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Attachment A <br />��;:E�'°""� � Minnesota Depanmenl of Public SaPety - � rKE.s,.,�r <br />�� �.� ALC(J130T� A1VD GA11'fBI.ING E�'FOf2C�M11ENT ll1VISI01�' �P ��� o <br />444 Cedar St., Suite 133, St. I'aul, MN 55 ] O 1-5133 =� ��� � i.� <br />s (651) 2fl]-7507 FAX (65I) 297-5259 TTY {651) Z82-6555 �' ��'''�� <br />'"� �` �a� il._:: <br />@�''��.""`,�' W W W.DPS.STATE.M]�t.US ��;�•'� <br />A�'PI.ICATIO�` FOR CQU�'TY/CITY Oh-SALE W1NE LICEI�`SE <br />(Not to exceed 14% of alcohol by volume) <br />E1'ERY Q�J�STION f�4iJST B� :�.NS\V�R�D, lf a corporation, an offlcer shal] execute this application. ]f a partr�ership, LLC, a parmer <br />sliall execute shis appiication. <br />Workers co�npensatian insurance company. N��r� T�" ., ��°,'�' _���uvrx�-�.cs�policy �+ ��� ��� 7�� <br />L[CET�'SEE'S MT�? SALES & USE TAX ID # ' _7'o ap�ly for Ml� Sales Tax #t call (65]} 29G-61$1 <br />LICE1�'SEE'S FED�RAL TAX ID # <br />AppIicants i��ame (E3usiness, Pariners�iip, Co�poration) TF-adc Name or DF A <br />�.� j��0 �'�� �.`� ��� <br />13usiness Adciress 8usiness Phone Applscant's Home Phone <br />f��� C c���� �� L' �((�(l i�3� -� 13 j�C7�7.� � Z`� ��`�`�� <br />City ` County State Zip Cnde <br />�O��V t� 1 e... �5�. �/U �� ( �� <br />Is Chis applicatian � If a transfer, give aame of I�ormer ou�ner Liccnse period <br />�New ora: 'I'ransE�er <br />lf a co� oraiion. ai�<c namc, iitic, address nnd datc of birih of caclk oFficcr. If a 8I'IRC!"Slll , L <br />Parrner/Ofrcer I��anie and titic Ade ss <br />P1CCI70T/OFF�SCP�' ��amP •�n.� T;.rl�. <br />� Partner/Officer T�'amP �n�+ 7�wiP <br />� Partner/�fFcer �ame and Title <br />d rja,-a�� 1 <br />n a,,1':__ <br />i <br />Address <br />... �1RATTONS <br />IJa�e of inc rp raii �n Staje nf incorpurfliion ` Certificaie �'umber s orporation authorized to do �usiness in tvtinnesota? <br />�( � ZC7 U% � tvli� o��`j' .�Ycs No <br />lia subsfdiary of anothercor��orafin�t. gi�e i}ame and address niparent� corWoralion <br />BUILI)ING ANll F2ESTAURANT <br />1'aiT7e of I�uiiding oµ'ncr Qwmcr's a dr 5 <br />� �.%L,S �a.,� ��z���.,. � `-�. � �v� W.�� �� Z'� <br />Are �'roperty Taxes delinquerii? Flas the building awne n.y conncclion, direct or i�ndirect, <br />�'e5 �I�O with the applicant? _ I Ye5 �`0 <br />Hnur's food will I�e atailalrle�1 No. of pcople restaurant en�ploys 1�0. of munths per year restaurant <br />� k%�.�'- '� ��� � S w il2 be open �� <br />Describe Ihc premises to 6e Gicznsect n <br />��s � C�.-s ��"� 2 Z�- v' e.W���`� �-,�: ._��� <br />If'ihe restaurant is in conjunciion w�th anolher business (resoi� eic.), describe business <br />Fram To <br />and dxtc of birth of each art�er. <br />r__:_, �. . �� DO� � <br />" ' Anr��lc�...._:._.L,� DbB � <br />c„���t ce,..,.:�„� �}�i g ` <br />� . ,. <br />I'Socia] Securiry # � DOB <br />� e. k�,� ��s <br />Resiaurant seating capacisy <br />�d <br />o-zz � � <br />Will food scrvice he lhe principle business? <br />�Yes -: t�o <br />� <� �- <br />1�'D LICENSE �i'ILL BC APPRO�'�l) OR �ZCL�ASED UN"I�li. 7'ItE $20 R�TAILER 1D CARD T'EE IS RGCEIVE� BY AGED <br />�zi <br />