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Mumesota Department of Pubilc 'Safety <br />ALCOHOL A.ND 1-9A-NI3LING ENT0R-('F\IF-N7, <br />J,'5 mb,-me <br />OFFICE 16 5 1, `55 ef, <br />APYLICATION FOR OFYS-Ul INTO -Xl('ATEKG LIQUOR LICE vSE <br />NO 111cense'n-ill be approl ed 01 rt'le;v.:ed until the S:O Retailer ID Card fee E iiceki ed <br />PLEASE COAMPLETE THI'� APPLICNTION ITS ENTIRETY. <br />rC:O-NMIPLETE APPLICATIONS WILL BE RETUR'NED WITH01-1- ACTION, <br />Licensee's Xr,; Sales and Use Tax ID To app4- fbT a ?4 IN'qzles and me tom,.call (6f7h <br />IA -) <br />teasee% federal Tax ID # Lt,:emsees mw, I re.- the Fed e rat T:m;knd Tr A de-74mrsan �:171E).j <br />iimr 'for informanon 1:0 1,151-3) 694-2079 or:-8rfi)43-1-9F464 <br />Applicant* <br />-ee Na <br />-me (Business . Panner-,hip. Corporation) <br />Businest Name (DBA.) <br />So -al secluitv <br />RASSEL WINE & SPIRITS INC <br />MERWIN 1,1QUORS <br />Licensee Location (Physical Address) <br />From /2024- a <br />L <br />D0B(1ufh-,-LdualApphcaW)-- <br />�2577Mounds View Blvd,, MN 55112 <br />Cotmtv <br />state. <br />Zip Code <br />Mounds View <br />RAMSEY <br />MN <br />55112 <br />____:j <br />E-mail Address <br />Business Phone, Niunber <br />Apphc-ant r Home Phone <br />eva Tr-jC-p-.zahf&6gniaiT. —co-m <br />L-7 �i432-1150 <br />L i6�2�5069 <br />;H'a stare aame,date ofbirth. S(KL-d Smtrit-Yt address, tide.and Fercent (A-medbv ench officel, <br />serer. cei7 <br />,t jrg� nn(J]Ue� JaSt.. <br />KM RASSEL ZAHID <br />Utill <br />I Me <br />PRESIDENT <br />rleycfllt <br />100% <br />1 77 =77T. t 1,7 7117-77p 1-Tre, <br />18097 66TLI 11LN- MAPLEGROVE, MN 55311 <br />icer <br />-ve y Off "First. middle� last) <br />DOB <br />SS# <br />Title <br />Percent <br />Addxe�,,t Cats :State, Zip Code <br />Officer First. mldffle. 135t) <br />DOB <br />SSA <br />p <br />.-Per, en <br />-A fv-,; -S-t- <br />'At"ZiPCore <br />atner Officer (-Firrt middle.'ast) <br />DOB <br />ss* <br />Title <br />��rc-�nT- <br />4tv <br />Addren, C� StAbe, Zn) C0,1e <br />-atior - STI-te, incorpol-ved in if <br />If a corporation- date of incoxpoi , 12/2012019 MINNESOTA <br />a subsidiary of any other corporation.,, so state <br />If incorporated under the laws ofanothef :Mate.. is corporation authofized to do bllsint�, In tht'state of \Nlimaesota-, <br />J—fves L�N,10 <br />Describe premises to which liceie applies: such as (first floor. second floor, basement- etc..) ot. if elifire building. <br />so state, FIRST FLOOR <br />ate uni-, -v� im - prison" <br />Is establishment located near any- st� :ersit state ho�>vital, training school. tek tatary of <br />7yes 7 <br />N-To- If yes, stale approximate distance. <br />4, Name and iddress of 1:111il"Wig Owner <br />Haowner of building my comiervion- directl- al- indirecl-l-l-, v"Eth <br />