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APPLICATION FOR RENEWAL OF ANNUAL INTOXICATING LIQUOR. <br />WINE, CWB AND 32 PERCENT MALT LIQUOR LJCEMBES <br />Cky af Orono <br />2760 Kelley Parkway, P.O. Box BB <br />Crystal Bay, MN 55323 <br />Phare: (952) 249.,= <br />DlmWom Thls form must be Mod out wM hpPswNer or by pry In ink. if the appicaftn is by sn <br />ftxffiftW pwwn, by mich person; 9 by a c wporaNln by an ditw >therll , y by a paftwd$, by <br />oft of ft pwtwW ff by an assodbtlbn, by the marmVer or m~g otl9�ceer. <br />Lleaeaaa year: 2011. - (January I -- Deoember 31) <br />Llcans* tW (check all that apply) <br />❑ On Sale IntmIcating liquor ($5,000.00) [Club ($200.00) <br />E:1 Wine ($2,000.00) Q 3.2% Ort -Sale ($1 OO.W) <br />Balte Y Liquor (8200.00) ❑ 3.2% Off- tle (;50.00) <br />❑ Off sale inWoe in l ($160.00) <br />1. Cornpleb the fbllovring Ink mabon for the Uconsee. <br />LiaMM (Name of MdMdnel, PertemesMM AaostelMn a` CdWM&n — Fad Nitre of the eta Enttty) <br />Holme Addteu <br />SpriMS Hili Golf Cub <br />Phone <br />Owkw s TM& Nana <br />Date of Myth <br />Sprtn3 Hilt Gaff Club <br />0 <br />Suatnesa Addnae t must be phvd d attest eddm% no Po bo j <br />my <br />state Zip Cade <br />725 County Road 6 <br />Oroero <br />MN 55291 <br />Metes Ad*= Of dtltimnt) <br />Sty <br />Saar 7Jp We <br />Sam! a: aba►ve <br />1 Home Addrete <br />Canted 1ttP I- <br />mum <br />EMaH AWMW <br />leifmay S. Mingen <br />952-473-lM <br />1trEfeam" ft c m <br />2. If the al lm named licensee is an Individual, cofnplete the falkmMng: <br />rim tWM Last Name t of ttMh <br />Holme Addteu <br />c*1 Setae ZIP laude <br />Phone <br />6ttaD <br />If the above named 11censee is a pedrorship, esaaocktIcn, or corpomdon, complain the fbllmft for each <br />paw. <br />A <br />e. <br />C <br />Plrst Nartte <br />�ttddM <br />tam Lantra <br />TRM <br />Date of Myth <br />Glen <br />0 <br />Mason <br />Presment <br />:p <br />r <br />1 Home Addrete <br />CUy <br />SCete <br />Z* Code <br />Ptmne <br />13956 Crown Hill Lame <br />Minnetonka <br />MN <br />55305 <br />rem -%84M <br />RMMM <br />Middle t+gme <br />tact panne <br />TUM <br />000 of Rkth <br />Brae! <br />PhArnsnn <br />5ecratari <br />Hans Addrem <br />CRV <br />State <br />lip Code <br />Phone <br />105 Ferndele Greer <br />Waynts <br />Mfg <br />SM <br />GIUMa gp <br />. rM Nemo <br />MMdM Name <br />Lest Rame <br />Ta <br />oft of RIM <br />DWW <br />cMsb ► <br />Treasurer <br />Some AM= <br />3 <br />Hamel <br />dry <br />SM <br />HP Cad <br />Phoma <br />7A�li Road <br />Harvel <br />MM <br />55340 <br />763.8784037 <br />Pape 2 <br />