Laserfiche WebLink
MTh NESOTA IOW's t.±KWRIT iG ASSGrTkTION <br />PIONEER P.O. BOX 1760 <br />ST. PAUL, MN 55101 <br />1-300-552-0013. OR (&i- 222-0454 <br />fr51 <br />APPLICATION FOR LIQUOR LLABIL.ITY COVERAGE <br />Coverage will not be bound 42 the c:.r.uct premium payment, witten refection, current License, and <br />required documentation of lcuor receipt; are act attached. Coverage cannot be bound prior to 12:01 <br />a.i"n. the day following receipt of the abcve by the Aurrunisz-ato.- <br />Legal Name of Applicant SP0Qrs"AE75 INC. forgOWr -ArJ <br />Trade Name S GLtL /P.) r. <br />Mailing Address 2q `i 3 Payer u , 1-1ThZ (Ar\I A J.D14 mN <br />_Individual _Parmer: hip ._Corporation ✓4an -Profit _Other <br />If Applicant is Individual: <br />Applicant Name'DDrJ QZ�n)r'\ari <br />If Applicant is a Parmershhin or Corporation: <br />Name of Each Parma. or Owner <br />'Do Ni how r r j <br />Operating Location(s) — List all - 'cations: <br />1. 24 S`0tCUTavi` 2D, <br />i--� 1, L€1 e.Ary a. r4 N CS-1/ <br />Casaiication <br />Spouse Name N 8CwmeoN/ <br />Percentage of Ownership <br />100 010 <br />'7. <br />Primary Nature of Business: 5 c- -r3.4 LL- STx o w2n .Ere n <br />Gecic all applicable. <br />1. Restaurant <br />4. Bowling Alley <br />7. ✓ Special Event <br />Z. _Club 3. Bar <br />5, On/Off Sales 6. Off Sale Only <br />Total Gress Receipts of Entire Establisi rnenc , ono • <br />OV <br />Cross Receipts from Liquor Sales Included Above 4- 1, n 00 , L7 <br />Seating Capacity ) 5 L) Total. ,S o Bar Only <br />License in. Effee:? Yes ✓ No <br />Licensing Authority f`,\ ry T i c I ry `IL Lt< ` 12JtET . C <br />Address <br />License Number - <br />Effective Date ! H u 17; ").00I1 Expiration Date r U G lc, 7_4'0 Li <br />Lictrse Ever IZeveice'd/Suspenried? Yes _1 o If yes, date' <br />If :yes. explain <br />5- <br />