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Minnesotal�t�aruuent ofi'ub1iC Sttfcry ,� �,.��,�
<br />�,IQUOR,CONTROLDIVISI�T �°'�i- � �
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<br />� 4�� Cedar St.. Suite 10q I„ St. Paul, MN 55101-2156 � �,� ri'
<br />�. R � (6 I2)29G-G43U "I°lY(612)282=G555 ��� ..'
<br />APPLICATION FOR OFr SALE iNTOXICATING LIQUOR LICENSE
<br />No license �lll bc approved or released until the $2U Retailer ID Card it� is received by MN Liquor Control.
<br />Warkerscompe�isntion insttrancecompany. Natn� ��t./ Policy#�, _
<br />l.1CF:NS'1�F'S SAI.I:S 1fi C1SL TAX ID# To apply for s�les I� #, cu11296-061$1 or 1-800-657-3777
<br />If a co oration an. officer shall execute this a lication If a artnershi a artner shal�l execute this a lication.
<br />].i�xnac� Name (Iudividtta(, Corporation, Partne.�r�liip} Trade Nanae or DBA
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<br />1.iccnse Location (Street Address & Iilock No.) Liccnse Pe.�riod Applicant's I[omc I'hone
<br />� � � �r7..r �'u� ' �� � 1��� fmns ���! "� To
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<br />����' �ow�t�� �LaL� {�r �acic T - -
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<br />h'��7L �� �8�� �[�s�.� I������ ���n�a T��_n�� I���I# (7�d� �d�i bL A��L�:�ht}
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<br />If a corporation, state name, date of birth, address, title, and shares held by each officer. If a partnership, state
<br />names, address and date of birth of each partner. .
<br />k�a:,i,is:,- pl�iccr (fiirsl, middle. las�t) UO}3 7'itic . Sliares Addr��cc. City, Sta1e, Zip Codc
<br />t'a��tncr Officer (Firs-�,middle,last)
<br />I'arin��r Officer (Fir�t, middlv, last)
<br />}'artn��r Officer (f� irst, middlc, last)
<br />2.
<br />3.
<br />4.
<br />5.
<br />6.
<br />7.
<br />UOL3 , 'I'it
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<br />I)OIi Tit
<br />DOB I Title
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<br />SUarc.s
<br />Shues
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<br />Address, Cit�', Sjatc, "l..ip Codc
<br />Add��sF Cit}`, �[�t. �,�;� f:od�
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<br />Address, City, State,'.I,ip Code
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<br />If acorporation, date of incorportition i� '"i , state iucotporated m �r���,�`� �� , a�uouut paid
<br />capital _�F s�� 'd' �{' �lx� a�� �I inq, so state and �c�+e purpose of
<br />corporation_�F Y±�+�•� �' ��� � . ff iucorporated under fhe laws of another state, is corporation
<br />authorized lo do busiaess in tlie slate of Minnesota? C� Yes 0 No
<br />��e�x� pr�.aai �+x�i� i�� ap ics• �r� s� (���floor, sccondfloqt,b• �t, cl�_ or if cntire buildwg, so state.
<br />�r�'� - ' ry��� +�� ���
<br />ls t:±•�l:sl�w,�:14r�pr� a �n• �lalc u���vcr�l�, �ela �tio;cpital. training�l,��reformato�' OrFr��p$ � Yes � Ifyes
<br />;���, : : �;'FSIY �.�i 6;� 'istance.
<br />P�r�s�a�:s�ri�����building�'x�':�� ��f.r��� ���r��r-�`��� � ��v �i•�
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<br />�. {'• ��,�. . ,�r� �Ias ownel�f building �y�r,�o�li�, directly or indiroctly, with applicant? 0 Yes ��� �a
<br />Is applicant or any �f the ��u�� in this a�plication, a metnber of tlxe governing body of dh� inunicipality in ��•hicu llxis liccvsc
<br />is lo be iss�ied? C� ��s��la Ifyes, m what cupacity?
<br />Stale wbcther any person other ihan applicauts has any ri�i��i�c or ailere�i in the fwniture, iLatures or equiptnent for which
<br />license is agglicd and if so, give name and details. �tir �J`
<br />+�'c applicants any interest whatsoever, directly or indirectly, ut �5' 4 ���4r ��61i�mo�� in ��,� �d �� �P�+[i�r�csoi��
<br />��'�� CJ No CPyes, givea�u� and addressof��lebl�i�ruc�S. 4��,�.��� ___�,
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