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i!; <br />P,/VRI' 1I9 —I'E S®NAT.lNi'r(3IgiV(ATIOi <br />City of St. Anthony Liquor & Wine License Application <br />This section should be completed by each individual, partner, officer, manager, proprietor or other <br />agent in charge, and each person �vho by combined. ownership or control has an interest in a <br />corporation or association ll excess of flue percent (5%) <br />True Name IMatthew Steven Ells _ _ <br />9/]2/65 Place ofBirh P <br />l0ateofBllth� _ Ind Lana olzs, ]N <br />Current HomeAddress 100 S. Marion Pkwy. <br />0209 <br />Cit State,s �neusua -} ° earned Steve — --j <br />Other Names UsedlAlias'usually ]y go by ru ml -d t e name, _ <br />Marital Status X Sn n lv i <br />Spousc's True Name <br />—.. _.._ <br />Due0fBxth -- PlaccofT3i to <br />- _....._ <br />Ronne Address <br />-- -- — _ <br />City, State Zip _ <br />Arc you. oryour spousea.registerodvoter? 1Applicaut-xYcc No 'Spouse Yes No <br />Looatio n ncnvcr Location <br />Rcsid.ence Address for Preceding 101 ears: <br />Please see attached. <br />�C11Y, Std�(.'... -.. — <br />Name, Address and 1 none Number of Individuat's Employers and Partners for Preccd r1 10 Years. <br />Please see attached. <br />Names, Addresses and Phone Number ofS 1) onso's Employers arid. Partners for Preceding 0 ears: <br />Has applicant or spouse, or a parent or sibling or child ever been convicted of any, crime or — <br />violation of any ordinance other than traffic? If so, please furnish information as to the time, place <br />and offense for which convictions were had: <br />N/A <br />Name, home address and business address of each person who is engaged in Minnesota in the <br />business of selling, manufacturing or distributing liquor and who is nearer to kin to the applicant or <br />spouse than second cousin, whether of the whole or half blood, computed by the rules of civil law, <br />or who is a brother-in-law or sister-in-law of the applicant or the_n)licant's spouse. <br />N/A <br />Military Service (Upon request, you may be asked to provide discharge papers) Yes z . 1 To <br />