05-09-1979 Council Agenda - Laserfiche WebLink

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PS VFAm STATE OF MINNESOTA DEPARTMENT OF PUBLIC SAFETY LIQUOR CONTROL DIVISION APPLICATION FOR RENEWAL OFF -SALE INTOXICATING LIQUOR LICENSE This application and bond shall be submitted in duplicate Whoever shall knowingly and willfully 1olsify the answers to the following questionnaire shall be deemed gllllly of perjury and snail be punished accordin(1ly. In answering the following questions "APPLICANTS" shall be governed as follows: For a partnership one of the partners shall execute this application for all members of the pariner100, Fora corporation one officer shall execute this app(lcat 00 for all officers, directors and stockholders. PART I BUSINESS PHONE NUMBER "'SAL - APPLICANT'S HOME PHONE NUMBER ]0L,-FL/L$ I,;9l//k/-IA) 4 /f ?' -sS F for and in behalf of l�!'fAli5/ Pi /4--Ltt f /e' lianivaiesil (Mariner, (ollicer of cor001Ot,on) {name Ol ,ndverovall SOS CZ. 4c"iEftSEt) OA3 L rn.Pc_-TERSEI- 0,3A 'Lc�T�c CntSfyoEy ` mameioi Panne") Lt Quu5t -4.A. make application for RENEWAL of Off -Sale • • or Irome of wr�mlmnl {J intoxicating liquor license located at 'Su2'' L` r e y .5 7' (meet address -- or - lol and block nvmLerl city ofci-Lt Llwrlh /v Zip Code "'113 ,c umy of fjm5s 19Sfu' commencing JO- 1% A 19 79 and ending k (U.v± - ?G ❑ Check III box it no changes since last applvin9 for re wal of license. If there has been a change: that is, change in ownership; addition of partner: administrator or adminhhatrix to an estate namnC change of officers, directors or stockholders in corporation; change of location: or new liquor establishment, then form PS 9136, Application for Off-Sale intoxicating Liquor License, most be executed Instead of this form Bee your city clerk for form PS 91361. PART II FOR CORPORATION: I namerof of 1 icerr, seer ors and 5locknol PART III a. State whether applicant, or any of his associates In this appl(cat loin have ever had an application for a liquor license rejected by any city or State authority; it so. give date and details /U U Has the applicant, or any of his associates in th0 application. during the live years immediately preceding this application ever had a license under the Minnesota Liquor Control Act revoked for any violation of such laws or local ordinances; if so, give date and details /uo State whether applicant, or any of his associates in this application, doling the past five years were ever convicted of any Liquor Law violation or any crime in this stale, or any other stale, or under Federal Laws: it so, give date and details 4../ 0 Applicant, and his associates in this application. will strictly comply with all the Laws of the State of Minnesota governing the taxation and the sale of Intoxicating liquor; rules and regulations promulgated by the Liquor Control Dimctnr; and all ordinances of the City: and I hereby certify that they read the foregoing questions and that the answers to said questions are true of my own knowledge. Subscribed and sworn to before me this di Maury Puhdcl My commission expires c/ 0011 001 applicant) G/iii1A koinx�EC- FREEMAN RA MSEY COUNTY o m tomtsrkn Erman Ow. a, 1101 t REPORT ON APPLICANT OR APPLICANTS BY POLICE DEPARTMENT This is to Certify that the applicant, Or his associates, named herein have not been convicted within the past f of Laws of 100 State of Minnesota, Or City Ordinances relating to Intoxicating Liquor, except as hereinafter stated years for any violation POLICE DEPARTMENT mime of city) Approved By' TITLE 111 you have no police department, either the Marshal or the Constable shall execute this report on the applicant.) 5, V 82