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Minnesota Depanment of Public Safety <br />LIQUOR CONTROL DIVISION <br />190 5th St. E.. St. Paul. MN 55101 <br />(612)296-64.^0 TDD (612) 297.2100 <br />QFF SALE INTOXICATING LIQUOR LICENSE APPLirATIQN OR THE <br />RENEWAL OF AN OFF-SALE lNTOXICATIN(-; LiniJOR I irPNSF <br />APPLICATION TYPE ^ NEW OR TRANSFER - COMPLETE SECTIONS 1, 2, AND 4 <br />CHECK ONE C RENEWAL - COMPLETE SECTION 1. 3 AND 4 <br />.. • « <br />rod^informatioo ** *'*•*’'“ B“yer* Card reoewablc each year. New Liceoceet call 612-296.6430 or 612.296*6434 for applicatic <br />I.ICP.NSKE’S SALES AND USE TAX ID NUMBER--------------------------------------To apply for sales tas number call 296-6181 or 1-800-657.3777 <br />If a corporation, an officer shall execute this application. If a partnership, a partner shall execute this application. <br />S <br />E <br />C <br />T <br />I <br />0 <br />N <br />1 <br />Licensee Name (Individual, Co <br />1 larya \a <br />poration, Partnership) <br />Wear <br />Trade Name or DBA <br />IZKt Liaacj^ <br />l icense Location fSircCjt Address.A Block No.) <br />Wc9v*|zaJiX ^Cvd <br />City <br />me UU)2, <br />Name of Stor^-Manager5. <br />License Period <br />From <br />County <br />Business Phone Number <br />6^2-4-^3-704-•7 <br />State <br />M/'i <br />Applicani'a Home Pnonc <br />6/£-475-403C <br />Zip Code <br />5535 6. <br />Date of Birth (individual applicant <br />TaUi 51, >924- <br />names, <br />Partner Officer (first middle fast)DOB Title Shares Address City <br />Partner Officer (first middle last)DOB Title Shares Address City <br />Parmer Officer (first middle Iasi)DOB Title Shares Address City <br />Partner Officer (first middle last)DOB Title Shares Address City <br />S <br />E <br />I I <br />i 0( <br />N <br />amount paid in capital <br />state incorporated in_____________amount of authorized capitalization <br />,, if a subsidiary of any other corporation, so state • <br />-■ ■ incorporated under the laws of another state, is corporation <br />Number of certificate of authority. <br />give purpose of corporation. <br />authorized to do business in the state of Minnesota?. <br />Describe •* (f'rsi floor, second floor, bssemeni. etc.) or if entire building, so stale <br />lospital. training school, reformatory or prison? N<CP . state app.o»i.7.:tc <br />W. W£q.r 36 Vlill, LflKg. K 5535 <br />:llv- with Annlir«nf*> /VI^ ^ <br />d*iiVa*nce'*^'”'"*/^A**** ***** university, state hospital, training school, reformatory or prison? A/<f7 . state app.o»i.7.:tc <br />State name and address of owner of building W)l|l3M___________________________ <br />Has owner of building any connection, directly or indirectly, with applicant? SDAde. <br />Is applicant, or anv of the associates in this application, a member of the governing body of the municipality in which this license is to <br />be issued? Mq_____________|| ,o. in what capacity? ___________________________________________________ <br />Slate whether any person other than applicants has right, title or imeresi in the furniture, fixtures, or equipment for which license <br />IS applied, and if to give name and details_______________________ <br />Have applicants any interest whatsoever, directly or in/5i^cily. in any other liquor establishment in the state of Minnesota*’ <br />Give name and address of such establishment.____________________________________________________ *------------------ <br />\ t#*