Agenda - Council - 10/23/1984 - Laserfiche WebLink

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I I I I I I I I I I I I I I I I 1 I STATE OF MINNESOTA DEPARTMENT OF PUBLIC SAFETY LIQUOR CONTROL DIVISION APPLICATION FOR OFF SALE INTOXICATENG LIQUOR LICENSE ~'' 1'!r'. ' · I I ', r .... ' 1'dl-" Whoever shall knowingly and wilfully falsify the answer~ to the following questionnaire shall be deemed guilty of perjury and sh~ll be punished accordingly. In answering the folZowing questions "APPLICANTS" shall be governed as follows: For a Corpora- lion one officer shall execute this application for all officers, directors and stockholders. For a partnership one of the "APPLICANTS" shall execute this application for all members of the partnership. EVERY QUESTION MUST BE ANSWERED.. BUSINESS APPLICANT'S HOME PHONE NUMBER 7,.~-,,~ - "7-- ~- <Tg ~ PHONE NUMBER ~/zZ-J 1 75-- (lndiogdual own,r, officer, or parmtr) for and in behaff of ; :~)~::~ },~'((,-~f~ ;:- t ._.- /.L ; hereby apply for an Off Sale Intoxicating Liquor License to be located at -ff-~-~? -'/~? ~ /id, (Street Address anol/or Lot ~ncl Block Numbtr) State of Minnesota, in accordance with the provisions of Minnesota Statutes, Chapter 840, commencing 19__, and ending. , 19__. Give appllcaqts' date of birth /~ /~ .~ 7 (Da[t) (Month) (Year) ,q / (Dav ) (Month) (Year) Birthdates of Partners Or' Officers of Corporation (l/all) (Mo. nth) (Year) (Year) (Day) (Month) 3. The residence for each of the applicants named herein for the past five years is as follows: 4. Is the applicant a citizen of the United States?. ~-~-~ . If naturalized state date and place of naturalization__ If a corporation, or partnership, state citizenship status of all officers or partners. 5. The person who executes this appll~tion shall ~ve wife's or husband's full name and address 6. Wha% occupations have applicant and associates fn this application followed for the past five years?. 7. If a partnership, state name and address of each member of partnership