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sft / <br />DEPARTMENT OF PUBLIC SAFETY <br />MINNESOTA ors a'� "r <br />LIQUOR CONTROL DIVISION <br />APPLICATION FOR OFF SALE INTOXICATING LIQUOR LICENSE <br />This application and the bond shall be submitted in duplicate <br />Whoever shall knowingly and wilfully falsify the answers to the following questionnaire shall <br />deemed guilty of perjury and shall be punished accordingly. <br />In answering the following questions "APPLICANTS" shall be governed as follows: Fer a Corpor <br />tion one officer shall execute this application for all office - directors and stoekholdem For a partnersh <br />one of the "APPLICANTS" shall execute this application for all members of the partnership. <br />EVERY QUESTION MUST BE ANSWERED. <br />BUSINESS APPLICANT'S HOME PHONE NUMBER 4 84 - 4// <br />( PHONE NUMBER - 4 94- b O 4- 9 <br />L L. Mara ar't-t B I C,0 r) as 04-0 n e i- <br />Ondividuar oa,xr, ofltcer. or txrtner) <br />for and in behalf � F310 o rn �-- t (� U OI' � � r1C ketchy apply for an Off Sall <br />Intoxicating Liquor License to be located at '2•-7 s Z k a k e S h O Y 4 d Q, <br />(Street Addrm and/or Lot and &ocR Number) <br />Municipality of :' I Q C n Gi cla county er_0 a m S V <br />State of Minnesota, In accordance with the provisions of Minnesota Statutes, Chapter 340, commencing <br />'I` i�- -7 -7 ,19 <br />_, and ending- <br />2. Give applicants' date of birthIq 9 <br />(Dav) (month) <br />S I Year) <br />Birthdates of Partners % <br />(�) (Month) <br />or Q 0 �• (Ybe) <br />(tit► J � I q 5 $ wt,.� <br />(Month) <br />Officers of Corporation <br />5;v- (Month) <br />(Yea) <br />8. The residents for each of the applicants named herein for the past five years is as follows: <br />107 Aus-fra. /,'a h Ave. t 0 -Etle Canada.. A11'I1.). <br />4. Is the applicant a citizen of the United States?- Ll e -C, <br />If naturalized state date and place of naturalization — <br />If a corporation, or partnership, state citizenship status of all officers or partners. <br />a.11 e�t:zen5 <br />5. The person who executes this application shall give wife's or husband's full name and address <br />tine �n - loom <br />e <br />6. What occupations have applicant and associates In this application followed for the past five years <br />*WS -PADe✓ L mere-✓ - Sf. fRn'fC �7 <br />Qsst-�' cook - S+SGhoo I <br />7. If a partnership, state name and address of each member of partnership <br />CLERK'S EXHIBIT 140. 11�� <br />Meeting-5-11-7? _ <br />