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Lwa CentrOl DIr1YM <br />N <br />VI IS 9007-02 <br />N..a.« suuane <br />.eo c.d.. su»t <br />STATE OF MINNESOTA <br />s,....., xdnn...,a estot <br />DEPARTMENT OF PUBLIC SAFETY <br />seaal aeewtea <br />CONSUMPTION & DISPLAY OF INTOXICATING LIQUOR <br />APPLICATION FOR <br />PERMIT TO ONLY ALLOW <br />(This Application Shell Be Typewritten and Submitted Before June let of each Yeer) <br />In answering the following questions "APPLICANT" shall be governed as follows: <br />For a Partnership, one of the partners shall execute this application for all members of the partnership. <br />For a Corporalion, one officer shall execute this application for all officers, directors, and stockholders. <br />For • Club, one of the club officers shall execute this application for all the members. If additional <br />space is required. use a separate sheet of paper, indicating by number the question answered. <br />po 0 _d (FEE FOR PERMIT — $100.00) <br />1. 1, Patricia s:mdur as Presiders'. «n, <br />Iry «e or y,non m fna .ommmen) (Individual a wn, y.nn.r. ere[ «, Club oT¢.rl <br />for and in behalf of Yho la-r tir !louse Inc. — ; C.rp.,«�..,.r..�n. et.,.b) <br />IM Vve". n ...I P.n.., nam. O <br />hereby apply for a permit allowing consumption and display of intoxicating liquor to be located at <br />9539 !I1 - `a y 10 , Municipality of �?Pmsey <br />Isv«, ad.'...nN. Lot and el «a numbarl „n olca Ramsay <br />Office of dnol:a ,County of (Town.na, .nd said.. <br />State of Minnesota, in accordance with the provisions of M.S. 340.119. <br />2. Will business be operated as a private club or public place <br />3. 'atype of business Food Service C tcri2 an <br />Bquets teceytions <br />4, A PUBLIC BUSINESS: If a partnership, state name and address of each member of partnership; if <br />a corporation, state name and address of officers and directors. <br />Patricia Suuder 22301 Su-srbush Rd. N.H, ill.: River, Yn <br />INama Ivp „t a (Addrw) <br />S;nue113'luder h "1 2 Su :- rbu ^h M. N.11. 01 ,fiver, lin. <br />IN.m.I I ... Iver <br />Iwnwl ' - - -- <br />5. FOR A PRIVATE CLUB: Date club was organized is club incorporated <br />number of members , length of time in present location , is club building owned or <br />rented what is the membership dues what are the requirements for <br />membership ,Names of all <br />Does club maintain lockers to be used by members for storing intoxicating liquor <br />officers and /or directors of the club: <br />(Nan.) <br />IN <br />(Ades) <br />(Add,.) <br />IAd.rewt <br />(Aadrw) <br />Enclose with this application a copy of the Constitution and By -Laws of the club and current list of bona <br />fide members. <br />S. If applicant or any partner, corporation officer or director, club officer or director, is not a citizen of the <br />United States, list such noncitizens <br />7. State name of person who will operate or manage business: <br />Patricia Snuder 1 2101 Su-orb a a, _2 !i <br />INMrI (Add,.) <br />B. On what floor is the establishment located, or to be located <br />9. How are the premises classified under the zoning ordinance <br />Approved for Violations by: <br />Ground level floor <br />l ssb. <br />DO NOT USE <br />Check <br />Cash <br />Reed. <br />Recd. by Cashier <br />