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• <br /> Item#17-CC Agenda-01/14/08 <br /> Licenses&Permits[Page 18 me 301 <br /> 10/04 APPLICATION FOR RENEWAL OF ANNUAL INTOXICATING LIQUOR, <br /> WINE, 3.2 PERCENT MALT LIQUOR, AND SETUP LICENSES <br /> City of Orono <br /> 2750 Kelley Parkway <br /> P.O. Box 66 <br /> Crystal Bay, MN 55323 <br /> Phone: (952) 249-4600 <br /> Directions: This form must 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 association, by the manager or managing <br /> officer. <br /> License type: (check all that apply) - <br /> ❑ On Sale Intoxicating Liquor ($5,000.00) 'Club ($200.00) <br /> ❑ Wine ($2000,00) ❑ Setup ($100.00) <br /> Sunday Liquor($200.00) ❑ 3.2% On Sale ($100.00) <br /> ❑ Off Sale Intoxicating ($150.00) ❑ 3.2% Off Sale ($50.00) <br /> License year 2008 _ (January 1 —December 31) <br /> 1. Name of applicant/licensee (name of individual, partnership, association or corporation): <br /> 3pr►•hg it C i ub <br /> Business Trade Name SQri'n H 1\ I 0 <br /> Business Address 7-25- ',,'4' Ed G Orono)mAl .533,7L Phone 952•V73•/5-00 <br /> (Street) - • - (Cl{y) trip) <br /> Mailing Address (if different) <br /> (Street) (City) (7Jp) <br /> Licensee's Minnesota Tax Identification Number /L/ 325-4/ <br /> Licensee's Federal Tax Identification Number 7l/- /g 'Z / <br /> 2. If the above named licensee is an individual, complete the following: <br /> a, <br /> Individual Name (First) (Middle) (Lest) Date of Birth <br /> Home Address (Street) (City) (Zip) Home Phone <br /> if the above named licensee is a partnership, association, or corporation, complete the following for <br /> each partner/officer; <br /> a. Andres-4-1 /Y�• /�vn —j , <br /> Partner/Officer Name (First) (Middle) (Last) (Title) <br /> 5.3 '7 ISG rroyfan /ed L- z cc. ,. 33 <br /> t'W / <br /> Horn,idress (Street) y (City) /� 9 <br /> (Zip) <br /> b. c/c-,-C-)< G-• Moir-L:5csrr <br /> Partner/Officer Name /(_Fi_rst),_ �{/ y� (Middle) (Last) (Title) <br /> r7r 3 l s- CJl� / I`"7'c <br /> Home Address (Street) (City) (zip) <br /> C. R01,e_r IL <br /> Partner/Officer Name (First) (Middle) (t'ast) (Title) <br /> F,�.,di L a il-( ,Qct. I y zcs�a tri.v <br /> Home Address (Street) (City) (Zip) <br />