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n <br />S1 A I E. Of- MINNE.SU I A Dez y13b 110 <br />DEPARTMENT OF PUBLIC SAFE.71 <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 be <br />deemed guilty of perjury and shall be punished accordingly. <br />In answering the following questions "APPLICANTS" shall be governed as follows: For a Corpora- <br />tion one officer shall execute this application for all officers, directors and stockholders. For a partnership <br />one of the "APPLICANTS" shall execute this application for all members of the partnership. <br />EVERY QUESTION MUST BE ANSWERED. <br />BUSINESSPRONE NUMBER APPLICANTS�T ` 1� I L PHONE NUER ME _ yl.� � <br />1. I-1A N 1 f L. b\ • 1)C i f L r t A., ,is Pf-1 [)T 6,r- Q_ <br />1 `` Ondit idud owner. o5cer. or parrnrr) <br />for and in behalf of � f 1: , `r M S h i i f L C.1%1\1 Ti a A k I (A. hereby apply for an Off Sale <br />Intoxicating Liquor License to be located At k L � 1 C L S i 1z �- L <br />(Stint Addrw and/or Lot and Block Numhn) <br />Municipality of ITT L A li n n County of tie R h1 -5 f y <br />State of Minnesota, in accordance with the provisions of Minnesota Statutes, Chapter $40. commencing <br />19---, and ending , 19_. c <br />2. Give applicants' date of birth 5 / 1-11 N Li 15 -3 <br />(DaV) (Month) (Yaw) <br />Birthdates of Partners 1 a , fJ . l q q q <br />(Day) (Month) (Yaw) <br />or <br />(LAW) (Month) (Y—) <br />Officers of Corporation <br />(Day) (Month) <br />The residence for each of the applicants named herein for the past five years is as follows: <br />(Y—) <br />JIA G 1, N ►: r(' /I L -ee lAl N P L �_ U-' r. r J r h \) N )u - -9 r0 Li <br />.�Qk,, ST P-Rtu RL•1L I?7 L <br />4. Is the applicant a citizen of the United States? Y S <br />If naturalized state date and place of naturalizatiar <br />If a corporation, or partnership, state citizenship status of all officers or partners. <br />A. <br />A•I cc i <br />6. The person who executes this application shall give wife's or husband's full name and address A A Q1 � f' r <br />,P.�F7it2.a�-k) 10L Ausr�'N•�IAI-- NtE LCITLt \N�.H�A )i11�1h _�-II• <br />6. What occupations have applicant and associates in this application followed for the past five years? <br />�1/i . : / /; • / i i :.� _'_ � is �. t ' [ I - c' •'/ �� i! c' 'J <br />7. U a partnership, state name and address of each member of partnership • 7I 1A { _ L � t- E {; . � t � z A-, <br />llus-Tf i��.l�\��rJ r1of ��r<< rlln;•�c�r1, 1t���►I�cl. ��7 <br />ri1'JAI)A ti1. 6-5 117 <br />CLERK'S EXHIBIT No. <br />Meeting May-10-1978 <br />