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Minnesota Department of Public Safety
<br />LIQUOR CONTROL DIVISION 4i---„°,�.,
<br />190 5th St. E., Suite 105, St. Paul, MN 55101
<br />(612)296-6430 TTY(612)282-6555...;,;
<br />OFF SALE INTOXICATING LIQUOR LICENSE
<br />7`kt
<br />r .- 1
<br />�
<br />.,...”
<br />APPLICATION FOR
<br />No license will be approved or released until:the 520 Retailer ID Card fee is received by MN Liquor Control
<br />Workers compensation insurance company.
<br />LICENSEE'S SALES & USE TAX ID # /y5(0
<br />Name CLU A U ,ciA (L Policy# 03 %b -6C)-- iZo.3 a _
<br />G j L/
<br />To apply for sales tax #, call 296-06181 or 1-800-657-3777
<br />a partner shall execute this application.
<br />If a corporation, an officer shall execute this application If a partnership,
<br />Licensee Name (Individual, Corporation, Partnership)
<br />£i) F.
<br />S TF. 0- Q le, 1-1 i
<br />Trade Name or DBA
<br />Steve J. Arhip, Jr
<br />License Location (Street Address ac Block No.)
<br />Z4.90 LAK E 0r ;of_
<br />I License Period
<br />From 7 � y6 To 6-30--77
<br />Applicant's Home Phone
<br />_ - =
<br />City
<br />L.; n)e i AI<.S
<br />County
<br />A /V cy kA
<br />State
<br />nix
<br />Zip Code
<br />5--o)4/
<br />Name of Store Manager
<br />P RC4et /)l' -cj doY�
<br />Business Phone Number
<br />DOB (Individual
<br />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)
<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 />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 />, state
<br />incorporated
<br />incorporated
<br />No
<br />second
<br />. - -
<br />so state
<br />in , amount paid in
<br />of any other corporation,
<br />. If
<br />and give purpose of
<br />is corporation
<br />building, so state.
<br />_
<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? 0 Yes 0
<br />2. Describe premises to which license 'plies; such as (first floor,
<br />ST Lo 0, . . _i
<br />3. Is establishment located near any state university, state hospital, . . ii , g school, reformatory or prison? 0 Yes .R No If yes
<br />state approximate distance. )
<br />4. Name and address ofbuilding owner
<br />-Pot'ST LA k P cS S Q a S
<br />Pella Si'mD. So ) 97S% 5GA/OrirA TR. O,
<br />Has comer
<br />of building any connection, directly or indirectly, with applicant? 0 Yes li(No -�j
<br />a member of the governing body of the municipality in which this license
<br />5. Is applicant or any of the associates in this application,
<br />is to be issued? 0 Yes .13'No 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 />0 Yes No If yes, give name and address of establishment.
<br />any right, title or interest in the furniture, fixtures or equipment for which
<br />/V 0
<br />or indirectly,
<br />m any other liquor establishment in the state of Minnesota?
<br />
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