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11/15/21, 4:50 PM <br />Revize Online Forms <br />This application is NOT for: Intoxicating Liquor, 3.2 Percent Malt Liquor, Brew Pubs, Peddler/Solicitor/Transient Merchant, <br />Tattoo/Piercing/Painting, Therapeutic Massage, Christmas Tree Sales, Garbage/Recycling. <br />Background Check form and color copy of current drivers license or ID required for: Cigarette/Tobacco, Lawful Gambling, Pawn Shop, and <br />Adult Establishment. <br />Have you ever had a business license revoked? If yes, please attach explantion. Explanation of license revocation if applicable <br />❑ Yes Choose File No file chosen <br />0 No <br />COMPANY INFORMATION <br />Corporation Name <br />Rydell Auto Outlet and Garage, LLC <br />Corporation Address <br />3400 Hwy 61 N <br />City State Zip Code <br />Vadnias Heights MN 55110 <br />* Email <br />val@stpautos.com <br />Valid Email Required <br />Fax <br />6514834397 <br />* Phone 1 <br />6512044762 <br />APPLICANT INFORMATION <br />* Applicant First Name MI <br />Richard R <br />Applicant Address <br />3400 Hwy 61 N <br />City <br />Vadnias Heights <br />* Email <br />val@stpautos.com <br />Valid Email Required <br />Fax <br />6514834397 <br />* Phone 1 <br />6512044762 <br />State <br />0 <br />Phone 2 <br />6124905171 <br />* Applicant Last Name <br />Herod, III <br />Zip Code <br />55110 <br />Phone 2 <br />6124905171 <br />https://moundsviewmn.rja.revize.com/reports/180204 2/3 <br />