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APPLICATION FOR ON -SALE INTOXICATING LIQUOR LICENSE <br />This form was prepared by the Minnesota Bureau of Criminal Ap- <br />prehension, Department of Public Safety, pursuant to Minnesota <br />Statutes, 1976, Section 340.13, for purposes of background in- <br />vestigation. It does not supersede any laws, rules or regula- <br />tions of the Division of Liquor Control regarding the issuance <br />of liquor licenses. Failure to provide information requested <br />may result in denial of the application. <br />Trade name <br />r <br />licensinj period <br />1. Type of Application: New Renewal <br />2. u� E- .f name of applicant <br />Y, <br />da �e of application <br />Transfer <br />A' 1-7/ <br />phone <br />ne <br />3. j�2 L`�42%L F (��tJ �yjriti� � <br />ome►a—da dress — ci ty state <br />4. ?_ - iv - 5r,1��tL. <br />date of birth place of birth <br />5 <br />ress of business location <br />6. e <br />legal description <br />7. List owners of building or premise to be licensed: <br />8 . jlv 12.f-7:7e_ <br />corporate or partnership titleOU A R- -z <br />corporeu-or par <br />10. List all partners, officers or directors, if corporation: <br />name address date of birth <br />.S.7 43 Tl,-r/ <br />