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Minnesota Department of Public Safety <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br />444 Cedar St., Suite 133, St. Paul, MN 55101 -5133 <br />(651) 296 -6979 FAX (651) 297 -5259 TTY (651) 282 -6555 <br />W W W.DPS.STATE.MN.US <br />APPLICATION FOR COUNTY /CITY ON -SALE WINE LICENSE <br />(Not to exceed 14% of alcohol by volume) <br />EVERY QUESTION MUST BE ANSWERED. If a corporation, an officer shall execute this application. If apartnership, LLC, a partner <br />shall execute this application. <br />Workers compensation insurance company. Name Policy # <br />LICENSEES MN SALES & USE TAX ID # To apply for MN Sales Tax # call (651) 296.6181 <br />LICENSEE'S FEDERAL TAX ID # <br />Applicants Name (Business, Partnership, Corporation) T <br />Trade Name or DBA <br />Business Address B <br />Business Phone A <br />Applicant's Home Phone <br />City Little Canada C <br />County Ramsey S <br />State Z <br />Zip Code <br />Is this application I <br />If a transfer, give name of former owner L <br />License period <br />If a corporation, give name, title. address and date of birth of each officer. If a partnership, LLC, give name, address and date of birth of each partner. <br />Partner /Officer Name and title A <br />Address S <br />Social Security # D <br />DOB <br />Partner /Officer Name and Title A <br />Address S <br />Social Security # D <br />DOB <br />Partner /Officer Name and Title A <br />Address S <br />Social Security # D <br />DOB <br />Partner /Officer Name and Title A <br />Address S <br />Social Security # D <br />DOB <br />CORPORATIONS <br />Date of incorporation S <br />State of incorporation C <br />Certificate Number I <br />Is corporation authorized to do business in Minnesota? <br />0 Yes o No <br />If a subsidiary of another corporation, give name and address of parent co poration <br />BUILDING AND RESTAURANT <br />3- <br />