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I <br />APPLICATION FOR RENEWAL OF ANNUAL INTOXICATING LIQUOR. <br />WINE, 3^ PERCENT MALT LIQUOR. AND SETUP LICENSES <br />Cityof Orono <br />2750 Kelley Partway <br />P.O.Box PS <br />Crystal Bay, MN 35323 <br />• • Phone:(952)249-4600 <br />rectioni: This form must be fitted out with typewriter or by printing in ink. If the epplication 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 Uie partners; if by an unincorporated association, by the manager or managing <br />officer. <br />cense type: (check all that apply) <br />G On Sale Intoxicating Liquor ($5,000.00) <br />□ Wine ($2000.00) <br />n Sunday Liquor ($200.00) <br />Is Off Sale Intoxicating ($150.00) <br />□ Club ($200.00) <br />□ Setup ($100.00) <br />□ 3.2% On Sale ($100.00) <br />□ 3ui% Off Sale ($50.00) <br />icense year:2006 (January 1 - December 31) <br />Name of applicant/licensee (name of individual, partnership, association or corporation): <br />V <br />Business Trade Name 3.V_\ (L'Cf V3 <br />Business Address^^^V Phone 0 G <br />CairMlI ic«y) {2>fi ' . <br />'1* <br />Mailing Address (if different) VW Vw, <br />(SlTMt) (CRy) <br />Licensee's Minnesota Tax Identification Number <br />u*p» <br />1 I <br />Licensee's Federal Tax Identification Number <br />If the above named licensee is an individual, complete the following: <br />a._______________________________________________________ <br />I f Individual Nam#(Firal)(Middle)(Last)OateofBinh <br />HomQ Addrtts (Stmt)(City)(Z'P)Home Phone <br />% <br />Vr <br />if the above named licensee is a partnership, association, or corporation, complete the following for <br />each partner/officer: <br />C «0\-\ <br />Partntr/OffioarNamt (Flfft)(Middia)(iMt)(T'N) <br />ir b. <br />t <br />I-: • • <br />C. <br />Home Addrcaa (Street)(City)(Zip)Home Phone <br />Pertner/OfVioef Heme (Fu»t)(Middle)(Lati)(T.iie)Date of Birth <br />Hom§AMf99u (Sl'aat)(City)(Zip)Home Phone <br />Fartner/Ofhcer Name (Firati (M«die)'.Last)(TiUe)Date 0/ dim <br />inomt Addrets (Stmt)(City)(Zic;Mcrre Pnaie