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V04 APPUCATION FOR RENEWAL OF ANNUAL INTOXICATING LIQUOR. <br />WINE, 3^ PERCENT MALT UQUOR, AND SETUP LICENSES <br />CityofOrono <br />^ w 2750 Kelley Parkway <br />Crystal £iy?MN^55323 <br />Phone: (952)249^00 <br />Irections: This tom must be Med out with typewriter or by printing in ink. If the appiication is by an <br />Individual person, by such person; if by a corporation, by an ofRcer thereof; if by a partnership, <br />by one of the partners; if by an unincorporated association, by the manager or managing <br />officer. <br />Icensetype: (check all that apply) <br />On Sale Intoxicating Liquor ($5,000.00) <br />Wine ($2000.00) <br />Sunday Liquor ($200.00) <br />Off Sale Intoxicating ($150.00) <br />□ Club ($200 00) <br />Setup ($100.00) <br />3.2% On Sale ($100.00) <br />3.2% Off Sale ($50.00) <br />Jcense year 2m (January 1 - December 31) <br />1: I •Name of applicant/licensee (name of indMdual. partnership, association or corporation): <br />Business Trade Name K^dJXhecAS. „ <br />i;:-. <br />i • <br />OAtfV, <br />Aiainiiss Address ^U<5V«.^W\e . f^x SS'MLPhone^‘^«*n I <br />(SnSi ^V»r) <br />Mailing Address (If different) <br />C8MU (City) <br />Licensee’s Minnesota Tax Identification Number <br />(Zipl <br />Licensee’s Federal Tax identification Number 4# Ml -I^^ZooH <br />2.If the above named licensee is an individual, complete the following; <br />A.______ua-/vtP.________A rv\cLL»si* <br />IndivKlual Nant* <br />• V <br />*. 0- <br />T* *. <br />HotTMAddrau <br />2.0 <br />Horn# Pt(one <br />If the above named licensee is a partnership, association, or corporation, complete the following for <br />each partner/officer; <br />Pwtn«f/Oflcar Namt <br />"bxs>*w». AiwllAC-t- pAJBXiA^ <br />Homt Addftu <br />*-1 b. <br />»t <br />\ <br />Ptrtntr/Offtcr Nam# <br />Homs AdMu <br />iffS WBW) (Mtdft*) . (Lilt) (Ti««) <br />(Sviti) ' (Ciiy) j (Z5i <br />•V.PartnsrOSktf Nam*(Prtt)(Middi*;(Last)(Ti##)Oal* ol 3«v. <br />horn* AdorM*(SVMO IC.ty)iZiOj Horn# Pnood <br />. !. . I