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No. 234Y.—State Form 109.
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<br />BUSINESS RECORDS CORPORATION. MINNESOTA
<br />STATE OF MINNESOTA
<br />Combination Application for Retailer's (On -sale) (Off -sale)
<br />Non -Intoxicating Malt Liquor License
<br />1
<br />To the 0,0,f Li, c, l_oKes
<br />7
<br />Name of licensing authority i county l (city)
<br />County of Ka
<br />/ CPTC- SErTFIV1
<br />CPT n/ th, r-ity, or
<br />-.
<br />town. of C: Act. tPn0. county of Au `(es State
<br />, ,
<br />of Minnesota, hereby make application for a Retailer's (On -sale) (fie) .1'on-intoxicating Malt
<br />Liquor Licr•n,sr• to .sett .welt..halt liquor and :r and int -r ,,tnt- to an orrlin,i ,',' (rc.,o/rttion) prr.e.ecr/ by city
<br />Cly 1-1.-c 4-
<br />roundI, con YritirPtrim(I of _ ' l ;
<br />and Chapter 340, Minnesota Statutes 1945, as amended, providing,' for Licensing and regulating the
<br />;ale of non -intoxicating malt Liquor.
<br />During, the past fcge years, my residence has bean as follows'
<br />C):
<br />1 was horn o1 /(c 4,_' t ,44^ne/o ./
<br />Mr •' Uay Year gqlaity
<br />AVl.' .1aes0119
<br />(Borough Town State or County
<br />1 am a (native) (rfRL4TSCYl) citizen, of the. United States.
<br />1 am married. My (wife's) (/4..') name and address is
<br />MAit<7 I S'elir^-- .313 SG,e,wt,00 Cr C -'-.Q '-,es '11--
<br />I am proprietor.
<br />Firm was incorporated 1 zS 69 in the state of /4 r='=7,q
<br />Corporation is authorized to do business in Minnesota.
<br />License is for L i LI -+s .S-cyr`kC=,'r -D7f (street) (highway) located as follows:
<br />s.,.-) 1: S r' 4k
<br />The license will be in connection with Sc, �� a', �= r
<br />Drug St„re. Car. Restaurant, notal. Club
<br />which has been in operation
<br />Months Years //J, LL
<br />?'he establishment is located ()it t]EC ” ✓n t•'x ' '" floor.
<br />y
<br />The business premises are owned by C. 1, k:(. `' ,, 0 L.. ,o1
<br />The taxes on the property are not delinqu<nt.
<br />1 am //0T rn.gaged in the retail sale of intoxicating liquor.
<br />1 have IY'T had an application for license rejected as follows:
<br />1 have never been convicted of a felony nor of violating any National, or state liquor law or local
<br />ordinance relating to the manufacture, sale or transportation, or possession for sale or transportation of
<br />,intoxicating liquor.
<br />Gambling or gambling devices will not he permitted on the licensed premises.
<br />1 am the owner of the leasehold, furniture, fixtures, and equipment in the premises for which the
<br />license is applied, except
<br />I have no intention or agreement to transfer the license to another person.
<br />I submit the following names of persons, including a bank, for reference, with whom I have had business relations
<br />as follows:
<br />I /1///1 intend to engage in the sale of intoxicating liquor and will have a Federal Occupational Tax Receipt
<br />in accordance with the ordinance governing this license. My Federal Tax Stamp Receipt is No
<br />I will comply strictly with the provisions of the ordinance relating to the sale of soft drinks for "mixing" purposes
<br />and will serve patrons in full view of the public.
<br />I agree to waive my Constitutional Rights against search and seizure and will freely permit peace officers to inspect
<br />my premises and agree to the forfeiture of my license if found to have violated the provisions of the ordinance (resolution)
<br />providing for the granting of this license.
<br />I hereby solemnly swear that the foregoing statements are true and correct to the best of my knowledge and that I
<br />agree to comply with all the provisions of the ordinance under which this license is granted.
<br />tX
<br />Subscribed d sworn to before me this c`• —
<br />day F 19
<br />of,
<br />rt- C-•tt 7t-+.(--1 �v ,.: L
<br />NOTE: Licenses may he issued only to persons who are citizens of the United States and ha a of good m ral character and repute. who have
<br />years and who are proprietors of the establishments for which the licenses are suedr Laws 1949. co 700.
<br />attained the age of 21 . Is
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