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S7 A] 1: OF MINNESO"I A Ovs Ulab 110 70 <br />DEPARTMENT OF PUBLIC SAFETY <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 />BUSINESS ON NUMBER ``�' APPLICANT'S HOME <br />PHONE NUMBER `f KS14 - (- r, 4 G1 <br />WAD-t�(ge(`t blC'( 'i to (-% .��E► <br />(Individual owrm, aseer. or partrm) <br />for and in behalf i o o . �, i ; c� 4� o r ►,c . <br />a hereby apply for an Off Sale <br />Intoxicating Liquor License to be located at S Z La k i S 6 of 4-, -Alt <br />(Street Addma and/or Lot and Biodh Number) <br />Municipality of t t-Elc C 4 el 4 J q_ , County of R a r'% y <br />State of Minnesota, in accordance with the provisions of Illianesota Statutes, Chapter 340, commencing <br />—1 19 / c-' and ending - 3 t „ 19_ Z <br />2. Give applicants' date of birth 1 q Ci I C 3 <br />(Dav) (Month) (Ytar) <br />Birthdates of Partners lU J 3 - 9 �Q <br />(Hatt) (month) (Yes►) <br />or ;�C. 19S� <br />(LA10 (Month) (Y—) <br />Officers of Corporation <br />(fait) (Month) (yam) <br />S. The residence for each of the applicants named herein for the past five years is as follows: <br />4. Is the applicant a citizen of the United States? Yr S <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 l l Cit,(. C: <br />6. The person who executes this application shall give wife's or husband's fun name and address <br />w'ayt)e A t31ca,» _ IC7-440S-&C& L.-Lt fe t". �)4cicc Aln <br />0 <br />6. What occupations have applicant and associates in this application followed for the past five years? <br />n\gty1% - C41•.vr <br />Win[c4 ►2n�Sr� Cic. <br />tllark - S��aer,-t <br />7. If a partnership, state name and address of each member of partnership <br />CLERK'S EXHIBIT NO. "I �-I''l <br />Meeti ng-May-10-1978 <br />