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i[Gil <br />Fee: <br />Date Paid.• <br />Receipt #. <br />APPLICATION FOR RENEWAL OF ANNUAL INTOKICATING 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, NIN 55323 <br />Phone: (952) 249-4600 <br />Directions: This form must be fiW out with typewirifer or by printing in ink. If the application is by an <br />individual person, by such person; if by a corporation, by an officer t5hemof; if by a partnership, by <br />one of the partnerW if by an unincorpodrafed assoclation, by the manager or managing ofter, <br />License year 2017 (January 'I — 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 Intoxicating ($150.00) <br />1. Complete the following information for the Licensee. <br />Licensee (Name of Individual, Partnership, Assodadon or Corporation— legal Name of the Business Entity] <br />Middle Name <br />Michael <br />Last Name <br />O'Sullivan <br />Voyageur Service Centers, Inc. <br />Date of Birth <br />" <br />Home Address <br />8047 Ranchvtew Lane <br />Business Trade Marne <br />city <br />Maple Grove <br />state <br />MN <br />Zip Code <br />55311 <br />O'Sullivans Holiday #546 <br />First Name <br />Middle Name <br />last Name <br />Business Address (must be physical street address, no PO bones) <br />City <br />State <br />Zip Code <br />1420 Shadywood Road <br />state <br />Navarre <br />MN <br />53392 <br />Mailing Address (if different) <br />Last Name <br />qty <br />state <br />Zip Code <br />PO Box 65 <br />Navarre <br />MN <br />55352 <br />Contact Name <br />Phone <br />E -Mail Address <br />John O'Sullivan <br />612-366-0163 <br />johnosdnternet.net <br />2. If the above named licensee is an individual, complete the following: <br />First Name Last V <br />Home Address City <br />Phone Email <br />If the above named licensee is a partnership, association, or corporation, complete the following for each <br />parinerloffloer. <br />F_114 <br />S. <br />C. <br />First Name <br />John <br />Middle Name <br />Michael <br />Last Name <br />O'Sullivan <br />Tdle <br />Owner <br />Date of Birth <br />" <br />Home Address <br />8047 Ranchvtew Lane <br />city <br />Maple Grove <br />state <br />MN <br />Zip Code <br />55311 <br />Phone <br />612-366-0163 <br />First Name <br />Middle Name <br />last Name <br />Title <br />Hate of Birth <br />Home Address <br />Clly <br />state <br />Zip Corse <br />Phone <br />I <br />s <br />First Name <br />Middle Name <br />Last Name <br />Title <br />Date of Birth <br />Home Address <br />I qty <br />state <br />Zip Code <br />Phone <br />Page 4 <br />