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W <br />City of 5t. Anthony <br />3301 Silver Lake Road <br />St. Anthony, MN 55432 <br />(612)789-8881 <br />Fce: <br />intoxicating 11HIPL&Wine <br />Sunday <br />Tenn <br />Investi afivo Pee <br />finvcstinative I�ee <br />APPLICATION FOR ON -SALE <br />INTOXICA'T'ING LIQUOR & WINE LICENSE <br />S8 000 <br />$ 200 <br />One ear <br />i. 500 m-statenon-refundable) <br />$2 5 0 out-of-state to maximum of $1_010 <br />Receipt #_-- <br />License <br />MN Tax ID # <br />DKl'A P12IVACY NOTICti: The tata yon supply on this form will be used to assess your qualifications for the license. You no not legally ragnh'ed to <br />provide this data, bat we will not be able to grwit the license without it. If a license is granted, the data you have supplied will constitute a public record <br />nut copies may be issted Co anyone recpiutiug Them "I1ie requiecd data al lows its to distinguish you from other applicants; to identify you in our licomm <br />files; to verify that you are Ole person who applied for the license; to contact you if any addifional information is required; to doiciam ne whellrer you <br />meet any rninimmn age requirements; mud to dcmriakic if any conviction you may have on record might affect your suitability as a licenscholder. Your <br />residence address and telephone number will be considered public data unless you request this information to be private and provide an al1>anative <br />address and telephone number (sec below). <br />Manse slap below to indicate that you have read this motlmn <br />L./ <br />I rexluest thatr sidcuw nitrous mid kelepLouc nunibor be wuside'edprivetc data. My nitenative address and telephomo nmrbee areas follows: <br />Address --- <br />1, GUYPETERSE(-_.—.—.. <br />(Fust,middlemudlast uanre ofperson making apphrntion) (Individual owner, officer or i ium.) <br />Sl. ANTIMONY RESTAURANT GROUP, INC. <br />for and in behalf of <br />(individual/PwmershiplCorpotahon) <br />hereby submit dais application for an On -Sale Intoxicating Liquor & Wine License for: <br />located at ST. ANTHONY PKWY/HWY 88/KENZIE TERRACE.. <br />for the sale of intoxicating liquor in accordance with the provisions of Minnesota Statutes, Chapter 340 and the St. <br />Anthony City Code, Cha ter 1000. <br />conunel � -- and ending <br />_ For:— <br />(Signa of Person Nia}aug Application (!Name of individual, Pailumbip, Corporation or Association) <br />Sone of Minnesota } <br />Count)ofHeunepin- } �7� <br />Sam—'r1bed, a tbR1ftC43 _ m f _ fu/ <br />ERIC B. BREVER <br />NOTARY PUBLIC MINNEWA 13yo <br />i HENNEPIN COUNTY <br />Tn support of said application and iu accordance with the requirements asset forth in said Chapters, there is <br />attached hereto, in duplicate, all applicable parts and personal information forms, liability insurance policy, <br />workers compensation policy, bond, license and Investigative fees. <br />