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<br />Minnesota Department of Public Safety
<br />LIQUOR CONTROL DIVISION'S
<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 />�..�°`�
<br />APPLICATION FOR
<br />No license will be approved or released until the S20 Retailer ID Card fee is received by MN Liquor Control,
<br />Workers compensation insurance company.
<br />LICENSEE'S SALES & USE TAX ID # i-j
<br />Name (D A U ,SA- (Z Policy# 03 L t7- 60 --i :_ Os 3 2 P_
<br />(O' 0 £ q A.—
<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 />FE
<br />SFEi)f. S APi, s.
<br />Trade Name or DBA
<br />Steve J. Arhip, Jr.
<br />License Location (Street Address & Block No.)
<br />7g(c LAkE nr iur_
<br />I License Period
<br />From 7-4,9z,To 4,-30 _07
<br />Applicant's Home Phone
<br />City
<br />L, I A) tO/ -1<c.5
<br />County
<br />A N o k A-
<br />State
<br />MA),
<br />Zip Code
<br />5-014/
<br />Name of Store Manager
<br />MOR 64 2.it 4444-3-1.07e-e"
<br />Business Phone Number
<br />DOB (Individual
<br />-
<br />Applicant)
<br />If a corporation, state name, date of birth, address,
<br />names, address and date of birth of each partner.
<br />title, and shares held by each officer. If a partnership, state
<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 />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 applies; such as (first floor,
<br />Sr Lo r,-P •.1
<br />3. Is establishment located near any state university, state hospital, tra if • g school, reformatory or prison? 0 Yes .No If yes
<br />state approximate distance. )
<br />4. Name and address of building owner
<br />-totE. sT LA K f 6 6 6 S
<br />/ A ia S i m o NSU N 9 7 R% .S c AN rJ r 4 TR, V,
<br />Has owner
<br />of building any connection, directly or indirectly, with applicant? 0 Yes li(No ,
<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 Fr 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 St No If yes, give name and address of establishment.
<br />any right, title or interest in the furniture, fixtures or equipment for which
<br />it) 0
<br />or indirectly,
<br />in any other liquor establishment in the state of Minnesota?
<br />
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