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MAY -24 -94 TUE 9:58 IDS FINANCIAL SERVICES FAX N0. 6712621 P,03 <br />MINNESOTA JOINT UNDERWRITING ASSOCIATION <br />PIONEER P.O. BOX 1760 <br />ST. PAUL, MN 55101. <br />1- 800 - 552 -0013 OR (612) 222 -0484 <br />APPLICATION FOR LIQUOR LIABILITY COVERAGE <br />Coverage will not be bound if the correct premium payment, written <br />rejection, current license and required documentation of liquor <br />receipts are not attached. Coverage cannot be bound prior to <br />12:01 a.m. the day following receipt of the above by the <br />Administrator. <br />Legal Name of Applicant AI T 724E c A,v. AA Ai c R ;47 11 sla cl/ rstu <br />Trade Name <br />Mailing Address' S"/.S C 4..2 7-74.c cg,,,,tA a Rb h,rnL cg4v404. ss) <br />Individual Partnership Corporation ✓Non- Profit Other <br />If Applicant is Individual: <br />Applicant Name Spouse Name <br />If Applicant is a Partnership of Corporation: <br />Name of Each Partner or Owner Percentage of Ownership <br />Operating Location(s) - List all Locations: <br />1. ?Zs )./rig ?4,Z IL ZZrrc.& C4NA -04 2 <br />Classification <br />Primary Nature of Business: ?i26&1ar Yt TH 4t7x v;r 7:4-S <br />Check all applicable,. <br />1. Restaurant 2. Club 3. Bar <br />4. Bowling alley 5. _On /Off Sales <br />6. _ _'Off Sale Only 7. ✓ Special Event' <br />Total Gross Receipts of Entire Establishment <br />Gross Receipts from Liquor Sales Included Above i /c?d 0 <br />Seating Capacity Total Bar Only <br />License in Effect? Yes No rtN 4 ye4 <br />Licensing Authority h 7-5-TA E c4a ADA <br />Address .615 G Alt,/.; c4A,AnG AA 4Zrrh (4,..A4A MN S'Sii7 <br />License Number <br />Effective Date G ii i 9 y Expiration Date _‘)/..-2./ 9 y . <br />License Ever Revoked /Suspended? Yes i/ No If yes, dae <br />If yes, explain <br />Page 4 <br />