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APPLICATION FOR RENEWAL OF ANNUAL INTOXICATING LIQUOR, <br />WINE, CLUB AND 3.2 PERCENT MALT LIQUOR LICENSES <br />City of Orono <br />2760 Kelley Parkway, P.O. Box fib <br />Crystal Bay, MN 55323 <br />Phone: (952) 249-4600 <br />Directions: This form must be filled out with typewriter or by prh*ng in ink If the appike6on is by an <br />individual person, by such person, r7 by a corporation, by ars officer dweoi, if by a partnership, by <br />one of the partners; rf by an unincorporated assocaia w, 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 />F9 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 />Lkensee (Name of individual, Partnership, Association or Corporation —Legal Name of the Business Entity) <br />Last Name <br />Woodhill Country Chub <br />- • If — <br />nate of Birth <br />Business Trade Name <br />PIAL M L 12', <br />Woodhill Coun" Club <br />, <br />Business Address (must be physical street address, no P4 boxes) <br />City <br />State Zip Code <br />200 Woodhill Road <br />wayzata <br />MN 55391 <br />Mailing Address (if different) <br />Gty <br />state Zip Code <br />Same as above <br />T��itle,rr <br />Vie President <br />I Date of Birth <br />Cotdaet Name Phone <br />Paul (Gus) Gustafson 952-345-0784 <br />E -Mail Address <br />e-, fir u S <br />eus@woodhillec.com <br />2. If the above named licensee is an individual, complete the following: <br />Zip Code <br />First Name Middle Name Last Name <br />Home <br />Phone <br />city <br />Email <br />If the above named licensee is a partnership, association, or corporation, complete the following for each <br />partner/officer. <br />A. i First Name <br />&"VRh Br;ttn <br />Home Address <br />B. First Name <br />Cassidy <br />Middle <br />Last Name <br />Title <br />- • If — <br />nate of Birth <br />eNName <br />PIAL M L 12', <br />President <br />, <br />Q L'Y1�.L;r.l� <br />City <br />State ZIP Code <br />Phone _32Z <br />r <br />Wayzata <br />MN 55391 <br />; 952-444 <br />Middla Name <br />Last Name <br />Burro <br />T��itle,rr <br />Vie President <br />I Date of Birth <br />Page 2 <br />nomE nuurvab <br />205 Hollander Road <br />City <br />Orono <br />State <br />MN <br />Zip Code <br />55391 <br />Phone <br />952-473-1494 <br />C. <br />First Name <br />V5 <br />Middle Name <br />* <br />Last Name <br />Tide <br />Treasurer <br />l pate of Bim <br />60- <br />r <br />Home Address �./�,p <br />e-, fir u S <br />dty <br />state <br />Zip Code <br />Phon- <br />►Nayzata <br />MN <br />53391 <br />Page 2 <br />