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Directions: This form must be filled out with use of a typewriter or by printing in ink. If the application is by a natural person, by such pe tin; if by a partnership, by one of the partners; if by a corporation, by an officer, thereof; or if by an uuuncorporated association, by the manager or managing officer thereof. PART I - GENERAL I FORMATION GUY L. PETERSON Name of applicant: ST ANTHONY RESTAURANT GROUP, INC BusL= name: Business address: _ _14693 WACO ST ANOKA MN 5536' ----- Business phone: 763-421-4209 Type of auplicamt: Nahual Person Partnership X _ Corporation Association or Other If business is to be conducted under a designation, name or style other than full individual name of the applicant, a copy of the'Prade Name Certificate, as required by Minnesota Statutes Chapter 333 cerofiedby ttae clerk of the'District Court must be attached. State fad extici legal description of the premises to be licensed. (Applicant must also submit a plot pian ortlw uvea sbowiug dincnsions, location of buildings, street access, parking facilities, au,d the locations of the distances To the nctucst church buildingand public school lnomids.) ATTACI IED AS EXI-IIF311 B How are the premises classified under the St. Anthony Zoning Ordinance? RETAIL State full name, residence/business address and telephone nmuber of owner or owners of the buildLng wherein the licensed business will be located, if owner is other than the applicant ln<&vidualorcorporate name AMCON ST ANTHONY, LLC Home or business address 26951"OWN LAKE DR, WOODBURY, MN 55125 Phone number Contact person TAMMY MEDINA Where the building is owned by other than applicant, state in summary the conditions of the lease avrecment, such as, terms of lease, monthly rental, renewal privileges, etc. (A true copy of the !ease shall be attached) SEE ATTACHED AS EXHIBIT C If building owned by individual applicant, partnership, corporation or assoAdon, state. (Attach a true copy of the Purchase Acreement)