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• /D. 00 BUSINESS RECORDS CORPORATION. MINNESOTA STATE OF MINNESOTA Combination Application for Retailer's (On -sale) () Non-Intoxicating Malt Liquor License e;"/' Of b LoI.�ICzo To the �• Name of licensing authority (county/ kit") County o oLo-- , of the city, or I t:5- county of Cil WUCi: State town of of .Alinnesota, here make application for a Retailer's (On -sale) (she) Non- intoxicating Malt Liquor License to sell smelt 3 all liquor under any pursuant to an ordinance (resolution) passed by city counril, (ward of arul Chapter 840, Minnesota Sta t 1945, as amended, providing for licensing and regulating the tale of non - intoxicating malt liquor. has been follows • During the past five years, my residence as MN _i born D io I D �� nt °('l -� mm2f I was Mor•F Day Year City Borough Town State or County I am a (native) (neeke u1tseti) citizen of the United States. married. My (toith s ) (husband's name and is I anb T J. Lc�hd -c 5x3-3(8 St . "t(.j MA) 6- I am proprietor / t %9 in the state of, Firm was incorporated Corporation is authorize(( todo business in Minnesota. License is for l I�r�l (fit) (highway) located as follows: 1 be in IC11-'7' AAP The lic(tnse will connection with Drug Store, Cafe, Roseau nt, Hotel, Club has been in operation /7 which Vmttha Ypre , is located an. A -II - I = floor The establishment -the I `f f W 01. I-GCLJ by 01 � c The business premises are owned -c2 The taxes on the property are not delinquent. I am /(JhY engaged in the retail sale of intoxicating liquor. I have had an application for license rejected as follows: 1 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. Oambling 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 license applied, except 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. 1 /V/� intend to engage in the sale of intoxicating liquor and will have a Federal Occupational Tax Receipt this license. My Federal Tax Stamp Receipt is No in accordance with the 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 is license is granted. Subscribed and sworn to before me this 19_ day of , NOTE: Licensee may be issued only to persons who are citizens of the United States and who are of good moral character and repute, who have nttnined the age of 21 years and who are proprietors of the establishments for which the licenses are issued. Laws 1949. c. 700.