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eo No. 2941—State Form 109. STATE OF MINNESOTA Combination Application for Retailer's (On -sale) (3) Non -Intoxicating Malt Liquor License To the City of Lino Lakes Name of licensing authority (county) (city) County of Anoka I, St. ,Joseph Parte of the city, or , town. of Lino Lakes county of Anoka State , , of .Alinnesota, hereby make applieation for a Retailer's (On -sale) (Off -sale) Non -intoxicating Jllalt Liquor License to sell such .Malt liquor under and pursuant to an ordinance (resolution) passed by city council, couu.ty hoard of , and (Chapter 340, Minnesota Statutes 1945, as amended, providing for licensing and regulating the rale of non -intoxicating malt liquor. During the past five years, my residence has been as follows. I was born at Msr"- Day Year City i Borough Town State or County I am a (native) (naturalized) citizen of the United States. 1 am married. My (wife's) (husband's) name and address is I am proprietor. - Firm, was incorporated 1891 in the state of Minnesota Corporation is authorized to do business in Minnesota. License is for 161 EZm Street (street) (highway) located as follows: The license will be in connection with August Festival , Drug Store, Cafe, Restaurant, Hotel. Club which has been in operation 105 years Months Years The establishment is located on the 161, 171, & 202 Elm Street fir The business premises are owned by St. Joseph Parish The taxes on the property are not delinquent. I am not engaged in the retail sale of intoxicating liquor. I have not had an application for license rejected as follows: I have never been convicted of a felony nor of violating any National or state liquor kw or local ordinance relating to the manufacture, sale or transportation, or possession for sale or transportation of intoxicating liquor. Gambling or gambling devices will not be permitted on the licensed premises. I am the owner of the leasehold, furniture, fixtures, and equipment in the premises for which the license is applied, except NSA I have no intention or agreement to transfer the license to another person. I submit the following names of persons, including a bank, for reference, with whom I have had business relations as follows: I intend to engage in the sale of intoxicating liquor and will have a Federal Occupational Tax Receipt in accordance with the ordinance governing this license. My Federal Tax Stamp Receipt is No I will comply strictly with the provisions of the ordinance relating to the sale of soft drinks for "mixing" purposes and will serve patrons in full view of the public. I agree to waive my Constitutional Rights against search and seizure and will freely permit peace officers to inspect my premises and agree to the forfeiture of my license if found to have violated the provisions of the ordinance (resolution) providing for the granting of this license. I hereby solemnly swear that the foregoing statements are true and correct to the best of my knowledge and that I agree to comply with all the provisions of the ordinance under which this license is granted. Subscribed and sworn to before me this day of --- f%h1 y 19 96 Olt i2 M, 77,424.0_,,-/-2,.......„," A , NOTE: L enses may be issued only to persons who are citizens of the United States and who are of good moral character and repute, who have attaine. for which the licenses are issued. Laws 1949, 700. establishments c. .-' M.i. ;