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10111 <br />Fee. - <br />Date Paid: <br />Receipt #: <br />APPLICATION FOR RENEWAL OF ANNUAL INTOXICATING LIQUOR, <br />WINE, CLUB AND 3.2 PERCENT MALT LIQUOR LICENSES <br />City of Orono <br />2750 Kelley Parkway, P.O. Box fib <br />Crystal Bay, MN 55323 <br />Phone: (952) 249-4600 <br />Directions: Thls farm must be Wed out with typewriter or by printing in Ink. if me application is by an <br />individual person, by such person; if by a corporation, by an officer thereof, If by a partnership, by <br />one of the partners; if by an unincorporated association, by the manager or managing officer. <br />License year: 2017 (January 1 — December 31) <br />License type: (check all that apply) <br />❑ On Sale intoxicating Liquor ($5,000.00) ❑ Club ($200.00) <br />❑ Wine ($2,000.00) ❑ 3.2% On -Sale ($100.00) <br />❑ Sunday Liquor ($200.00) ❑ 3.2% Off -Sale ($50,00) <br />❑ Off Sale Intmdcating ($150.00) <br />1. Complete the following information for the Licensee. <br />Licensee (Na me of Individual, Partnership, Association or Corporation —Legal Name of the Buskum Trrtity) <br />Middle Name <br />,��,y st N me <br />Orono Golf Course <br />pate of Birth <br />Phone <br />?� <br />am dress <br />Y' �t.vn �. <br />Business Trade Name <br />First Name <br />Middle Name <br />La Name <br />Orono Golf <br />Date of Birth <br />Home Address <br />Business Address (rust be physical street address, na Po hones) <br />City <br />City <br />State <br />Zip Code <br />265 Orono Orchard Road <br />Middle Name <br />Wayzata <br />MN <br />55391 <br />Mailing Address (ifdlfferant) <br />Horne Address <br />City <br />state <br />Zip code <br />PO Box 66 Crystal Bay Road <br />up Code <br />Orono <br />MN <br />55323 <br />Contact Name <br />Phone <br />E -Mail Address <br />Ron Steffanhagen <br />952-215-8160 <br />rsteffanhagen@ci.orono.mmus <br />2. If the above named licensee is an individual, complete the following: <br />First Name Middle Name <br />Homa Address <br />Phone <br />I <br />Last Name I Date of Birth <br />City State Zip Code <br />Email <br />If the above named licensee is a partnership, association, or corporation, complete the fallowing for each <br />partnerlofficar. <br />A. <br />B. <br />C. <br />First Name <br />Middle Name <br />,��,y st N me <br />Title <br />pate of Birth <br />Phone <br />?� <br />am dress <br />Y' �t.vn �. <br />State Zip Co a <br />Q.� h h .�' <br />First Name <br />Middle Name <br />La Name <br />Titre <br />Date of Birth <br />Home Address <br />City <br />State <br />Zip Code <br />Phone <br />First Name <br />Middle Name <br />last Name <br />Title <br />Date of Birth <br />Horne Address <br />City <br />State <br />up Code <br />Phone <br />Ore.: <br />Page 4 <br />