Laserfiche WebLink
NAY- 9 -95 TUE 7:46 IDS FINANCIAL SERVICES FAX NO. 6712621 P.04 <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 /,717/if CAA/AAA Re cR. EA r r04, At toCSArxc.v <br />Trade Name <br />Mailing Address SAS E .4ZTr44A Cd4 Ain dn f2/a LSrrse CA,v,d1d <br />Cin <br />Individual _Partnership Corporation tNon- 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. P.ZPNF; PAleK 4-Z7 nit 2. <br />CA ,g4A <br />Classification <br />Primary Nature of Business: <br />Check all applicable.. <br />1. Restaurant 2. Club <br />4. T'- Bowling alley 5. On /Off Sales <br />6. Off Sale Only 7. - ?Special Event <br />Total Gross Receipts of Entire Establishment <br />3. Bar <br />Gross Receipts from Liquor Sales Included Above 4/600 <br />Seating Capacity <br />Total Bar Only <br />License in Effect? Yes No PEN&Am G <br />Licensing Authority Ltfr4E CA.vAD,9 <br />Address S- /S C L-17 TL CAi.t4D4 R-A LZi7 tsz CA.v/044 MN SS/) <br />License Number <br />Effective Date c ./if, // 94- Expiration Date G //i /9 C <br />License Ever Revoked /Suspended? _Yes !/No If yes, date <br />If yes, explain <br />