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Dire lions: This orm must be filled out with use of a typewriter or by printing in ink. If the application is by a natural person, by such erson; if by a partnership, by one Df the partners; if by a corporation, by an officer, thereof; or if by an unin< orporated association, by the marn ger or managing officer thereof. PAR I - GENERAL INFORMATION Nam' i of applicant: �o 'R,u,2STA T, �niTKoivY /2rST/4{r 9�1" �2DKr° in�C• Bush ess name: Bus' ess address: Business phone: Type) of applicant: _ Natura Person _ Panne, ship Corpot fiott — Associ rtion 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 Trade Name Certificate, as required by Minnesota Statutes Chapter 333 certified by the clerk of the District Court must be attached. Stat the exact legal description of the I remises to be licensed. (Applicant must also submit a plot plan of the area sho To the ding dimensions, location of buildi nearest church building and pub tgs, street access, parking facilities, and the locations of the distances is school grounds.) IIo ; are the premises classified under I ac St. Anthony Zoning Ordinance? Stat lic4cd full name, residence/business add business will be located, if ow ess and telephone number of owner or owners of the building wherein the ter is than other the applicant hndi i idual or corporate name S t-lC r- Horr e or Uusnness address 142 r(Dt� RIS �T Phor e number - — Sft n—A SoT r4 E L, VS Con act person �qN Sit �-ri-Ltc (✓. ian applicant, state in summary the conditions of the lease agreement, such, as, Whe e are building is owned by other t term i of lease, monthly rental, renewal privileges, etc. (A true copy of the lease shall be attached) If building owned by individual Purc applies rase Agreement) at, partnership, corporation or association, state. (Attach a true cop of the copy 2%