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10. State whether any person other than applicants has any right, title or interest in the furniture, <br />fixtures, or equipment for which license is applied, and if so give name and details. <br />SntnN T. STMON (BUILDING OWNER) OWNS WALK IN COOLER, SHELVES, COUNTERS. <br />11. Have applicants any interest whatsoever, directly or indirectly, in any other liquor establishment in <br />the State of Minnesota? NO Give name and address of such establishment <br />12. Furnish name and address of one bank reference <br />NORTHEAST STATE BANK <br />77 V.E. BROADWAY STREET, NPLS, MN. 55413 <br />TEL = 612-379-8811 <br />13. Under what classification is the license applied for: EXCLUSIVE OFF -SALE LIQUOR STORE, DRUG <br />STORE, COMBINATION ON & OFF LIQUOR, OR GENERAL FOOD STORE Ex. OFF SALE LIQ. STOR <br />14, Are the premises now occupied, or to be occupied, by the applicant entirely separate and <br />exclusive from any other business establishment? YES <br />15. If a drug store, state length of time the store has been in operation N/A - <br />16. State whether applicant has, or will be granted, an On -Sale Liquor License in conjunction with this <br />Off -Sale Liquor License, and for the same premises NO <br />17. State whether applicant has, or will be granted, a Sunday On -Sale Liquor License in conjunction <br />with the regular On -Sale Liquor License NO <br />18. State whether applicant has, or will be granted an Off -Sale Non -Intoxicating Malt Beverage (3l2) <br />License in conjunction with this Off -Sale Liquor License NO <br />19. During the past license year has a summons been issued under the Liquor Civil Liability Law (Dram Shop) <br />M.S. 340A.802. Yes E No. If yes, attach a copy of the summons. <br />Subscribed and sworn to before me this I hereby certify that I have read the above <br />S question and that the answers are true of my <br />_ day of % t ^ �� 19-D own knowledge. <br />Mafary vue(y - j <br />J <br />M commission expires j 31 '�, BARB lSlgnalure Of appliwnrl <br />Y f =_NUL N0TAAVN1R11r...MINYF5nT1 <br />REPORT ON APPLICANT OR APPLICANTS BY POLICE DEPARTMENT <br />This is to certify that the applicant, and the associates, named herein have not been convicted <br />within the past five years for any violation of Laws of the State of Minnesota, or Municipal <br />Ordinances relating to Intoxicating Liquor, except as hereinafter stated <br />Approved By: <br />of C Iy. 'collage or aorougnl <br />Police Department <br />Title <br />(If you have no police department, either the <br />Marshal or the Constable shall execute this report <br />on the applicant.) <br />