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I <br />m <br />APPUCATION FOR RENEWAL OF ANNUAL INTOXICATING LIQUOR. <br />WINE, 3.2 PERCENT MALT LIQUOR. AND SETUP UCENSE8 <br />City of Orono <br />^ 2760 KeHey Parkway <br />ISiP C.yW^j!fN“55323 <br />Phone: (952)249-4600 <br />irectlons: This formmust be fiUed out vm typewriter or by printing in Ink. Iftheeppiicetionisbyen <br />IndMdual 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 unincorporated association, by the manager or managing <br />r^cer. <br />icaneetyiM: (check ail that apply) <br />■f; <br />On Sale Intoxicating Liquor ($5,000.00) <br />Wine ($2000.00) <br />Q Sunday Liquor ($200.00) <br />Off Sale Intoxicating ($150.00)C <br />Icenaeyear <br />□ Club ($200.00) <br />□ Setup ($100.00) <br />S 3.2% On Sale ($100.00) <br />□ 3.2% Off Sale ($50.00) <br />(January 1 - December 31) <br />L Name of applicant/licensee (name of individual, partnership, association or corporation): <br />. ■ » <br />G (circV Ru\^g.l( ___________________________ <br />t: <br />% <br />Business Trade Name ^ Ormo • <br />^ * Busir>ess Address *‘IQ^ f^r.AU Afr>t i^- Phone • iVs'v'- •I <br />Vi (llrMtl ^ <Oly) <br />Mailing Address (if different) he ':>Kc.c <br />(Zip) <br />(a»MD <br />I <br />•V <br />Licensee's Minnesota Tax Identification Number <br />Licensee's Federal Tax Identification Number_ <br />• (D»m aw <br />Hi ' HI <br />2. If the above named licensee is an individual, complete the following: <br />a.br-.-A'I*■AK i.v*' .'K- <br />i <br />Individual Ninw (First) <br />"7 1 O' rJ ^*V.ci< fv <br />(Middia) <br />(t \ C Vtty<< (D aj <br />(LMt) <br />tt-u </ <br />HonwMdTMS (StTMt)(City) >(Zip) <br />If the above nanied licensee is a partnership, association, or corporation, complete the following for <br />^ * each partner/ofTicer; <br />1 <br />V <br />•«. <br />a <br />N.- <br />•%•fa. <br />r • <br />Partntr/OffiOK FMmt (MMa)(LS«)(Tins)Oats of Birth <br />!\i:!(StTMt)(City)(Zip)HomaPhont <br />P«rtr.tr^6fAcQf Namt (First){mm (Last)(Title)Data of Biftf) <br />HomaAddrtu (StTMt)(City)(Z.p)inoma Pnona . <br />Partntr/Ofl^ctr Namt (First)(Middw)(Lssi)(Tills)Data cf 9;rtn <br />Horn* AddiMi (StTMt)(City)(Zip)•^oma Phont <br />• 1 <br />;.j <br />. -.7a <br />♦ ! <br />::•■' i <br />• \ <br />'e- •