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"�j OtND r VOW <br />T Application Date: ate: 2021 <br />1►'j, _3 ►11_.C_,_1(11 COUNCIL Approval Date: 07/12/2021 <br />2401 Mounds View Boulevard " Mounds View MN 55112-1499 Public Hearing Date: 07/12/2021 <br />(763) 717-4000 • Fax (763) 717-4019 Publication Date: 06/22/2021 <br />infoomoundsviewmn.org ' www.moundsview.rnn,org <br />I TEMPORARY LIQUOR LICENSE APPLICATION I <br />LOCATION OF EVENT: <br />TYPE OF EVENT: <br />DATE OF EVENT: <br />❑ Temporary On -Sale Intoxicating Liquor ❑ Temporary On -Sale 3.2% Malt Liquor <br />Non -Prof it • . <br />Event Sponsor/Organization/Licensee: ,� P Q%(P <br />Contact Person: <br />Fax: <br />Address: <br />City , <br />Sta <br />Zip: <br />Em� f <br />Signature of Licensee: <br />Selling/Dispensing'.Contracting Business (That Who is <br />Person Responsibl ' nt ICltylProvince) Late of B'rth: Date f Birth- <br />Person <br />Business As: <br />Business Address: <br />Fax: <br />City: <br />State; N. <br />Email: <br />Are you a MN resident? o No _ es If not, where do you reside: From: to: <br />Have you ever been convicted of violating federal, state or local liquor laws or regulations? o ii Yes <br />If yes, please explain on separate piece of paper. <br />PropertyOwner of Premises Used (if Different Than Event Sponsor) <br />Property Owner City of Mounds View <br />Address 2401 Mounds View Boulevard <br />Phone: <br />City: Mounds View State: MN <br />Zip: 55112 <br />Fax: <br />Email: <br />List four business references that are familiar <br />Business Name <br />with you and your required <br />Address/City/State/ZipAddress/City/State/Zip <br />Contact Name <br />Phone <br />1. <br />2. <br />3. <br />_ <br />4. <br />• • I• • • • • ■ • •ilm• • • <br />• • i - . • <br />Date(s) of License: <br />2. <br />What is the maximum occupancy for the premises? <br />Have you ever had a license revoked? ><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 />