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Liquor Control 081,100 <br />r nmldm9 <br />400 Cedar sumo STATE OF MINNESOTA <br />(612/ Pew, 206•6139 9om 83101 DEPARTMENT OF PUBLIC SAFETY <br />APPLICATION FOR PERMIT TO ONLY ALLOW CONSUMPTION & DISPLAY OF INTOXICATING LIQUOR <br />(This Application Shall Be Typewritten and Submitted Before June 1st of each Vear) <br />In answering the following questions "APPLICANT" shall be governed as follows: <br />For a Partnership, one of the partners shall execute this application for all members of the partnership. <br />For a Corporation, one of titer shall execute this application for all officers, directors. and stockholders. <br />For a Club, one of the club officers shall execute this application for all the members. If additional <br />space is required, use a separate sheet of paper, indicating by number the question answered. <br />(FEE FOR PERMIT — S456BBF <br />EVERY QUESTION MUST BE ANSWERED <br />1. 1, -)a.,Ff.,A. if d11et ktrtue, as Ursbliov` <br />(Moron m of pods" making nnolicnrionl (Individual wn pa <br />Inn , of mm. clM1 o mt <br />nr <br />for and in behalf of r :,.LHC1+ -h. frYJma <br />v. <br />IMy,nll, m4. of partners, name of corOOretlon, or name of club) <br />hereby apply for a permit allowing consumption and display of intoxicating, liquor to be located at <br />1-/a5 b- (. Hlc Cc.vtdal Pa- Municipality of U tile. (ar44J_.e._. <br />(Street 0010,00, one /o; Lot one °lock number) ) <br />Post Office of <01 f1' . ft. Zip Code �� /' County of /(o ffaC +/ rro.nfNln and Section) <br />State of Minnesota, in accordance with the provisions of M.S. 340.119. Tel. No. .22i2 `isd <br />Oros code) <br />2. Will business he operated as a private club or public place _. RubGc Riacc» <br />3. State type of business A r -; L/<t <br />4. FOR A PUBLIC BUSINESS: If a partnership, state name and address of each member of partnership; if <br />a corporation, state name and address of officers and directors. <br />do fa it ti 111 VO''lAvs :¢Srr <br />1 N,amm IAddrestl <br />�.'C /S, 4 ft- 'pi z l t .¢4z', ci <br />(Namnl udarmfl <br />Natl )0: ,(iaSri 71>a y;s.a S.1- <br />S'tfaI.U,1'Yfn ,5-s u,3 <br />5,5.100703 <br />fietl - ,Crl Jt— .3TIrur1 /-II'S Sll <br />././1 44 t r•.l df -1;i1 fl)a hill = Shd <br />INnmol IA01000001 <br />5. FOR A PRIVATE CLUB: Date club was organized is club incorporated <br />number of members length of time in present location is club building owned or <br />rented what is the membership dues what are the requirements for <br />membership <br />Does club maintain lockers to be used by members for storing intoxicating liquor . Names of all <br />officers and /or directors of the club: <br />I Nmmnl <br />Norco) <br />(Nnmm) <br />lnddrntf) <br />(Address) <br />(Aderotn <br />INemel Inddrefel <br />Enclose with this application a copy of the Constitution and By-Laws of the club and current list of bona <br />fide members. <br />6. If applicant or any partner, corporation officer or director, club officer or director, is not a citizen of the <br />United States, list such noncitizens- -' --"' <br />7. State name of person who will operate or manage business: <br />Or; ft mart J< >ti I 5)artr:en .. <br />nom J Inee..o) <br />N8. 0n what floor is the establishment located, or to he located Z. t`■ (.'rf <br />9. How are the premises classified under the zoning ordinance lu'-> l - -cct I )CLCL <br />Approved for Violations by: DO NOT USE <br />Check <br />1 0 Cash <br />Rec,t. <br />Reid. by Cashier <br />