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Emall <br /> momns <br /> Vto <br /> FBusilness <br /> se Application Date: 0 '�� �Q se COUNCIL Approval Date: <br /> 2401 Mounds View Boulevard•Mounds View MN 55112-1499 PPLICATION <br /> (763)717.4000"Fax(763)717.4019 AL APPLICATION <br /> info moandsyiewmn,4r •www.�naundsview.mn.orgFER <br /> LIQUOR LICENSE APPLICATION <br /> Business Name: �•'"i'+�/�iJ 1 �1 00 <br /> License Address: <br /> � •� ,� Phone Number7��• _.�,IS�. <br /> Email: State: Zip: 5 //,Z Fax Number: 77� <br /> �t'< tam <br /> aBA (Doing Business): <br /> ❑ Individual ❑ Corporation <br /> SA ILQ -j_ 1,IC©r2 ❑ Partnership LLC <br /> ownerslCor orate Officersli'artnersl[3irectars name and title <br /> ti R 2atG E ,2 <br /> 2. <br /> 3. <br /> 4. <br /> pp Icant/Licensee F I Nam, j <br /> Country/City/ProvincelState of Birth: <br /> Applicant/Licensee Address, <br /> City: F State: <br /> �'- G �7 O <br /> Y 'i r I�-( ti) Zlp' S / L' Fax; <br /> Email• �l !'l•f��Jll-�.5 i d C � i <br /> Are you a MN resident? ❑ No Yes If not, where do you reside: From: <br /> to: <br /> Have you ever been convicted of violating federal, state or local liquor laws or regulations? fi No Yes <br /> If yes, please explain on separate piece of paper. <br /> Property owner <br /> LEmail: <br /> s • ' f ' 2 '' t / <br /> OR2 [1G' ! �Gs Phone: <br /> Zip: Fax: <br /> 2�A 4AE-5-1 A-1 i ,A I i, <br /> ■ <br /> ❑ On Sale(sq.ft. of;7,jr-,,re,j <br /> /restaurant area) On Sale <br /> Off Sale Off Sale ❑ On Sale <br /> On Sale Wine Temp. 3.2 Beer Special E <br /> ❑ Sunday Sales vent (tepraafn) <br /> ❑ Bottle Club ❑ Temp. On Sale 3.2 Beer/ El Off Sale El On Sale <br /> Malt Liquor ❑ Sunday Growler ❑ Off Sale <br /> Temp. Intoxicating Special Event Festival in the Park(Temp.) Sales <br /> ❑ Temp. Intoxicating Liquor Banquet <br /> a L-1V1MLGQ1j11TI9 MA <br /> Business Name ■ ti <br /> AddresslC <br /> A�r C Is it /State/Zi Phone Contact Name <br /> 1. µ^-r 1 t-? <br /> 2. ate. -v _ <br /> r <br /> 4. s f Spa <br /> r <br /> ■ ■ • / • ■ i ! ■ • / PKI <br /> WERE P.M. ^/ • <br /> I, C Date(s)of License: <br /> 2. <br />