Laserfiche WebLink
PS.9007.04 MINNESOTA DEPARTMENT OF PUBLIC SAFETY <br /> LIQUOR CONTROL DIVISION <br /> 333SIBLEY · ST. PAUL, MN 55101 <br /> <br /> APPLICATION FOR PERMIT TO ALLOW ONLY CONSUMPTION AND DISPLAY OF INTOXICATING LIQUOR <br /> <br />PHONE 612-296-6159 PERMIT FEE $151.50 <br /> <br />Applicant Name (BusineSs, Partnership, Corporation) <br />Street Address <br /> <br />City <br /> <br /> ~/o/4,4 <br /> <br />PERMIT TYPE <br /> [~] Private Club <br /> <br />E~uPublic Business <br /> <br />Name of Business or Club Manager <br /> <br />County <br /> <br />DBA or Trade Name <br /> <br />Business Address <br /> <br />State | Zip Code <br /> ~/'~f/~' I <br /> <br />Type of Business (Restaurant, Dance Hall, etc.) <br /> <br />Address of Manager <br /> <br />/o o ,d <br /> <br />Name of Building Owner Address of Owner <br /> <br />ARE THE UB OR BUSINESS PREMISES SERRATE FROM ANY [HAS OR WILL A NON-INTOXICATING MALT LIQUOR LICENSE BEEN ISSUED <br />OTHER BUSINESS ESTABLISHMENT? ~S ~No [TO THIS BUSINESS FOR THIS LOCATION? ~Yes <br /> I <br /> FOR A PUBLIC BUSINESS: <br /> <br /> If a Corporation, State the Name and Address of Each Officer. <br /> <br />If a Partnership, State the Name and Address of Each Partner <br /> <br />Business Partner/Officer <br /> /. <br /> <br />Business Partner/Officer <br /> <br />Address <br /> ~1~3o I Sd6.4/~8~sM Rb <br /> <br />Address <br /> <br />Business Partner/Officer Address <br /> FOR A PRIVATE CLUB <br /> <br />Date Club Organized <br /> <br />Length of Time CJub <br />At Present Location: <br /> <br />Club Officer/Director Name <br /> <br />Club Officer/Director Name <br /> <br />Club Officer/Director Name <br /> <br />Number of Members [Amount of Dues <br /> lis Club Building <br /> Owned or Rented? <br /> <br />IMembershi p Requirements <br /> <br />Address <br /> <br />Address <br /> <br />Does Club Maintain Lockers <br />For Members To Store Liquor? [~Yes E~No <br /> <br /> 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.,%r suspended or been convicted for any violation of State <br />Laws or local ordinances; if so, give date and details . IV (? <br /> <br />I hereby certify that the answers are true of my own knowledge and understand that the giving of false information or the failure to give pertinent information <br />constitutes cause for revocation of this permit. ANY PERMIT ISSUED HEREUNDER DOES NOT ALLOW THE SALE OF INTOXICATING LIQUOR. <br /> <br />NO CONSIDERATION WILL BE GIVEN TO THIS APPLICATION <br />UNLESS APPROVED AS PROVIDED BELOW: <br /> <br />IF THE BUSINESS IS LOCATED IN A COUNTY: <br /> <br />Approved -- Chairperson County Board or Representative Date <br />IF THE BUSINESS IS LOCATED iN A MUNICIPALITY <br /> <br />Approved - Council President or Representative <br /> <br />Date <br /> <br />~ignature- ut orized Applicaf¢[ / Date <br /> <br />IF A CLUB ATTACH A COPY OF THE CONSTITUTION AND <br />BYLAWS OF THE CLUB AND A CURRENT LIST OF <br />MEMBERS. <br /> <br /> CASH <br /> <br />CHECK <br /> <br /> <br />