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<br />r� +I�Ed �'al�r �;I._ �u;�� 1�1i� L. :i+. ]'�1_MN �� 10 I-? l�6 ���'a�. r. '
<br />- �f, i����r,.{,.�.i[r �� ��Y�6 ]����i�-�55s ��� �`�'�
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<br />A�t��I�T��N f�$. �Ef �[.� �N'�O3�Cl�'ATI[��'r i.����f�l� I..rI��EN��:
<br />No licensewill be approved or �lensed�ntil the $20 Retailer ID Cardfec is reccived by MN Liquor Control.
<br />�
<br />' �Vorkerscompcusation:i��:r�,it4-�omp.an}•. �;Wl� LUMBERMENS �JTUAI. CASUALTY __ Policy#� � `_ _ �
<br />� LICC:NSEE' S SAI.!'sS & tlSL T� ID# ,_'1'o apply for snlcs ta� #1, cull 296-U6 18l or 1-8�U=657-3777
<br />If a corporation, an officer shall execute this
<br />l.icensee Name (Individual, Corporalion, Partnership)
<br />lication If a partnership, a partner shall execute this application.
<br />1�racic Name or llf3A
<br />SPEEDWAY SUPERPMERICA LLC � SUPERAM�RICA # 4210 ?
<br />i--- -..._. — �
<br />1.iccnu; I.ocatiou (Skeet Address & Block No.) • LIG�I1t�; I��.710(1 �1���li��ir';c f lomc I'l�onc �
<br />� 2172 LEXINGTON AVE. � � � {'� �� 'Co . I
<br />�•-• • �—
<br />, �.i. ---
<br />ROSEUILLE
<br />� �•r� i4 of Storv Mana�er
<br />��Fif4' �T
<br />�'i7.ri¢y
<br />RAMS�Y � -�
<br />I3u:+iueas Phone Nuniber
<br />, If a corporation, state name, date of birth, address, title, a�ld shares
<br />+_names, address and date of birth of each partner.
<br />� ParU�er Of7iccr (Firs1, middte, last) T'itic ��1�arts
<br />�i�s �;�I�
<br />55113-4317
<br />l�Of3 (Individual Applic��t)
<br />held by each officer. If a partnership, state
<br />�
<br />�
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<br />t P�EASE SEE ATTACHED LIST OF OFFICERS I
<br />' I'v�tncr C7�iccr tiT'ir�, middle, laa-t) U013
<br />1'arU���r O�cer �E'v�a midd(e, last)
<br />f'ailu��r Ot�'►cer (First, middlc, last)
<br />'I'itic � jl�,n•,:�s
<br />Address, City, Stale. "l.ip Codc
<br />Adch•css, Cit}', Statc, "l.ip Codc
<br />�,1i nr��s j Address, CitS•, State, Zip Code
<br />ares Address, City, Stale,7.,i�> Code
<br />= If a corporation, date of iocac�+or u�iuu �,�;�{��q7 , staie incorporuted in DEI �FF. , mnount paid 'ut
<br />capital ._. If a subsidiary of �rr}- other corporation„ so state MAP 1 I r. �u,d t�4'� pwpose of
<br />corporation �j��}���E �1LR:"J{{�f�ET�•i� ��7�,�, . If iucorporated imder the la�vs of smothcr state, is coiporltion
<br />authorized to do husiness in tlie state of Mirwesota? �S7 Yes U No
<br />=. Describe premis�;s to which license applies; sue6 as (first floor, sccond floor, basement, ctc.) or if �-�� u� building, a+� slate.
<br />1F Per�!+1' ��� ��rJF �r�i-A�t'�1� ��LT�'�{_ j�_��� STOPF bJAI L Wfl_I SFPARATF I Tfl! 3C7R SI�f'3E FRfiM �T�1.�F�J ��-Tti" r-rq-
<br />�. Isestablishmeutlnaatec:�sz�nrs�r:�slrl�university,sldi�hospitaLtrainingsehool,refomlatoryorprison? �pYes �No Il�yes
<br />state �pprv���s�_- c�i ��� .� ; '' �LIL�a'-T—��..I� �� T�—��ILE rfif'f-�:,��'�C���tti' �
<br />•:. }� �ri i� �u:r; a��;ih :lf �'��kr+iic:l�•, u �s�:�.: ��F� TililiY ��'�:- r i r o Il � 7y�#��� � ��'�--ti•�a`r4`'
<br />_. __ fTas p�vner of buiidixtg my comiec;tion, directly or indirectty, �vith applicant? � Yes U No
<br />S. Is applicant or auy of the associates iu �li i Y��L,ca[o�u, a ai i�,�i7�• of ti�e goveming body of ihe municipality in ��'hich this liccusc
<br />is lo be issued? C] Yes L� No If yes, ii: what capacity? �_
<br />'�• State wl�cther a��y person other kh;u� app}icauts has ,��ti• rigl�t, tiUc or urierc� in the rurniwrc, fi�tures or equipmcut for �vhich
<br />license is appGcd and if so, give name and details. h,�1
<br />� ��� ��
<br />. i Tiri�� applicants any inierest wl�atsoevcr, directly or indirectly, ll� � other liquor esiablislunent iu the s�tale of Minnesota?
<br />i I�D(Yes i:l �� If yes, give naiue and address of ��I�Lis�l��nl . SPEEDWAY SIJPERAMERICA . LLC HOLDS MANY OFF SALE 3.2_ %
<br />�^�E�R LICENSES I N M E STATE � MINNESOTA '-`.'r `_ — _.
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