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g~corporat]on, date of incorporation 2/1]/71 <br />nount of authorized capit~ization "' <br /> IsSdiary of any other corporation, so st~ie <br /> <br />, state in which i~corporated Hinn"e'Jota <br />amount of paid la capltal <br /> <br />[velwpose of corporation~ Retail O.r_ocery SiLoIe <br /> dd <br />amc an a tess of all officers, directors and stockholder~ and the number of elan.res held by each <br /> <br /> iBrooks ltauserr 12001 Bass Lake R~_~j_ Pl.y~..outhm MN 90~.' ' <br /> {No~e) (Add~rta -- numbe~ ond street or lot and bfo~k) (ChILl <br /> <br /> th P. Carlson, 7299 I4. 142nd Street, Appl'e Valley, biN : ' ' -10~-': <br /> <br />·(Nam*) (A ddrrss) <br /> <br /> incorporated under the laws of another state, is corporation authori2ed to do business in this State? <br /> <br /> Iq'umber of certificate of authority. <br /> <br /> (his appl[mtion is for a new Corporation include a certified copy of A_rticIes of Incorporation and <br /> <br /> l I/ this application is for a BENEWAL of license state whether any changes have been made in the <br /> <br />rticla of Incorporation and By-Laws since the last issue of License " ' <br /> <br /> Ftcribe premises to which license applies; such.as (first floor, second floor, basements etc.) Floor -..2,000 square feet plus outside; or, it' entire building, so state .... <br /> cooler <br />l)erating under a zoning ordinance, bow is the location of the building classified?. <br /> <br />I. ]l[lestabllshment located near academy, state college, university? No <br />ate~a~proximate distance from such establishment <br />· itc name and address of owner of building _ Vilgo ; <br /> <br />s~owner of building any; connection, directly or indirectly, with applicant? bio. <br />yo~o not own building, state type rental agreement urt eton 1 ~qo ' ; submit copy of such <br />reenrentm (need only be submitted with original application for liquor license -- not necessa~ for yearly· ' <br />~ewal of license. Lease pendtng- to be signed at time of purchase., <br /> l <br />ie whether applicant, or of his s. ssoc~atem in this application, have ever had an application for a <br />~uor License rejected by any municipality or State authority; ff so, give date and details No <br />Is the applicant, or any of his associates in this application, during the five ;years h-nmediately preced- <br /> <br /> this application ever had a license under the l~Iinnesota Liquor Control Ac% revoked for any violation of <br />h les or local ordinances; if so, give date and der.ails <br /> No <br /> <br />il;whether applicant, or any of his associates in this application, during the past five years were ever <br /> of any Liquor Law violations or any crime in this state, or any other state, or under Federal Laws, <br /> <br /> No <br />if so, give date and details <br /> <br />~..~ ,~ppli~ant. ,,~ any of hi- ~,~r,~,~.~v m thi~ ,~:~plicatinn, ~ n,omher nf th,. ItnverniniI b,,dy of th,:. mnnlci. <br /> ., <br />I..... ' ....... '" .......... -.'--.'i <br /> <br />1 <br /> <br /> <br />