Agenda - Council - 04/24/1984 - Laserfiche WebLink

Home

I I I I I I I I I I I I ! I I I I I I STATE OF MINNESOTA ~'s-~a~ DEPARTMENT OF PUBLIC SAFETY LIQUOR CONTROL DIVISION APPLICATION FOR OFF SALE INTOXICATING LIQUOR LICENSE Whoever shall knowingly and wilfully falsify the answers to the following questionnaire shall be deemed guilty of perjury end shall be punished accordingly. In answering the following questions "APPLICANTS" shall be governed a~ 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 nil members of the partnership. EVERY QUESTION MUST BE ANSWERED. BUSINESS , PHONE~.I~MBER /'/'2 7 - ~t 72_ ~. ~, " t ,4., L_ ~_ . (,/ ~ r~,"i' c ,~ for and In behalf of.. ~k APPLICANT'S HOME PHONEN~U%ER '7~ '7 ' '-~=~_~/ (Indloidual owner, o~ctr, or partner] _J. ~t/CL,. , hereby apply for an Off Ssi (&trttt Addreu and/or Lot and Blah I/urnb~r) Municipality of [~/~r~- ~.e t , County of State of Minnesota, in aec ante with the provisions of Minnesota Statutes, Chapter 340, commencing ~ ' ,19-~ and ending "~ , 19 . 2. Give applicar~ts' date of b~h ~ ~ ~ (Da;) , (Month) Birthdates of P~rtnets [ (Da~) (Monlb) (Year) or (Daft) (Mon th) (Y~r) Office~s of Corporation (Day) f ~ontO ) ~ ( Ytar ) 8. The residence for each of the applicants named herein for the past five years is as follows: ,~ · /2~ ~ d~,,~: ~M/, , ~tx 4. Is the applicant a citizen of the United States? . ~e' S If naturalized state date aaa place of naturalizatio~ If a corporation, or partnership, s~te citizenship s~tus of all officers or panners. ,~// os 6',¢,~ IL~_.___The person who ' .'q',exeeutes/thls application shall give wife's or husband's full name a~do~ddress 6. What. occupations have applican~nd associates in this appli~tion followed for the past five years? 7. If a partnership, state name and address of each member of partnership