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,-.,';j.--;6,,,--,,,Minnesota
<br />v.
<br />L k !
<br />Department of Public Safety ,{F_,
<br />LIQUOR CONTROL DIVISION 5, ,, gr
<br />190 Sth St. F., Suite 105. St Paul. MN 55101 ' -'
<br />sr
<br />(612)296-6430 TTY(612)282-6555 .�1.,.-
<br />OFF SALE INTOXICATING LIQUOR LICENSE
<br />APPLICATION FOR
<br />No license will be approved or released until the $20 Retailer ID Card fee is received by MN Liquor Control.
<br />Workers compensation insurance company.
<br />LICENSEE'S SALES & USE TAX ID # '7"/---/-17--�To
<br />Nance ,c!// t; O c.,,,.Vt-/ S Policy#
<br />apply for sales tax #, call 296-06181 or 1-800-657-3777
<br />'
<br />a partner shall execute this application.
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<br />If a partnership,
<br />-t-1/ irt" t' % &
<br />If a corporation, an officer shall execute this application
<br />Licensee Name (Individual, Corporation, Partnership)
<br />%/47 4- /')-,YAt rn/LLe. /',5- LNG.
<br />--1-3----194-1--Z--1- er
<br />Trade Name or DBA
<br />ill /4/ C'S' a•y /174-/.zy
<br />License Location (Street Address & Block No.)
<br />,�OC// ,4"4 -Kc 0,'
<br />License Period
<br />From 5
<br />t _ 1_ To -;—/ - (j5
<br />Applicant's Home Phone
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<br />City
<br />I,/i✓e ti//%cs
<br />County
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<br />State
<br />r' /7/
<br />Zip Code
<br />S^J n/ y.
<br />Name of Store Manager
<br />J i/11 J'h/LLc,-
<br />Business Phone Number
<br />7,'j.., 7/e6
<br />DOB (Individual Applicant)
<br />If a corporation, state name, date of birth, address, title, and shares held by each officer. If a partnership, state
<br />names, address and date of birth of each partner. -
<br />Partner Officer (First, middle, last)
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<br />DOB
<br />Title
<br />Shares
<br />Address, City, State, Zip Code
<br />MA( J^.S e' % y
<br />Partner Officer (First, middle, last)
<br />DOB
<br />Title
<br />i.-, i c t
<br />o
<br />./c...., ""-
<br />Shares
<br />_
<br />Jo fa/0„,^40-
<br />Address, City, State, Zip Code
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<br />Partner Officer (First, middle, last)
<br />DOB
<br />Title
<br />Shares
<br />Address, City, State, Zip Code
<br />Partner Officer (First, middle, last)
<br />DOB
<br />Title
<br />Shares
<br />Address, City, State, Zip Code
<br />1. If a corporation, date of incorporation
<br />capital . If a subsidiary
<br />9 - Y/ , state
<br />incorporated
<br />incorporated
<br />No
<br />second
<br />so state
<br />in ii /y , amount paid in
<br />of any other corporation,
<br />. If
<br />and give purpose of
<br />is corporation
<br />building, so state.
<br />corporation
<br />under the laws of another state,
<br />floor, basement, etc.) or if entire
<br />authorized to do business in the state of Minnesota? ❑ Yes ❑
<br />2. Describe premises to which license applies; such as (first floor,
<br />EtY rif L 43c' , L 41.'-,-
<br />3. Is establishment located near any state university, state hospital, training school, reformatory or prison? D Yes I o If _yes
<br />state approximate distance.
<br />4. Name and address of building owner:
<br />/1/y h . s" c0 "y
<br />,714-/17 t} / /1i / /,L.Gr" 7 rS/ 4-A6 G £- />/" / L i'Mei
<br />Has owner
<br />`irk,
<br />of building any connection, directly or indirectly, with applicant? le'Yes ❑ No
<br />a member of the governing body of the municipality in which this license
<br />5. Is applicant or any of the.as ciates in this application,
<br />is to be issued? ❑ Yes VNo If yes, in what capacity?
<br />6. State whether any person other than applicants has
<br />license is applied and if so, give name and details.
<br />7. Have applicants any interest whatsoever, directly
<br />❑ Yes Lp'No If yes, give name and address of establishment.
<br />1- to 0 c ..,..i TR if- c T
<br />any right, title or interest in the furniture, fixtures or equipment for which
<br />or indirectly,
<br />in any other liquor establishment in the state of Minnesota?
<br />Se} L. 0 Pi If Ri-i S Dr -4-/Z / ", /11 /
<br />
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