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Application Date: <br />JQfSj' �� <br />FOR OFFICE USE <br />Application No. <br />Date Received <br />By <br />CITY OF LINO LAKES <br />APPLICATION FOR OFF -SALE AND <br />NON -INTOXICATING MALT LIQUOR LICENSE <br />This application form requests information which may be classified <br />as private or confidential under the Minnesota Data Practices Act. <br />This information is required by State law or City ordinance. The <br />information will be used to determine your eligibility for issuance <br />of a license, permit, or identification card. Failure to provide <br />the information will result in a denial of the license, permit, or <br />identification card. <br />Directions: <br />This form must be filled out with a typewriter or by <br />printing in ink. If the application is by a natural <br />person, by such person; if by a corporation, by an <br />officer thereof; if by a partnership, by one of the <br />partners; if by an unincorporated association, by <br />the manager or managing officer thereof. <br />1. Name of the Applicant (name of individual, partnership, <br />corporation or association): <br />yy <br />`V'�a L % n C :; e S Si"( ,- r s, n e, <br />S e 711 /y1v t! vv- r ( [L n // l ,, <br />2. Business Name: r w: n e. ;' 'e s St o r e s, <br />Business Address: "2,5-0 q)L a_ le .t /%,. ,' y t <br />(Street, City, State, Zip) <br />Business Telephone: boa o S : /r e %/ Rel jk-o7.3 <br />1/ 6/ <br />�n . na :o0.S/S nln <br />l<< <br />no AeetS <br />a..1 k n dryy <br />IF BUSINESS IS TO BE CONDUCTED UNDER A DESIGNATION, NAME OR <br />STYLE OTHER THAN FULL INDIVIDUAL NAME OF THE APPLICANT, ATTACH <br />TWO COPIES OF THE TRADE NAME CERTIFICATE, AS REQUIRED BY <br />CHAPTER 333, MINNESOTA STATUTES, SECRETARY OF STATES OFFICE <br />.0 -re <br />3. Type of Applicant: <br />c <br />Natural Person (Indi"vidual) U <br />X Corporation <br />Partnership <br />Association <br />PAGE 1 <br />