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��°'"�f. Minnesota Departmen# of Public Safery <br />�� ALCOHOL AND GAMBLING EllFORCEMENT DIVISION <br />444 Cedar St., Suite 133, St. Paul, MN 5510]-5133 <br />�,����• (651) 201-7507 FAX (651) 297-5259 TTY (651) 282-6555 <br />� WWW.I�PS.STATE.MN.I1S <br />APPLICATION FOR COUNTY/CITY ON-SALE WINE LICENSE <br />(Not to exceed 14% of a[cohol by volume) <br />Attachment A <br />�����? ��N ° yc <br />�`}`�' c� <br />�„' ��: ; <br />_����,`�i.,;��. <br />EVERY QUESTIOi�' MUST BE A�fSWERED. If a carporation, an officer shall execute this ap�lication. If a pa�tnership, LLC, a partner <br />shall execute this application. � � f��� �� <br />Workers compensat'ton ins�rance company. Name �� H F_} (ZT ��J„ (��M� # � � ';° �'" <br />LiCEh!5EE'S MN SALES & USE TAX ID # To apply for �MN�S�s Tax # cal� (651) 296-6181 <br />LICENSEE'5 FEDERAL TAX ID # Z S i — �Z,�(o � <br />A�plicants Name (Business, Partnership, Corporation) Trade Name or �BA <br />-�'� � �1 �1 :� 1�` C._ G �C S C �- �L_, � � _ <br />Business Address ' Busi�ess Phone AppEicant's Home Phone <br />� � � ��iC 1 � ` -�-���I ��. �� � '--� -� {' ) <br />Ci.ty Counfy State I Zip Code <br />C�S�?-v i <br />Is this application <br />�New or a � Transfer <br />ir a co oraz�on, rve name, t�iie, aaare� <br />PartnerlOfficer Name and title <br />�� � � � <br />Partner/Officer Name and Title <br />�,� �--�� ��-�-k�� � � <br />Partner/Officer Name and Title <br />Partner/Officer Name and TitEe <br />tf a transfer, give naEne of former owner <br />i affie or oiRn oi eacn orttcer. �t a artnersh3 , L <br />, Address <br />� ���� � . <br />��`�'� Address <br />-��;���� .... <br />Date of incorporation � State of incorparation <br />Address <br />CORPORATIO�S <br />]f a subsidiary of another corporation, give name and address of pazent corporation <br />>� � I <br />License period <br />From To <br />, address and date of birth of each artner. <br />5ocial Securiry # DOB <br />� <br />Social Security # �B <br />a. - <br /># <br />0 <br />Social Securi7y # � DOB <br />Number s corporation authorized to do busfness in tvlinnesoia? <br />es G No <br />BUILDING AND RESTAURA.iVT <br />Name of buiiding owner Owner's address <br />Are Property Taxes delinquent? Has the building owner any connection, direct ar indirect, <br />G YCS �No wiih the applicant? 0 Yes I�p <br />Hour's food tivil] be available No. af people restaurant employs No. of months per year restaurant <br />�� '�� n��( �� wi31 be open t� <br />�3escribe the preFnises to be licensed <br />_ ..�'k'12-i P �-�l, ��.L- <br />[f the restaurant is in conjunction with another business (resort etc.), describe business <br />i� � <br />Res[aurant seating capaci .ry <br />Wfll food service be the principle business? <br />4�81'es � No <br />NO I.ICENS� WILL BE APPROVED OR RELEASED IJNTIL THE $20 RETATI,ER ID CARD FEE IS RECEIVED BY AGED <br />� <br />