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Form No. 234% -State form 109 <br />Election Systems and Software 1-800-800-8225 <br />STATE OF MINNESOTA <br />Combination Application for Retailer's (On -Sale) (Off -Sale) <br />3.2 Beer <br />oe Lino Lakes <br />(Name of licensing authority (county) (city) <br />County of Anoka <br />1, St. Joseph Parish , of the city, or <br />town of Lino Lakes county of Anoka State <br />of Minnesota, hereby make application for a Retailer's (On -Sale) (Off -Sale) 32 Beer License to sell such 32 Beer under and <br />to (resolution) by city council, county board of, ; and <br />pursuant an ordinance passed <br />Chapter 340, Minnesota Statutes 1945, as amended, providing for licensing and regulating the sale of 32 Beer. <br />During the five my residence has been as follows: <br />past years, <br />171 Elm Street <br />1 was born at <br />. av av <br />,,,..., ran. S.. .. C.i.Oy <br />1 am a (native) (naturalized) citizen of the United States. <br />I am married. My (wife's) (husband's) name and address is <br />I am proprietor. <br />Firm was incorporated 1 R91 in the state of Mi nneeota <br />Corporation is authorized to do business in Minnesota. <br />License is for 171 Elm Street (street) (highway) located as follows: <br />The license will be in connection with Eventide <br />o. .�.. ...�.�W <br />which has been in operation 110_sears <br />The establishment is located on the lst floor. <br />The business premises are owned by St. Joseph Parish <br />he taxes on the property are not delinquent. <br />am not engaged in the retail sale of intoxicating liquor. <br />1 have ..-,r had an application for license rejected as follows: <br />1 have never been convicted of a felony nor of violating any National or state liquor law or local ordinance relating to the <br />manufacture, sale or transportation, or possession for sale or transportation of intoxicating liquor. <br />Gambling or gambling devices will not be permitted on the licensed premises. <br />1 am the owner of the leasehold, furniture, fixtures, and equipment in the premises for which the license is applied, <br />except <br />N/A <br />1 have no intention or agreement to transfer the license to another person. <br />1 submit the following names of persons, including a bank. for reference, with whom 1 have had business relations as follows: <br />I intend to engage in the sale of intoxicating liquor and will have a Federal Occupational Tax Receipt in <br />accordance with the ordinance governing this license. My Federal Tax Stamp Receipt is No <br />1 will comply strictly with the provisions of the ordinance relating to the sale of soft drinks for "mixing" purposes and will <br />serve patrons in full view of the public. <br />I agree to waive my Constitutional Rights against search and seizure and will freely permit peace officers to inspect my <br />premises and agree to the forfeiture of my license if found to have violated the provisions of the ordinance (resolution) providing <br />for the granting of this license. <br />1 hereby solemnly swear that the foregoing statements are true and correct to the best of my knowledge and that 1 agree <br />to comply with all the provisions of the ordinance under which this license is granted. <br />Subscribed and sworn to before me this is 'r le j7 . Q... 111. — <br />day of 3 n v CI (1 , Year aG c 1 Applicant s Signature <br />��., <br />\.7 r' })1 I CYV1/L° <br />VAMMMNAMMAMANWOVVINONOMMe <br />USA PA HOGSTAD <br />', NoTARY PLO MINNESOTA <br />mss h�:s m s 1! 2005. <br />Licenses may be issued only to persons who are citizens f t e rtked States and who are of gg,� moral character and repute, who <br />have attained the age of 21 years and who are proprietors of frifte . "" • , • =ti fs are issued. Laws 1949, c. 700. <br />