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Attachment A <br />-�-� �s�",;�� <br />,�'���°� ALCOHOL AND GAMBi,3NG ENFORCEMENT DIVISIdN "� ""°" ���, <br />� N" �..� <br />�144 Ceciar St., Suite 133, St. Paul, MN 55 3 0 l-5 I 33 �' �;`_~__ � <br />�r� �, ��f, <br />Fax{651)297-5259 � �,�u�:��`r <br />���j�yil�VY' <br />"'� � (651) 201-7507 TTY (651) 282-6555 <br />W W W.DPS.S'�ATE. MTT. US <br />APPLICATION FOR COUNTY Ol�i-SALE INTOXICATING LIQUOR LICENSE <br />No.Iicense:rvilt be apptoved or.released antil N!N Liqubr Control receives tt�e $20 Retailer ID Card fee. <br />Workers Com ensaFion Insurance Com an Z��ch Arr�erican Insurance <br />p � i i �a�1 � _ �nv Po����, # «c914o��a-o� <br />LICENSEE'S SALES & USE TAX ]D # To appl.y for MN sales tax number call 65i-296-b1$1 <br />' LICENSEE'S FEi3ERAL TAX ID # 7b--0�44I89 <br />ApplicanPs name (Business, partnershi.p, LLC, Corporatipn) DOB Social Security # <br />Crab Addison Inc. <br />License address Business phone <br />2704 5ne11ing Avenue North P���,ing <br />City County State �ip Cade <br />Roseville 12amsey mN 55113-1732 <br />DBA or trade name <br />Joe's Crab Shack <br />:iriil�]CRFIt's hnmr nhnnP <br />�,icense period <br />Give natne, residence, DOB, Social Security #, title and age for all pariners, or the officers and directors of a partnership ar <br />cor oration. and. the ercent of stnck held b each offieer if a lica6le. <br />Name Sacial Secarity # Tit1e DOB Percent s#ock oe partnership interest <br />a <br />Address <br />Name <br />r� <br />: Address <br />Narne <br />Address <br />Date of Incorporation � StatP of incorporation <br />c��y <br />I " ' <br />Socia] Security # � Title <br />ciiy <br />� �l.� <br />StaEe <br />Percent stocic or partnership interest <br />0 <br />State <br />Houstan TX <br />Socia] Secnrir., � 'r;r1P DOB Percent stock or partnership interest <br />0 <br />c�ry 5kate <br />Certifiaate Number ls corporatian authorized to do business in Minnesota? <br />�'es ❑ IVa <br />Pur�ose of corporation <br />For Protit Business <br />1. Uescrihe premises to be licensed {location, facil�ties). <br />E?e s tauran t <br />Floor establishment is located on 5eating capacity <br />�arst floor 290 <br />months per year establishment will be apen <br />12 <br />If a subsi.diary of another corporation, give name <br />�gnite Restauran� Group, Inc. <br />1-]ours food wil] f�e available <br />Sian —Thur s . 11 am-10� <br />Fri—Sat 11ar�-11pm <br />IVame of rnanager <br />Timathy Melton <br />Number ofpeople restaurant employs <br />Fror� 50 —60 <br />2. If Fhis res#aurant is in conjunction with any other business (resort, etc.}, describe the business. ' <br />3. Name the nearest �nunicipality in which On Sale ]icenses are issued. <br />4. Has applicant, partners, officers or employees eve d any �'elony Cqnvictions ar LiqUOr Law vialations in MinnesoEa or elsewhere, <br />inc�uding State Liquor Control PenalEies? Yes o If yes, give date, charges and final outcame. <br />5. Is thej�� licant or any af the associates in this a p�cation a m.ember of the County Baard in which the license wiEl be issued? <br />Yes { 1Vo�if yes, in what capacity? If the applicant for ihis 9icense or any of Ehe associates is the spause of a <br />memb�af the gave tng body or where a family relationship exists,. the member shall not vote on this application.) <br />DYes ONo � �� <br />6. Have the applicants any cnteresE, directly or indirectly, in any other ]iquor establishment in the counYy or any cify <br />in Ehe cor�nty issuing this license. lf yes, give the name and address of the esta6lishment. I1T� <br />