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FINANCIAL DISCLOSURE STATEMENT
<br />On-Sale Liquor License (Intoxicating)
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<br />State full names, residences, business addresses and telephone numbers of the owner or owners of
<br />the building wherein the licensed business w411 be located, if the owner is other than the applicant
<br />(if other than new construction).
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<br />Where the building is owned by other than applicant, state in summary the conditions of the lease
<br />arrangement, such as, term of lease, montkly rental, renewal privileges, etc.
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<br />III. If the building is owned by the individual applicant, partnership, corporation, or association, state:
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<br />A) Date purchased (or planned completion date for new construction).
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<br />B) If new construction, total cost of the building and method of financing such cost.
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<br />1) If financed by mortgage, name and address of mortgage holder.
<br />2) If conkact for deed, name and address of holder of such contract for deed.
<br />3) Rate of interest on mortgage or contract for deed.
<br />4) Monthly payment for liquidation of mortgage and/or contract for deed.
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<br />State the total cost of assets acquired to start this business including the business premises, ff
<br />purchased, fixtures, furrdture, equipment, merchandise for resale, cash for working capital, prepaid
<br />insurance, and any other assets.
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<br />A)
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<br />Of the above costs of assets acquired, state the amount that is provided by the person(s)
<br />investing in this business (attach proof of the source of such money).
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<br />Give full names, addresses, teIephone numbers of all persons, other than the applicant, who have
<br />any financial interest in the business, buildings, premises, fixtures, furniture, or stock in t~ade. State
<br />the nature of the interest amount thereof, and the terms for payment or other reimbursement (this
<br />shall include, but not be limited to, any leasees, Iessors, mortgagors, mortgagees, lendees, lien
<br />holders, trustees, trustors and persons who have cosigned notes or otherwise loaned, pledged or
<br />extended security for any indebtedness of the applicant).
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<br />FullName: Garv Lee Oruber Phone Number: (61.2)
<br />Address: 1327 0akview Way Anoka, MN 55303
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<br />422-4971
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<br />Nature of Interest: President/ Stockholder
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<br />FullName: Richard Allen Boushek Phone Number: (612) 421-8034
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<br />Address: 15566 Kiowa St. NW. Andover, MN 55304
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<br />Nature of Interest: Vice President/ Stockholder
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