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2401 Mounds View Boulevard * Mounds View MN 55112-1499 <br />(763) 717-4000 * Fax (763) 717-4019 <br />info(c�moundsviewmn.orq * www.moundsview,mn,org <br />Application Date: Le '.r 5 - ���/Z^ ++Q I q <br />COUNCIL Approval Date: l <br />Public Hearing Date: �7; D� Q .0 I <br />Publication Date: <br />TEMPORARY LIQUOR LICENSE APPLICATION <br />LOCATION <br />-t ! <br />OF EVENT: <br />vu r 1/ Pa rk_-. <br />TYPE OF EVENT: <br />Ie 1 tA4litta <br />DATE OF EVENT: /(j./7 <br />t C44?-5'MI"A/'lf <br />❑ Temporary On -Sale Intoxicating Liquor ❑ Temporary On -Sale 3.2% Malt Liquor <br />Non -Profit Organization: <br />Event Sponsor/Organization/Licensee I T" , 0, f / j/4� L <br />re i jt' <br />P R 78 7e <br />Contact Person: e y� A r <br />Fax: <br />Address 5 /7,!! i/ (zo swco •- / <br />City �]Di 11 <br />' <br />St e l <br />�Ipp r <br />Z.J.5il A <br />Emajl: t� <br />�� <br />CO, t/ - Z i° • tie <br />Sign►►a'tfiure of Licensee' <br />/ <br />e L , 1 I / .. �.� f/ . .. <br />Contracting Business (That Who is Selling/Dispensing Alcohol) <br />Person Responsible:.- Cou try/City/Province/State of Birth: <br />� �.5 ( L fe,... vr . ,I 1'.,,,, / /h Ei✓ <br />Date Birth: <br />;� - zj - / cl ? S'Doing <br />As:e.ilyse <br />Phone/, {e <br />Business Address: 6'lX-C'�' PO • f /w v- (' <br />/L <br />Fax: - <br />City: A '�-L ili: `�ll. <br />State: /2?C'o <br />Zlp 'J-// 2 <br />��,,' <br />Emai. .. Sfi h�/./r r co I <br />Are you a MN resident? ❑ No )1 Yes if not, where do you reside: From: to: <br />Have you ever been convicted of violating federal, state or local liquor laws or regulations? ,Si No ❑ Yes <br />If yes, please explain on separate piece of paper. <br />Property Owner of Premises Used (If Different Than Event Sponsor) <br />Property Owner ...q C, <br />Address <br />Phone: <br />City: <br />I State: <br />Zip: <br />Fax: <br />Email: <br />List four business references that are familiar with you and your business (not required <br />for renewals): <br />Contact Name <br />Business Name <br />Address/City/State/Zip <br />Phone <br />. , .,) c Goa �9c y <br />2. 1,,.- .).;.,-,e.o., j <br />3. <br />Please list the following information for other liquor licenses you hold or have held <br />(not required for renewals): <br />Date(s) of License: <br />1. <br />2. <br />What is the maximum occupancy for the premises? <br />Have you ever had a license revoked? `1 No ❑ Yes If yes, please explain: <br />I and my associates in this application will strictly comply with all the laws of the State of Minnesota <br />governing taxation and the sale of alcohol; rules and regulations promulgated by the Alcohol and <br />Gambling Enforcement Division the Department of Public Safety; and all ordinances of the <br />