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MINNESOTA DEPARTMENT OF PUBliC SAFETY <br /> PHONE 612-296.6159 LIQUOR CONTROL DIVISION <br /> 333SlBLEY · ST. PAUL, MN 55101 <br /> APPLICATION FOR CONSUMPTION AND DISPLAY (SET-UP) PERMIT <br /> PERMIT FEE $151.50 <br /> IF NAME AND ADDRESS SHOWN ARE <br /> 5229 NOT CORRECT. MAKE CHANGES IN <br /> SPACES BELOW. ,. <br /> On The Green Rest. Inc. <br /> 16659 St. Francis Blvd NW <br /> Ramsey, MN 55303 <br /> NOTE: ALL 'ON-SALE' INTOXICATING LIQUOR LICENSEE'S ARE EXEMPT FROM APPLYING. <br /> <br />City State Zip Code <br />PERMIT Type /./of~ Dance Hall, etc.) <br /> <br /> Name o! Business or Club Manager Address of Manager <br /> Name of Bullding/.~v,'ner Address of Owner U <br /> ARE THE CLUB OR BUSINESS PREMISES SEPARATE FROM ANY HAS OR WILL A NON-INTOXICATING MALT LIQUOR LICENSE BEEN ISSUED <br /> OTHER BUSINESS ESTABLISHMENT? []Yes ~No TO THIS BUSINESS FOR THIS LOCATION? ~Yes <br /> gNo <br /> <br /> 15 APPLICATION JIF TRANSFER, FORMER LICENSEES NAME AND BUSINESS TRADE NAME <br /> ORIGINAL ~ RENEWAL ~' TRANSFER [] <br /> FOR A PUBLIC BUSINESS: <br /> II a Partnership, State the Name and Address of Each Parlner; If a Corporation, State the Name and Address of Each Officer_ <br /> <br /> Business Par nar/Officer AOdres$ <br /> Business Partner/Officer Address <br /> FOR A PRIVATE CLUB <br /> I J <br /> Length o1' Time Club j I~ Club Building Does Clue Maintain Lockers <br /> At Present Location: I Owned or Rented? For Members TO Store Liquor? []Yes ~INo <br /> Club Officer/Director Name Address <br /> Club Officer/Director Name Address <br /> Club Officer/OireClOr Name Address <br /> <br /> Has applicant; if partnership, any partner; if corporation, any officer or director; if club, any club officer or director, ever <br /> had a license under the Minnesota Liquor Control Act revoked or suspended or been convicted for any violation of State <br /> Laws or local ordinances; if so, give date and details~/~.~.~ <br /> I hereby certify that the answers are true of my own knowledge and understand that the giving of raise information or the failure to give pertinent information <br /> constitule$ cause for revocation of this permit. ANY PERMIT ISSUED HEREUNDER DOES NOT ALLOW THE SALE OF INTOXICATING LIQUOR, <br /> NO CONSIDERATION WILL BE GIVEN TO THIS APPLICATION <br /> UNLESS APPBOVED AS PROVIOED BELOW: <br /> <br />IF THE BUSINESS IS LOCATED IN A COUNTY: Signature--¢'-~,uthorized~-/J~pplicant Date <br /> IF A CLUB AYTACH A COPY OF THE CONSTITUTION AND <br /> BYLAWS OF THE CLUB AND A 'CURRENT LIST OF <br /> MEMBERS. <br />I IF THE BUSINESS IS LOCATED IN A MUNICIPAL1TV <br />i CASH <br /> <br />CHECk, <br /> <br /> <br />