05-09-1979 Council Agenda - Laserfiche WebLink

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Pb 9001D1 STATE OF MINNESOTA DEPARTMENT OF PUBLIC SAFETY LIQUOR CONTROL DIVISION APPLICATION FOR RENEWAL OFF -SALE INTOXICATING LIOIIOR LICENSE This application and bond shall be submitted in duplicate Whoever shall knowingly and willfully falsify the answers to the following questionnaire shall be deemed guilty of perjury and shall Ise punished accordingly. 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 partnership. For a corporation one officer shall execute this application for all officers, directors and stockholders. PARTI s/.. Tr 97 BUSINESS PHONE NUMBER YD �" 7 " / APPLICANT'S HOME PHONE NUMBER F EY Y P o fo es for and in behalf 01 lea eof individual) l• i liV June loaemed (of icor of t / nel nr Or Lame, el partners) • OF make application for RENEWAL of Of1.Sale intoxicating liquor license located at City of A74 0 N. 1(k 1 7C.L Zip � Code s /// T , County of--RA-111-6---44— 192-t. and ending Tune 30 ,19.0..u.. ❑ Check 111 box If no changes since last applying for renewal of license. If there has been a change; that is, change in ownership; 15,,001 edam:: - or - ml end block number) St P/3 u commencing 4s I - addition of partner: administrator or administratlix to an estate named; change of of freers, directors or stockholders in corporation, change of location: or new liquor establishment, then form P59136, Application for Of6Sale intoxicating Liquor License, must be executed instead of this form (see your city clerk for form PS 91361. PART 1111 FOR CORPORATION: mama of olbcers, directors and stockholders) r -2 j?etev-- pernkAr J o kP e h l erne9 Ares- Ireaa, U. eras— SCC-J PART III a. State whether applicant, or any of his associates in this application, have ever had an application for a liquor license rejected by any city or State authority: if so, give date and details b. Has the applicant, or any of his associates in this application, during the live years immediately preceding this application ever had a license under the Minnesota Liquor Coptrol Act revoked for any violation of such laws or local ordinances; it so, give date and details State whether applicant, or any of his associates in this application, during the past five years were ever convicted of any Liquor Law violation or any crime in this state, or any other state, or under Federal Laws; if so, give date and details 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 Director; and all ordinances of the City; and I hereby certify that I have read the foregoing questions and that the answers to ohs are true Subscribed and sworn to before me this day of ,197, INOta'n Publlel My commission expires_ 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 five years for any violation of Laws of the State of Minnesota, or City Ordinances relating to Intoxicating Liquor, except as here'nafter stated Approved By POLICE DEPARTMENT hems of city) TITLE 111 you have no police department either the Marshal or the Constable shall execute this report On applicant)