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BUSINESS RECORDS CORPORATION, MINNESOTA STATE OF MINNESOTA Combination Application for Retailer's (On -sale) (Off -sale) Non - Intoxicating Malt Liquor License To the City of Lino Lakes Name of licensing authority (county) (city) County of Anoka St. Joseph Parish , of the eity, or 1 Lino Lakes county of Anoka , Stale town of , of . Jinnesota, hereby make application for a Retailer's (On -sale) (Off -sale) Xon- intoxicating Malt Liquor License to sell such Malt ligicor under and jntrsuant to an ordinanee (resolution) passed by city board couneil, county of and Chapter 340, Minnesota Statutes 1945, as amended, providing for licensing and regulating the Bale of non - intoxicating malt liquor. has been as follows: During the past five years, my residence I born at was M•r!` Day Year City Borough Town Stab or County I am a (native) (naturalized) citizen of the United States. I married. My (wife's) (husband's) name and address is am I am proprietor. incorporated 3.891 in the state of Mi nnPanra Firm was Corporation is authorized to•do business in Minnesota. License u for 171 Elm Street (street) (highway) located as follows: licsnse be in with August Festival The will connection , Drug Store. Cafe, Restaurant, Hotel, Club has been in operation 107 years which months Year. The is located on the 171 & 202 Elm Street floor. establishment The business owned by St. Joseph Parish premises are The taxes on the property are not delinquent. I am not engaged in the retail sale of intoxicating liquor. 1 have. 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 looal 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 is except N/A license applied, 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 follows• as I intend to engage in the sale of intoxicating liquor and will have a Federal Occupational Tax Receipt in the this license. My Federal Tax Stamp Receipt is No accordance with ordinance governing 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. Subscribed and sworn to before me this —. day 19_ / e) . IL•_...`11 - 4a.ii 4:202.sl of y- NOTE: U may be issued only to persons who are citizens of the United States and who are of good moral character and repute, who have attained the age of 21 years and who are proprietors of the establishments for which the licenses sr. issued. Laws 1949. r. 700.