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TRANSFER <br />STATE OF MINNESOTA <br />DEPARTMENT OF PUBLIC SAFETY <br />LIQUOR CONTROL DIVISION <br />PS 0906802 <br />APPLICATION FOR RENEWAL OFF -SALE INTOXICATING LIQUOR LICENSE <br />This application and bond shall be submitted in duplicate <br />Whoever shall knowingly and willingly falsify the answers to the following questionnaire shall be deemed guilty of perjury and <br />shall be punished accordingly. <br />In answering the following questions "APPLICANTS" shall be governed as follows: For a partnership one of the partners shall <br />execute this application for all members of the partnership. For a corporation one officer shall execute this application for ail <br />officers, directors and stockholders. <br />PART I <br />BUSINESS PHONE NUMBER "T l7^ /•.2I& APPLICANT'S HOME PHONE NUMBER /T 37 -3'/ C <br />42,9 h v, /,y 7,1/ r_ 4' Q , for and in behalf of <br />Name of: (individual)V (partner) (officer of corporation) (name of individual) <br />or <br />(names of partners) / 7• ,,t(e�r{ / r��r <br />or Cah��rbiihj ..�nU«$ e f5 XhC trade name /,!r("( Z:`9c" o �r/a'Plio`�SC: <br />(name of corporation) <br />Tr et 6 r <br />make application for RENEWAL of Off -Sale intoxicating liquor license located at: <br />(street address — or — lot and block number) <br />City of L , 1 f /e_ & h Zip Code <br />commencing (, C i6; t t <br />/9 <br />.5.5'/( 7 , County of <br />, 19 g 7 and ending <br />Check ( ✓ ) box if no changes since last applying for renewal of <br />ownership; addition of partner; administrator or administratrix to an <br />in corporation; change of location; or new liquor establishment, then <br />License, must be executed instead of this form (see your city clerk for <br />RCc- M 5' 7 <br />19 <br />license. If there has been a change; that is, change in owner - <br />estate named; change of officers, directors or stockholders <br />form PS 9136, Application for Off -Sale Intoxicating Liquor <br />form PS 9136). <br />Will applicant be granted On -Sale ; Sunday On-Sale Intoxicating Liquor License in conjunction <br />(Yes or Nn) (yes or No) <br />with the Off-Sale Intoxicating Liquor License for this location? <br />PART II <br />FOR CORPORATION: <br />(names of of liters, directors and stockholders) <br />Page 6 <br />(Over) <br />