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MIS­ <br />APPLICATION FOR RENEWAL OF ANNUAL INTOXICATING LIQUOR, <br />WINE, 3^ PERCENT MALT LIQUOR, AND SETUP UCEN8ES <br />City of Orono <br />. 2760 Kelley Perkway <br />P.O.Box 66 <br />Crystal Bay. MN 55323 <br />Phone: (952)249^00 <br />e • <br />irections: This fbm mutt be filled 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 unincorporated associabon, by the manager or managing <br />li . officer. <br />iceneetype: (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 />IB^.2% On Sale ($100.00) <br />□ 3.: <br />Icenseyear.2006 <br />3.2% Off Sale ($50.00) <br />(January 1 - December 31) <br />I. Name of applicant/lioensee (name of individual, partnership, association or corporation); <br />• <br />I, <br />Business Trade Name G)rcvio <br />Business Addrass r>X)ciii ^)fouo •^^^Phone—-s—H jaS(iMO iwy) <br />% <br />•t <br />Mailing Address (if different) ^ <br />Licensee's Minnesota Tax Iderttlficatlon Number____________ <br />Licensee’s Federal Tax Identification Number_____________ <br />■a', <br />*. » <br />i. <br />If the 3bove named licensee is an Individual, complete the following: <br />a <br />individual Name (MMdto)(Ladi) <br />If the above named licensee is a partnership, association, or corporation, complete the following for <br />each partner/officer <br />Am <br />. i a. <br />■ a <br /><c. <br />' V <br />f.. <br />Partnar/OffioarMma (MMdIt)(Ljai)rim Dale oT Birtti <br />, ^^ a <br />Home Addrau (Strati)(City)(Zip)Home Phone <br />’ • ■ ’ • <br />P»rtn#ffOfftctr Namt (Firet)(MidM)(Last)(T'llt)Data of BiTh <br />A: <br />* • * ’ • • <br />HomeAddraaa (Strati)(City)(Zipl home Pnore . <br />• a <br />Paftr>aK>Scaf Namt Ifvii)(MfdM)(Last)(Tma)Data of Birtn • • . • • <br />• <br />• e <br />nomaAddiasa (itraaii (Ci:y)(Zci Hcme Pnone i