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Directions: ink, if the application is by a natural person, by This form must be filled out with use of a typewriter or by printing PP such person; if by a partnership, by one of the partners; if by a corporation, by an officer, thereof; or if by an unincorporated association, by the manager or managing officer thereof. PART i - GENERAL Mi ®RA"HON GUY L. PETERSEN Name of applicant:" --"—"— ST ANTHONY RESTAURANT GROUP, INC Busuiess name: Business addiess: 14693 WACO ST RAMSEY--- Business phone: 763-421-4209 — Type of applicant: _ Natural Person Partnership X� Corporation _ Association or Other If business is to be conducted under a designation, name or style other than hill individual name of the applicant, a copy of the Trade Name Certificate, as required by Mimiesota Statutes Chapter 333 certified by the clerk of thio District Court must be attached. Stare vlic exact legal description of the premises to be licensed. (Applicant must also submit a plot plan of the area showing dimensions, location of buildings, sheet access, parking facilities, and the locations of the distances To the nearest church building and public school grounds.) ATTACHED AS EXHIBIT B How are the premises classified under the St. Anthony Zoning Ordinance? RETAIL State full name, residence/business address and telephone niunber of owner or owners of the building wherein the licensed business will be. located, if owner is other than the applicant Individual or corporate name AMCON ST ANTHONY, LLC Home or business address 2695 TOWN LAKE DR, WOODBURY, MN 55125 Phone number Contact person TAMMY MEDINA — Where the building is owned by otber thanapplicant, state in summary the conditions of the lease agreement, such as, terms of lease, monthly rental, renewal privileges, etc. (A true copy of the lease shall be attached) SEE ATTACHED AS EXHIBIT C If building owned by individual applicant, partnership, corporation or assoc&on, state. (Attach a trice copy of the Purchase Agreement)