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No. 2844 —State Form 109. BUSINESS RECORDS CORPORATION, MINNESOTA To the STATE OF MINNESOTA Combination Application for Retailer's (On -sale) OEM Non - Intoxicating Malt Liquor License City of Lino Lakes Name of licensing authority (county) (city) County of Anoka • .1, St.Joseph Pariah , of the city, or town. of Lino Lakes , county of Anoka , State of .Alinnesota, hereby make application for a. Retailer's (0n -sale) (Off -sale) Non - intoxicating Malt Liquor License to sell such Malt liquor under and pursuant to an ordinance (resolution) passed by city council, count!/ board of arul Chapter 340, Minnesota Statutes 1945, as amended, providing for licensing and regulating the Tale of non - intoxicating malt liquor. During the past five years, my residence has been as follows I was born at Mnrt Day Year City Borough Town State or Counts I am a (native) (naturalized) citizen of the United States. I 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. 171 Elm Street street hi peas located as follows: License is for (street) ( g y) f The license will be in connection with Fish Fry Drug Store. Cate. Restaurant. Hotel. Club which has been in operation 107 years Months Years The establishment is located on, the 171 & 202 Elm Street The business premises are owned by St.Joseph Parish The taxes on the property are not delinquent. I am I have floor not engaged in the retail sale of intoxicating liquor. 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 law 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 N ?A 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. Subsc D tAN of iiiiand sworn to before me this 11111� Liivt►wer:.r•►••en. , 19 R 0 0..A-6—A- m . Licenses may ed the age of 21 ye I States and who are of good moral character and repute, who have licenses are issued. Laws 1949, c. 700.