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<br />Minnesota Department of Public Safety
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<br />APPLICATION FOR OFF SALE INTOXICATING LIQUOR LICENSE
<br />No license will be a rove� or released until the $20 Retailer ID Card fee is received
<br />Warkers compensation insurance company. Name �i���'���'�� ��������� Policy
<br />Licensee's MNSalesandUseTaxiD# 1730704 TbapplyfnralV6Vsalesa„dasao-rtlD�,ca1t(65!}296-5I8I
<br />Licensee's Federal Tax ID #
<br />If a carparation, an of�`tter shall execute this application If a partnership, a partner shall execute this application.
<br />Licensee Name (Individual, Corparation, Partnership, LLC) Social Security # Trade Name ar DBA
<br />Roseville Properties Management
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<br />License Location (Street Address & Block No.) License Period ApplicanPs Home Phone #
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<br />If a carparation ar LLC state name, date of birth, Social Security # address, title, and shares held by each officer. If a partnership, state
<br />namcs, addressand date ofbirth ofeucl� partner.
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<br />partr�r{�fficer�Fir�rrrit,dle,iasl} =x�fl :�� ii� SIIBLSS '•.��U:tk•..�.':I••.>�lal�.li���.:i�c: i
<br />Par€nar Officer (First. ntiddle, last) DOB �SS�
<br />; Partner Officer(First, middle, last)
<br />: DoB �ssa
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<br />Shares � Address, City. State, Zip Code j
<br />Shares � Address, City, State, Zip Code
<br />lfa corporation, date of incorporation .� �.�'• �� 1979 , statc incorporated in Minnesota , amount paid in
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<br />T�+ralirn �ra�re r± v tan��,�1�#`•n� . If ir.mr?�r:tii nderrr.. I� i�^rt*r�t•- �nr� i5?*�7�nt�'I
<br />authorized to do business in the state of Minnesota? 'I Yes .i No
<br />Deseribe premises t which li ,� �r a�plies; such as (�rst floor, second floor, basement, etc.) or if entire building, so state.
<br />Portion ef first ��s�e
<br />Is establishment located near any statc university, state hospital. training school. refonnatory or prison? : Yes � No tf yes state
<br />approximate disiance.
<br />4 Ja�ra���k�;-�,�„ u Roseville Prone
<br />��`� Ro�evi't_'te. �i� ��113
<br />Has owner of building any connentian, directly or indirectly, witl
<br />`.. Is applicant or any of the associates in this application, a member
<br />to be issued? =}'ty �i No If yes, in what ca�acity?
<br />6.
<br />anrr � res �.�ivo
<br />�overnin� body of the municipality in which this license is
<br />State whether any person other than applican� 1�� any right. title or interest in the furniture, fixtures or equipment for which
<br />is applied and if so. give name and details. �
<br />Have applicants any interest whafsoe�er, directly or indirectly, in any other liquor establishment in tfte state of Minnesota?
<br />Yes ��lo If yes, give name and address of cstablishment.
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