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1612) 2966430 ~TATE OF MINNESOTA <br /> DEPARTMENT OF PUBLIC S~,FETY <br /> LIQUOR CONTROL DIVISION <br /> ST. PAUL, MN 65101 <br /> <br />APPLICATION FOR RENEWAL OFF-SALE INTOXICATING LIQUOR LICENSE <br /> <br />Whoever shall knowingly and willingly falsify the answers to the following questionnaire shall be deemed guilty of perjury arvJ <br />shall be punished accordingly. <br /> <br />In answering the following questions "APPLICANTS" shall be governed as follows: For I partnership one of the partners sholl <br />execute this application for all members of the 13ertnership. For e corporation one officer shall execute this application for all <br />officers, directors and stockholders. <br /> <br />or <br /> <br />(namel of perlners} <br /> <br />or , trade name <br /> <br />{name of corporation) <br /> <br />make application for RENEWAL of Off-Sale intoxicating liquor license located at: <br /> <br />(street address - or - Iol and block number) <br /> <br /> · z,p Code 5-5- d County <br /> <br />· 19 ~:) , and er,ding ,~(,(/L,/ E.- --~D <br /> <br />~;~Check ( V ) box if no chan~es since last applying for renewal of license. If there has been a change; that is, change in owner. <br />ownership; addition of ~3attner; administrator or edministratrix to an estate named; change of officers, directors or stockholders <br />in corporation; change of location; or new liquor establishment, then form PS 9136, Application for Off-Sale Intoxicating Liquor <br />License, must be executed instead of this form (see your city clerk for form PS 9136). <br /> <br />lYes o, No) <br /> <br />Intoxicating Liquor License in conjunction <br /> <br />Will applicant be granted On-Sale /C/O ;Sunday On-Sale <br /> (Yes or No) <br />with the Off-Sale Intoxicating Liquor License for this location? <br /> <br />PART II <br /> <br />FOR CORPORATION: <br /> <br />(n. imes of officer~, directors and itockholders) <br /> <br />(Over) <br /> <br /> <br />