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RECEIVED <br />APPLICATION FOR RENEWAL OF ANNUAL INTOXICATING LIQUOR, <br />WINE, CLUS AND 3.2 PERCENT MALT LIQUOR LICENSES• , r 0"A <br />City of Orono C{TY OF 0"ANO <br />2750 Kelley Parkway, P.O. Box 66 <br />Crystal Bay, MN 55323 ch I <br />Phone: (952) 249-4600 <br />Directions: This form must be fled 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 partnersl*, by <br />one of the partners, if by an unincorporated association, by the manager or managing ~. <br />License yeas: _-- 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 />R1 Sunday Liquor ($200.00) ❑ 32% Off -Sale ($50.00) <br />❑ Off Sale Intoxicating ($150.00) <br />1. Complete the following information for the Licensee. <br />licensee (Name of IndMdual, Partnership. Association or Corporation — Legal Name of the Business Entity) <br />Middle Name <br />Wayzata Country Club <br />)Itis <br />te <br />Daof Birth <br />Business: rade Name <br />James <br />Kernan <br />Wayzata Country Club <br />Rome Address=RIIYO <br />Busnress Address (must be physical street address, no PC boxes) <br />City <br />State Iip Code <br />ZOO Wayzata Blvd West <br />Wayzata <br />MN 55391 <br />Mailing Address (if differentl <br />First Name <br />City <br />State Zip Code <br />Same as above <br />para cifgttth <br />George <br />Contact Name <br />Phone <br />E—Mail Address <br />Chris Gerardt - General Manager <br />952-475-9753 <br />elgerardi@wayzatacc.com <br />2. If the above named licensee is an individual, complete the following: <br />First Name Addle Name Last Name Date of Birth <br />Home Address City State ZIPCode <br />Phone Email <br />If the above named licensee is a partnership, association, or corporation, oomplete the following for each <br />partner/officer: <br />U <br />B. <br />C. <br />First Name <br />Middle Name <br />Last Name <br />)Itis <br />te <br />Daof Birth <br />Edward <br />James <br />Kernan <br />President <br />Rome Address=RIIYO <br />State Zip Code <br />Phone <br />18718 E. Amarado Cirde <br />Verde <br />AZ 85263 <br />952.473.0026 <br />First Name <br />Middle Name <br />last Name <br />para cifgttth <br />George <br />Sutton <br />7V1cePresident <br />Phone <br />Home Address City state Zip Corte <br />509 Ferndale Rd.N <br />Wayzata <br />MN 55391 <br />' 952.473-1665 <br />First blame <br />Middle Name <br />Last Name <br />Title <br />Date of girth <br />Thomas <br />Cullum <br />Treasurer <br />< <br />Home Address <br />City <br />State Zip Code <br />Phone <br />785 N Ferndale Rd <br />W ata <br />MN 55391 <br />952.475-9470 <br />Page 2 <br />