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APPLICATION FOR GAME ROOM LICENSE <br />APPLICATION FOR GAME ROOM LICENSE <br />ATTACHED TO TAVERNS <br />(Intoxicating and Non -intoxicating Licenses) <br />The Outer Limits Februar34 6 <br />trade name date of application <br />icensing period <br />1. <br />Type of Application: ® New � Renewal � Transfer <br />2-James F. Hoff 483-2857 <br />name of applicant p one <br />3. <br />3261 N. Victoria Street Shoreview, Minn 55112 <br />home address city state <br />4. <br />July 4, 1948 Madison, Wisconsin <br />ate of birth place of biro <br />5. <br />Market Place Shopping Center; 2900 N. Rice Street; Suite I j- <br />address of business location <br />�l 6. <br />legal description <br />7. <br />List owners of building or premise to be licensed: '!• <br />g. Quali-Tec Corporation <br />corporate or partnership title <br />9. Same as applicant <br />corporate or partnership address <br />10. List all partners, officers or directors, if corporation: <br />name address <br />Applicant <br />date of birth <br />Clerk's ex::ibi t no. 0032 <br />X,eting-2-°-78 —' '— <br />