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STATE OF MINNESOTA
<br /> DEPARTMENT OF PUBLIC SAFETY
<br /> LIQUOR CONTROL DIVISION
<br /> ST. PAUL, MN 55101
<br /> {612. J 296-6430
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<br /> APPLICATION FOR OFF SALE INTOXICATING LIQUOR LICENSE
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<br />EVERY QUESTION MUST BE ANSWERED. If a corporation, an officer shall execute this application. If a
<br />partnership, a partner shati execute this application.
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<br /> · If a corporation, state name, date of birth, address, title, and shares held by each officer.
<br /> · If a partnership, state names, address and date of birth of each partner.
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<br />Panner Off,cst I D.O.B. ~ Aoore~ ~C~I1
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<br />1. If a corporation, date of incorporation ~./,:,2'~../¢,.(/ , state incorporated in ./~/-/. amount of
<br /> authorized capitalization/¢f///C/ao¢v,'v¢ , amount of paid in capital ldo~ 0¢42.--; if a subsidiary of any
<br /> other corporation, so state ~ give purpose of
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<br /> corporation ,~,g'~'~/&. ~',,¢¢£~' O~' ~//~'¢~ if incorporated under the taws of another
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<br /> state, is corporation authorized to do business in the State of Minnesota? -- Number of
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<br /> certificate of authority
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<br />2. Describe premises to which license applies; such as (first floor, second floor, basement, etc.)
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<br /> .~5'-¢:>'~ ~ F~C~Z" ,-'-~/~_c~- ,~'z<c~e or if entire building, so state
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<br />3. If operating under a zoning ordinance, how is the location of the building classified?,'¢~/
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<br />4. Is establishment located near any state university, state hospital, training school, reformatory or
<br /> prisoa?"":?O/~-' , state approximate distance
<br /> /~¢>~4~-;~'~¢"~ ~. ~.....~ ... ...':
<br />5. S~ate' name 'and address of ~'~ner-of building ~,~,¢,¢'/! Z-¢,,,,¢ _¢,,-...¢,,~. ~-'~.~p~,_~f .,.~w..~.~?~ ;
<br /> has owner of building any connection, directly or indire~ctly, ~ith'~)~iida~t? ~"~ S'~o/~ ,
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<br />6. State whether applicant, or any of the associated in this apphcat~on, have ever ~ad an application
<br /> for a Liquor License rejected by any municipality or State authority; if so give date and detaiis
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<br />7. Has the applicant, or any of the associated in this application, during the five years immediately
<br /> preceding this application ever had a license under the Minnesota Liquor Control Act revoked for
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<br /> any violation of such taws or local ordinances; if so, give date and details
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<br />State whether applicant, or any of the associates in this application, and employees while
<br />emptoyed by applicant during the past five years were convicted of any Lic~uor Law in this state,
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<br />or under Federal Laws, and if so, give date and details ,/JO
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<br />9. Is applicant, or any of the associates in this application, a member of the governing body of the
<br /> municipality in which this license is to be issued? ,A/'¢ . If so in what capacity ~
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<br />FOR OFFICE USE ONLY
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