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APPLICATION FOR RENEWAL OF ANNUAL INTOXICATINO LIQUOR, <br />WINF 3.2 PERCENT MALT UQUOR, AND SETUP UCENSES <br />City of Orono <br />’ ,/v . . ^ 2750 Kelley Parkway <br />•4 p: ‘ Crystal Bay, MN 55323 <br />Phone; (952)249-4600 <br />irwctlons; This form must be niM out with typewriter or by printing In ink. If the application is by an <br />individual person, by such person; if by a corporation, by an officer thereof; if by a partnership, <br />by one of the partners; If by an unincorpc~^ted association, by the manager or managing <br />officer. <br />ieeilse type; (check all that apply) <br />□ On Sale Intoxicating Liquor ($5,000.00) <br />n Wine ($2000.00) <br />Sunday Liquor ($200.00) <br />Q Off Sale Intoxicating ($150.00) <br />0NCIub ($200.00) <br />□ Setup ($100.00) <br />1 3.2% On Sale ($100.00) <br />□ 3,2% Off Sale ($50.00) <br />2 (January 1 - December 31)Icense year. _____ <br />M. Name of appllcant/lioensee (name of individual, partnership, association or corporation); <br />1 ‘ <br />Business Trade Name _ 11 CjCX C* .U <br />nw*i <br />Mailing Address (if different) <br />IStW) <CHy) <br />Licensee’s Minnesota Tax Identification Number <br />f2ip) <br />4 <br />Licensee’s Federal Tax identification Number I - CXo 19 C) <br />If the above named licensee is an individual, complete the following; <br />» ? <br />I *.a. ^'V\rL <br />t;mt <br />\f Horn# AMtusIdrm (SMt) ' <br />41 hrpfh-?- <br />(Zip)Home Phone <br />U« <br />, <br />y <br />1 <br />.4 <br />If the above named licensee is a partnership, association, or corporation, complete the following foi <br />each partner/officer; <br />.» I Pha(JUJj <br />&• <br />r'. <br />¥b. T /ywreesu\.^i(Sueet) <br />Lp). 0r(ju.V\L\ <br />_. (Middle)- (LmI) -J <br />'A'i. (frrsc--m<r <br />r.(Cl <br />V ^'vNiri:(cf <br />S!' <br />ti <br />(Siraei) <br />cfr :'S Li V i^ri'xlAic 7nCi=^vI <br />(MKidle) (Lett)(Ti«e)^ <br />J V <br />(O,, <br />J <br />(Zip) <br />\ <br />f^fwr^fllc^ Name (Fif»t) ^ <br />^ ‘*T’, 1 r"““iivibj.r 11-*^ <br />) (Sireei)home Add/eit <br />^ . ^(Middle) (l«t) <br />kO ______'■ A /i' <br />(Title) <br />(City!.,(Zip) <br />*a • <br />Howi« PnofM