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M. 0 TM D VWE_W A��liNUL Date: l Date: 2024 <br />VJ•�ILIJ !r i,G!'l� cQu�vctL Approval Hate: _ 06/24/2024 <br />2401 Mounds View Boulevard " Mounds View Mid 55112-1499 Public Hearing Date: 06/24/2024 <br />(763) 717-4000 ` Fax (763) 717-4019 Publicatlan Date: 06/10/2024 <br />infoCcOmoundsviewmn.ora `www.moundsview.mmora <br />TEMPORARY LIQUOR LICENSE APPLICATION <br />LOCATION OF EVENT: <br />Silver View Park, Mounds View <br />TYPE OF EVENT: <br />Festival <br />DATE OF EVENT: <br />08/17/2024 <br />0 Temporary On -Sale Intoxicating Liquor ❑ `temporary On -Sale 3.2% Malt Liquor <br />Organization: <br />Event Sponsor/Organization/Licensee: Festival in the Park of Mounds View Phone:763.780.0960 <br />Contact Person: Kathryn Smith Fax: <br />Address: 2401 Mounds view Blvd <br />City: mounds View <br />State: MN <br />Zip: 55112Email: <br />kathyn.k9training@gmail.com <br />Signature of Licensee: Kathryn Smith <br />Contracting Business (That Who is Sell ing/Dispens! ng Alcohol) <br />Person Responsible: Bruce Westman CountrylCity/Province/State of Birth: <br />Date of Binh: <br />Doing Business As: Maxx Bar and Grill <br />Phone:612-834-0694 <br />Business Address: 17846 Central Avenue <br />Fax: <br />City: Ham Lake <br />State. MN <br />Zip: 55304 <br />Email: <br />Are you a MN resident? <br />I INO <br />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? No ❑ Yes <br />If yes, please explain on separate piece of paper. <br />Propertyf Different Than Event Sponsor) <br />Property Owner City of Mounds View <br />Address 2401 Mounds View Blvd. <br />Phone: 763-717-4000 <br />City: Mounds View <br />State: MN <br />Zip: 55112 <br />Fax: <br />Email- info@moundsviewmn.org <br />List four business references that are familiar <br />Business Name <br />with you and your business (not required <br />Add ress/Cit /State/Zi p <br />for renewals): <br />Phone <br />Contact Name <br />1. <br />2. <br />3. <br />4. <br />Please list the following information for other liquor licenses you ..for <br />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? ❑ es 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 />