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w 4i« <br />APPLICATION FOR RENEWAL OF ANNUAL INTOXICATING LIQUOR, <br />WINE, 3^ PERCENT MALT LIQUOR, AND SETUP LICENSES <br />^ CityofOrono <br />•.» <br />2750 Kelley Parkway <br />P O. Box 66 <br />Crystal Bay. MN 55323 <br />Phone: (952)249-4600 <br />irections: Thia tom must be fitted out wOh type¥^riter or by printing in ink. If the application Is by an <br />Individual parson, by such person; if by a corpaatlon, by an ofhcar thereof; if by a partnersNp, <br />by one of the partners; if by an unincorporated association, by the manager or managing <br />officer.i <br />IcenMtype: (check all that apply) <br />• '.1 <br />On Sale Intoxicating Liquor ($5,i <br />Wine ($2000.00) <br />□ Sunday Liquor ($200.00) <br />□ Off Sale Intoxicating ($150.00) <br />1.00)□ Club ($200.00) <br />□ Setup ($100.00) <br />□ 3.2% On Sale ($100.00) <br />3.2% Off Sale ($50.00) <br />Icenae year:2006 (January 1 - December 31) <br />,1 <br />I <br />Name of applicant/lioensee (name of individual, partnership, association or corporation): <br />0'S UL. L.M/n*J s u ABusiness Trade Name __________ <br />Business Address $TV>'ZPhQrie -*/70 J^- <br />' k <br />I <br />$ <br />Mailing Address (If different)f. t) J^o r <br />w*m <br />Licensee's Mnnesota Tax Identification Nurnber <br />Licensee’s Federal Tax Identification Number_ <br />ICNyl <br />l^n-zc ? <br />(Z«J <br />V/ ■ KZo <br />a. <br />.o <br />If the above named licensee is an individual, complete the following: <br />a. _____________________________________________ <br />Individual Mama (Fifft)meet)(Laat)Dateof Birlh <br />.V Homa Addrasa (Straat)(Oty)(Zip)Hooit Phone <br />A <br />K~ <br />VV <br />If the above named licensee is a partnership, association, or oorporatioh, complete the following foi^ ; <br />' each partner/officer: <br />a- .* <br />i • • . <br />t <br />a. <br />• / <br />Partnar/OMoer (Laat)(TMa)OMoiaaSi <br />A ' <br />•iV . <br />V <br />c. <br />» fi <br />Home Addraaa ^ (Straat) <br />C <br />ew^ fti^dv^ l^IrTyL.^ <br />(City) <br />I)r.-0At.C> >ffUTH>- <br />Mer^ Phone <br />Partnar/Officar Mama (l^t) <br />fcl rtfiiu.Ln <br />(Middle) (laat) <br />„'t" P»Zc.v'»’ <br />(Tina) <br />Homa Addraaa (Straat)(City)(Zip)iWDt rnon® <br />PartnMf/OfKcQT Nam# (F<rt:)(MMtf) (Last)(Tioai Data of B an <br />HemaAdoraaa (Siraai)(City)(Zip)HomaPhor*