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nelie bl STATE OF MINNESOTAf (V• <br />DEPARTMENT OF PUBLIC SAFETY <br />LIQUOR CONTROL DIVISION <br />S�.-WL,.M 5m 101 <br />(6121296.64% <br />APPLICATION FOR OFF SALE INTOXICATING LIQUOR LICENSE <br />EVERY QUESTION MUST BE ANSWERED. If a corporation, an officer shall execute this application. If a <br />Dartnershio. a Danner shall execute this application. <br />Aopocant's Name 'Individual, corporation, Pannersmpl <br />Trade Name or 08A <br />STANLEY J. MURZYN SR. <br />MURZYN LIQUOR <br />License Location 61reet Address Lot !r Blocs No I <br />License Polled <br />PRESENT 6-30-94 <br />Applicant's Home Ph ns <br />6121 482-�70 <br />2840 HIGHWAY 10 <br />From TO <br />l <br />Municipality <br />MOUNDSVIEW, <br />county <br />RAMSEY <br />State <br />MN. <br />Zip Code <br />55112 <br />Name of Store, Manager <br />Business Phone Number <br />Date of Bi h Iln ividual Applicantl <br />4-f1-�19 <br />STANLEY J• MURZYN SR. <br />If a corporation, state name, date of birth, address, title, and shares held by each officer. <br />If a partnership, state names, <br />address and date of birth of each partner. <br />Partner Officer <br />D.O.B. <br />Addmss <br />CM <br />71ImShares <br />Partner Officer <br />D.O.B. <br />Address <br />City <br />TillmShams <br />Pinner Officer <br />O.O.B. <br />Address <br />City <br />TtivShares <br />Pinner Officer <br />Doe. <br />Address <br />city <br />Tillebhans <br />1. If a corporation, date of incorporation state incorporated in amount of <br />authorized capitalization amount of paid in capital , if a subsidiary of any <br />other corporation, so state give purpose of <br />corporation if incorporated under the laws of another <br />state, is corporation authorized to do business in the State of Minnesota? . Number of <br />certificate of authority <br />2. Describe premises to which license applies; such as (first floor, second floor, basement, etc.) <br />FIRST FLOOR, BASEMENT, EAST SIoEif entire building, so state <br />3. If operating under a zoning ordinance, how is the location of the building classified?-z ? <br />4. Is establishment located near any state university, state hospital, training school, reformatory or <br />prison? NO , state approximate distance <br />5. State name and address of owner of building SIMON T. SIMON 7821 GROVELAND RD. - <br />has owner of building any connection, directly or indirectly, with applicant? NO <br />6. State whether applicant, or any of the associated in this application, have ever had an application <br />for a Liquor License rejected by any municipality or State authority; if so give date and details <br />NO <br />Has the applicant, or any of the associated in this application, during the five years immediately <br />preceding this application ever had a license under the Minnesota Liquor Control Act revoked for <br />any violation of such laws or local ordinances; if so , give date and details NO <br />S. State whether applicant, or any of the associates in this application, and employees while <br />employed by applicant during the past five years were convicted of any Liquor Law in this state, <br />or under Federal Laws, and if so, give date and details <br />9. Is applicant, or any of the associates in this application, a member of the governing body of the <br />municipality in which this license is to be issued? NO . If so in what capacity <br />FOR OFFICE USE ONLY <br />'damng Addunv ill mb➢ than Lcenunq AnthWilV) <br />Approved <br />Apomved <br />