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MINNESOTA JOINT UNDERWRITNG 'ASSOCIATION <br />PIONEER P.O. BOX 1760 <br />ST_ PAUL, MN 55101 <br />1 -800 -552 -0013. OR (�T 2= -0484 <br />APPLICATION FOR LIQUOR LIABILITY COVERAGE <br />Coverage will not be bound if the correct premium payment, <br />written rejection, current lir°nsr, and <br />required documentation. of liquor receipts are Loge mot be bound prior to 12:01 <br />am. the day following receipt of the above by the <br />Name of Applicant Little.. Canada Canadian Day , =nc• <br />Trade Name Cana 414n D ujS <br />Mailing Address 515 E . LS-1+1,0 (Avila a_ goad ie (sic, , /17 5511-7 <br />_Individual _Partnership C Corporarioa Non -Profit Other <br />If Applicant is Yndividuai: <br />Applicant Name Ni/Pr Spouse Name <br />If Applicant is a. Partnership or Corporation: <br />Name of Farb Palmer or Owner <br />usan klr bon Prys 4ent <br />I -'sa ('re s,'dent <br />Char!" Anne flechmann, Co- TreaSuferS <br />Delon. Si n n a C0erfhtarti <br />Operating 1„ocatinn(s) — List all Locations: <br />cast-sit:1u Canaa MN 5511 7 Liffle_ Canada., 11'IC <br />011 <br />1. 515 E ante. Carvai.. <br />Percentage of Owuessliip <br />N/A <br />Will <br />N/A <br />Al/ A <br />2 c. goner" -Park 350 En. zad <br />Primary Nature of Business _Orrn S•14 479 Plan a nit tier -. (' (4-tics annuQ l -Qs '✓a.( <br />Check all applicable. <br />1. _Re ? _Club <br />4. _Bowling Alley 5. ,.On/ Sales <br />7. _L Special Event <br />ZO00 - <br />Total Gross Receipts of at Establkie nr Woo - <br />Gtoss Receipts from Liquor Saks lactated Above 4 <br />Searing Capacity Total <br />License hi Effect? _Yes J.L.No <br />Lirr+rginw Authority 034 ti Lf. Li*LP Ctcf a4a- <br />Address . 515 a Ite-friP can Lt. (Qd , L.141-Ir. Cana ..L, MN 551(-7 <br />License Number <br />Effective Date ftu.Ric 3. WO1 Expiration Date Pruaf4Si' S Zoo <br />3. _Bar <br />6. _Off Sale Only <br />6arnb1'ny —fi 438' ait/•UD <br />Fesh' ✓aI — # 7L,fiL -.Sri <br />3U1.o0 <br />Bar Only <br />License Ever Revo Suspended? _Yes X No if yes, <br />If yes, explain <br />Page 91 <br />