br />No <br />BUILDIMG AND NF.S"�'AVRMIF <br />Name of buitding ow��er Owner's acidress <br />Gaceway Washington Inr. 47 C? Lexington Ave., Suire 90Q, N�nr York, NY 10170 <br />Are property #axes delinquent Has the buifding t�wner any cr�nnectian, direct Restaurant seat#ng capacRy Hours food witl be ava <br />Q Yes � No or �n�iirecC with the applicant3 [� Yes � No 4z 11:�0 am ta 12:00 am <br />Numberof restaurar�R em�loyees Number of mant#►s peryear restaurant is open Wi�f f�oaz{ service be #he principal business? <br />� 8 12 k�] Yes [� No <br />7escribe #he �remise;c to be litensed <br />a retall space in Nar I�4ar Ma#1 <br />f the restaurant is in cor�junction with another bustness (resort e�e ), descrif�e business <br />� ••+� ..■��■=a�: ..+..._ �� nrrnvr �v a»s rsc�.e,tiatv u�v 1 �! TF1E �i0 RETAtI,ER ID CARD FEE 1S REC€IVED BY AGED <br />❑ Yes [�]C Nc Has #Ite applkarrt tfr assaciates been gran#ed an on-saie malt fiq�,EOr {3.2) andfor a"set-u�s".. ._. �...."` <br />iicense in tanjunctian with thts wine iicense? <br />❑ Yes [�X No is the applicarat or any of the assacia�tes in this application � memk�er af the cou►ny baard or Ehe city caunci�, which <br />wi II issue this Ikense? If yes, in what c,�pac+ty� <br />tif �he appiicant is the spouse of a�ber o�F the governing body, or another famlly relatlonship �xists� #he member <br />sha#t nat vate an i�is apptication. <br />❑ Yes � No Durtn�g the �ast ficense year, has a summons k�n Ess�ed under ttre liquor ciwil Eiability tDram Shop)(M.S. 34�A,8d2)• If <br />Yes, a�ttach capy of the sumrnans. <br />❑ YeS � t+1D H�s 8ppi3C�ttt, pattrwers, offi�ers pr ernployees eve�r hact any liquor law violatinns in Minnesc�a or eisewhere. !f so, give <br />names, dates, viala#iar�s and final oirtcome details. <br />Page t of 2 <br />