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<br /> ..? STATE OF ~IINNESOT ; I L~
<br /> " ': Combination Application for Retailer's (On-Sale) ('Off-sale)
<br /> ::' :" Non-lntoxicath~g ?,lalt Liquor License
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<br /> '-- ~~~' - r ~ .'. ~ ', ,
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<br /> o[ 3[inne~o~, herebp '~ke appt~t~ for a Reta~l~F* (On-sa~} (~ff-*a~) ~4ntoxl~t~nff
<br /> L~r L~o ~ tet[ ~tt~h ~[att libor un~r a~ pursuant ~ an ordi~.(re~[ut~n) ~ts~ bg
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<br /> and Chapter 3~0, 3Iinne~ota. ,$ta~ut~ lP~, ~ amended, prouidin~ for l~e~in5 a~ re~ttn~
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<br /> I am a (~) (naturali~d) elt~.n ofthe UniI~
<br /> ! am ..................... married. J[~ (wife's) [husba~'t) ~me and addr~s ~ .............................................................
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<br /> I am (proprietor) (manager) ..................................................................................................................................................................
<br /> ~lrm wat ln~r~rate~ ........................................................................................... l~ ~tatz of ...........................................................
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<br />'· ~ "' ' r~' t~' ' ~,z~' · ~ ,,' ~o~t~' ~,~' ............. ':~.....~.:~~ --'" · · ~ ....... .~.:_.~,.~...:....:.:..~..:.:...; ' '
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<br /> ':' ': ............... ........... ::..::.:.._.: .....................................
<br /> ....: .. The ~ o~ th~ pro~e~ are ~o~ ~gin~., . :~ . ."~ , .
<br /> , '~ ~' ' " ',"' ' ' .-," ~ ~,.';~.l. ~ ¥.
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<br /> ordlnane~ rela~in~ ~ the ~nufacture, ~ale ~ tran~a~, or ~se~n for ~a~ or tr~at~
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<br /> Gambl~n~ or gamblin~ dev~e~ wi[~ ~ b~ ~t~d on t~ l~ premM~.
<br /> I nm the owner of the ~eho~d, f~ture, ~t~r~, hn~ ~u~p~nt ~ tl~ ~em~ f~ wh~h
<br /> ~,=, ~ ~,,z~,' ~,,~..~...,.....~....~...-~....~~ ....................................................................................
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<br /> I have no In~ntion or agreement ~ t~nsfer the license to another person. ..~r
<br /> I submi) tbs fo]lo~ng ~mes of person, [nclud[pg · bank, for r~erence, with whom I have had buslness relstlo~
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<br /> I do not poseess and ~11 not purchise a $25.00 Federal Re~ll Liquor Dealers Sp~ial S~mp. '
<br /> ~ I ....................... :..., In~nd ~ engage ~ the eale ~[:ln~xlcaglng liquor and ~ll have a Federal Occupational Tax ~elpt
<br />"' ~n accordance ~th the ordinance gaveling thle license. ~{y Federal T~x S~mp ~eeipt ~ No ........................................ : ........
<br /> - I will comply strictly with the provlsione o~ the oM~ance r~latlng ~ the eale'of soft d~n~'for "m~ln~ pu~ose~
<br /> and will ~e~e patrons in full ~ew of the publtc.~ * ~ ' ': ...... ; "¢' '." '~.'v' '. ~ .....
<br />' ' I *~ee ~ waive my Constitutional Kight~ ~galn~t see<h ~nd seizure ~nd ~ll fr~ly ~mlt peace offiee~ ~
<br /> my premises and agree ~ the /od~lture of mr i~e~e ff/ound. ~ h~ve HoMt~ the pro~lon, of ~e ordinance
<br /> tton) providing for the granting of this llcen~e. " ' ........ ~ ~ -" ,:' '
<br /> I hereby .nl~mnly ~we~r that th~ foregoing ~tements ~re ~ eom~{ ~ t~)~tof my knowledge ~nd that
<br /> ~gree to comply with all the provisions of th~ ordinance under wh~hl= Ilcense)s k~nted~ '
<br /> ' .Z~' ' ~ ~'/~'~~~/' ' ~
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<br /> ...~ , ~,....-~ ~..v~..:-~ ......... , ....' ---.. At o~[y I~ BAC~ ,
<br /> ~~....~.mm.~l.....m/. ........................... '::' ':h' "O".,~',"'..~',,,,r~O,, t
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