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Form No. 23454 -State form 109 Election Systems and Software 1.800480046225 STATE OF MINNESOTA Combination Application for Retailer's (On -Sale) (Off-Sale) 3.2 Beer re City of Lino Lakes, Minnesota (Name of licensing authority (county) (city) County of Anoka 1, St. Joseph Parish of the city, or town of Lino Lakes county of Anoka State of Minnesota, hereby make application for a Retailer's (On -Sale) (Off-Sale) 32 Beer License to sell such 3.2 Beer under and to an ordinance (resolution) by city council, county board of, ; and pursuant passed Chapter 340, Minnesota Statutes 1945, as amended, providing for licensing and regulating the sale of 32 Beer. During the past flue years, my residence has been as follows: 1 was born at AV Vem .M1 . *—_ Crsly 1 am a (native) (naturalized) citizen of the United States. 1 am married. My (wife's) (husband's) name and address is 1 am proprietor. Firm was incorporated 1891 in the state of Minnesota Corporation is authorized to do business in Minnesota. License is for 171 Elm Street (street) (highway) located as follows: Lino Lakes, MN 55014 The license will be in connection with Fish Dinner and Dance •A Aim.. fi 3 • a_• n • ..... .. <s.. �a . ,,.. a. - which has been in operation 109 years The establishment is located on the 1st floor. The business premises are owned by The Church of St. Joseph of Rice Lake, Lino Lakes, MN The taxes on the property are not delinquent. 1 am engaged in the retail sale of intoxicating liquor. 1 have had an application for license rejected as follows: m re, sale or transportation, or possession for sale or transportation of intoxicating liquor. illu e never been convicted of a felony nor of violating any National or state liquor law or local ordinance relating to the mb ling or gambling devices will not be permitted on the licensed premises. 1 am the owner of the leasehold, furniture, fixtures, and equipment in the premises for which the license is applied, except 1 have no intention or agreement to transfer the license to another person. 1 submit the following names of persons, including a bank, for reference, with whom 1 have had business relations as follows: 1 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 1 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. 1 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 tf found to have violated the provisions of the ordinance (resolution) providing for the granting of this license. 1 hereby solemnly swear that the foregoing statements are true and correct to the best of my knowledge and that 1 agree to comply with all the provisions of the ordinance under which this license is granted. Subscribed and sworn to before me this oD 3�{ 0.' e., YNI . / , AYVV --0.n/� ., day of (UQ (1.1 , Year ) a Applicant' Signature 4 , {• LISA M. NDGSTAD NOTARY PUBLIG.M!NNESOTA szsZj v, " My Cmnassia^ Espiras Jan. 31,:8O5 Note: Licenses may be issued only to persons who are citizens of tiie mte°d'Stt 'ri 1f lit?'Ielittfd13'fif oral character and repute, who have attained the age of 21 years and who are proprietors of the establishment for which the licenses are issued. Laws 1949, c. 700.