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10. State name and address of owner or owners of building wherein the business will be located: �•
<br />i1 U I D. I/ kuk o1RS1 Yhtkr; 1 Si 1 3
<br />INe,rol c, 4/ �H L(F, )in S5q
<br />(nddreeal
<br />11. Has applicant; if partnership, any partner; if corporation, any officer or director; if club, any club
<br />officer or director, ever had a license under the Minnesota Liquor Control Act revoked or suspended or been
<br />convicted for any violation of State Laws or local ordinances; if so, give date and details n U
<br />12. Is applicant; if partnership, any partner; if corporation, any officer or director; if club, any club officer
<br />or director, a member of the governing body of the municipality or county in which this permit is to be
<br />issued; if so, in what capacity (1,r t
<br />13. Has applicant; if partnership, any partner; if corporation, any officer or director; if club, any club
<br />officer or director, any interest whatsoever, directly or indirectly, in any liquor establishment in the State
<br />of Minnesota ,1.0 . Give name and address of such establishment
<br />14. Furnish the name and address of at least three business references, including one bank reference:
<br />(.;r' 1 Nlf'■ IC ; >(a _)' ,,t- Li file pane an_ '. T.
<br />�Lre :zr—' Ll l{'I P_ Lu vmx CC
<br />(Nnnel � :1 �
<br />(Address)
<br />I I ) y� q 11
<br />Interne) II it; Cr /f!'F� U(4. (. VF(.;t 1 A re SIP e
<br />(nudrem �7
<br />F'l A)lec� �4. Q � � 41,A !Q Pt�a.It /lve$ (s
<br />INnmm (Address)
<br />15. Will intoxicating liquor be sold on the premises U
<br />16. (a) State whether application is: 1. Original ✓ 2. Renewal 3. Transfer
<br />(b) Former licensee's name "— trade name
<br />17. Are the premises now occupied, or to be occupied, entirely separate and exclusive from any other
<br />business establishment 1'`.0 n /
<br />18. State trade name to be used L,; N-le- f2av o.. a. ke4v ?ca /-Aa I
<br />r
<br />19. State whether an "On -Sale" or "Off-Sale" Nom(ntoxicating Malt Beverage License has or will be granted in
<br />conjunction to this business and for the same premises Perk nY 'DLL;
<br />20. Has there been issued, or will there be issued, a $54.00 Federal Retail Liquor Dealer's Special Tax Stamp
<br />for the sale of liquor on these premises 71
<br />21. Has your local government an ordinance regulating the consumption and display of intoxicating liquor
<br />22. If operating under zoning ordinance how is location of building classified 05(c(PrLEx.g E3c'. 'rte, •
<br />1 hereby certify that 1 have read and understand every question In this avpn<eunn, and that the a of my own knowledge. 1
<br />further understand that the giving of false information In this application, or the tenure to give pertinent informaton constitutes cause for the
<br />mediote revocation of this permit. 1' 15 FURTHER UNDERSTOOD THAT ANY PERMIT ISSUED HEREUNDER DOES NOT ALLOW THE
<br />SALE OF INTOXICATING LIOUOR. Enclosed Is payment of 5150.00 payable to the Liquor Control Director as provided by M.S. 19NT, Section
<br />3130]19.
<br />NO CONSIDERATION WILL BE GIVEN TO
<br />THIS APPLICATION UNLESS APPROVED AS
<br />HEREINAFTER PROVIDED:
<br />If applicant is located in the County, the Chairman
<br />of the Board of County Commissioners or his
<br />Representative shall approve both copies of the
<br />application.
<br />(clm,mnn, ooerd of County comma, loner, or bit noa,0,,,, ye)
<br />If applicant is located in a Municipality, the
<br />President of the Council or his Representative shall
<br />approve both copies of this application.
<br />(F,mldent nr the cannel a, hl. Pen,a,enunve)
<br />L11'7l/[',
<br />! na /n4
<br />(Name of Esteelhhmentl
<br />(Stgneture of nuthorlard Applicant)
<br />Subscribed and sworn to before me this _ day
<br />of 19 .
<br />(Nolen, Public)
<br />My Commission expires
<br />1.
<br />
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