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• ei �:� Miz�nesaCtl �7c�aru��e:nt of Public 5afety
<br />r��.C()I[Qi, AND GAMBLING ENi�Q12CEA2�+.N"t' DIVISION
<br />�� 4�4 C:eclat- St, S�it� 133, St. Paul, MN 55101-5133
<br />"���. (65 t} 201-7507 FAX (651) 297-5259 TT'Y (65l} 282-6555
<br />. . ��lWW,�F'S.S'1'�'1'�,�I�I.US
<br />APPLICATION ��E�k� C�UN'i""YICiT�,' ON-SALE 'V4'�i�; L�CE:tYS�.
<br />(Not to cxcccd !�1°/n of alcohol by vnfume}
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<br />�;V�;RY QUESTION MUST B�; ANSWERED. If a corporation, an o�fic��-shall cxecute tltis application. If u parenershi�i, LLC, a partncr
<br />sl�ait �xec�ate this appfieatio��. Am I n s.
<br />Workerscc��pea�s�iioninsurai2cecompa�iy. Name �C•'•'L'.£STi�F �r€s�7ura.c'� •. �olicy# � 92991400, 913991400
<br />LICENSEE'S �3h1 SALES &. [JSE TASC ID� 41— �. 7�+� 5 __,�l'n appiy for MN Sales Tax # calf (f � t} 296-G i&t
<br />I.IE;Fi�lST.:�'S FEDERALTAX ll7 �� 84--1 +8�9�
<br />Applicants t�larx�e° (Business, Yartaers�ii��, Cor�oratio�r} iTi �:le t�amc or DBA
<br />Chipotle Mexican G r i 1 1 0� Colorado, LLC Chipotle Mexican Grill
<br />Business Address Business Phone App icant's ar��'� �,3 ti� _ iSOn
<br />10 Roseda�e Center, Suite 1020 t �' (303 ) 595�-��C}0{3
<br />:��•: �'.�F.IIIIU ���'.� ' �I�".�T�S
<br />RosevilYe �.anisey MN 55113
<br />Is this application Cfa transfer, give na�n� of f�nner owner License period
<br />�Ne4v ora�7T'r:�iesfer �fy� 2007 To2008
<br />Ir.y u�� �•:i�ikti Y�� C i�7_.� :�t. �_ilf{ii 21�;: J)I_ n j lir II� �ifr_Y'.4���C'G� If � �
<br />�'1~.IIrt���4�1�;: _' � ':i'��L• :� �.I Lil -
<br />M�tthew Steven Ells (LLC Manager)
<br />Partneel0ffiicer Na�a�e and Title
<br />Montgomery Frederick Moran (LLC �anager
<br />Partr�ec/Cif�cer Name and'i'iCle
<br />d�iCi tiu� -,r:: :�i •_ �.kf3_: aij d�lf al l•i lli L"_S _I• tci h�h
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<br />�.ti„ •I �-•• •�i,• J �'�,5�!
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<br />Address ', � Social Security # DOB
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<br />f'artnc�/C3f'ticer Nan«: and T� i�� � Address I Social Security # I DOR
<br />��Pa���T��� �.LC
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<br />�,,<5•i_��?-�aoi.zaCi033 �u�eat,l',.,•�ani.�^f'3:�iY^..�,r,•�.kt•.,i,• 1=re�p�:�+�Y•��uthnn��diodo';;:i-•,YY�IMIF1qC5ola�
<br />1; ",r 1��1� Colora�o' �Y�S ar�a
<br />f#'a su�si�[i�vy ofa�io[Ger corpora[ion, give natpe �Uid ad�fress af pa�e�leotporattvR ���s, O t 1 0 M0X1C 1ri G I 1 1 1, 1 ri C.
<br />.� Wazee St., �204i, Denver, CO 80202
<br />BUILDING AND �t�STAURANT
<br />t�ia�ne��� bllllChllg bwi�er wwners per�f�ffig @!
<br />YYr' RTL Rasedale Shopping Center, LL�C 4405 LaSa11
<br />Are lyropaiiy �'axes dclinqtFCnt7 - Hi}dic buiitling 4wnbt my Cni�neclion, ciircot R ll1dllECi.
<br />O Y0S C�i NO � wish Ihe applicant? '� ��g `�l NO
<br />:F[ossr`s foodwill l>eavailxblc � No. uEµ��14MW�eu+lu�ap���x : No, Ofn�ontl�s p+ryea� rest.auranf
<br />� � I ..� —1 �' L—I'— -- � �'� - . _ . . I will be opeif 1 �
<br />Describellk premiscslobeiicenscd
<br />main floor (approximately 2,647 sq. ��.} and outdoor seating area.
<br />:f i`s �t:l�ic�rl i• ii. {0 ��8:11'} uul• kqlFr{ I� �s_y+st •i •.•i�'..i• : •Ir4_.'e :: u °y.
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<br />� iviorgan aianiex u� ice .�nves��n
<br />e St:; 17th F�.��z, Chicago, iL Q�i��
<br />itestausaal seatin� capacity
<br />5591 f(lOd service be tSie principle business7
<br />F�'i'�s f� No
<br />NO LICENSE �+[(,�, BE �1pt'[t()V�D OR RELEASED UNTIL THE $20 Ltk;`1'Ail.�=.�t ID CA� FEE IS t?i:C�i(Vh D BY AGCE3
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