Agenda - Council - 05/25/1982 - Laserfiche WebLink

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STATE OF MINNESOTA DEPARTMENT OF PUBLIC SAFETY LIQUOR CONTROL DIVISION PS 09068-02 APPLICATION FOR RENEWAL OFF-SALE INTOXICATING LIQUOR LICENSE This application and bond shall be submitted in duplicate Whoever shall knowingly and willingly falsify the answers to the following questionnaire shall be deemed guilty of perjury and shall be punished accordingly. In answering the following questions "APPLICANTS" shall be governed as follows: For a partnership one of the partners shall execute this application for all members of the partnership. For a corporation one officer shall execute this application for all officers, directors and stockholders. PART I BUSINESS PHONE NUMBER Name of: (individual)' (partner] (officer of corporation) or APPLICANT'S HOME PHONE NUMBER ~'/'~//--~'~ '~ , for and in behalf of ~'...-~...-'~)/~ (name of individual) (names of partners) l or //~/ q /~,,¢',?,~ ~ ,~// 6;;t//,/--)/'~--~ ~Jt~. , trade name (name of corporation) make for RENEWAL of Off-Sale license located application intoxicating liquor at: (street address or lot an~block number) ~ City of ~ ~ ~/ ,Zip Code .~C.~O~ ,County of / [~ Check ( V ) box if no changes since last applying for renewal of license. If there has been a change; that' is, change in owner- iownership; addition of partner; administrator or administratrix to an estate named; change of officers, directors or stockholders in corporation; change of location; or new liquor establishment, then form PS 9136, Application for Off-Sale Intoxicating Liquor License, must be executed instead of this form (see your city clerk for form PS 9136). IWill applicant be granted On-Sale ; Sunday On-Sale (Yes or No) with the Qff-Sale Intoxicating Liquor License for this location? lYes or No) Intoxicating Uquor License in conjunction PART II FOR CORPORATION: (names of officer~, directors and stockholders) (Over)