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PS 090684)2 <br /> <br /> STATE OF MINNESOTA <br /> DEPARTMENT OF PUBLIC SAFETY <br /> LIQUOR CONTROL DIVISION <br /> <br /> APPLICATION FOR RENEWAL OFF-SALE INTOXICATING LIQUOR LICENSE <br /> <br /> This application and bond shall be submitted in duplicate <br /> <br />Whoever shall knowingly and willingly falsify the answers to the following questionnaire shall be deemed guilty of perjury and <br />shall be punished accordingly. <br />in answering the following questions "APPLICANTS" shall be governed as follows: For a partnership one' of the partners shall <br />execute this appllcation for all members of the partnership. For a corporation one officer shall execute this application for all <br />officers, directors and stockholders. <br /> <br />P. ART' . / - ?/ <br />BUSINESS PHONE NUMBER <br /> <br /> Name ofi {individual) (partner) {officer of corporation) <br /> <br />APPLICANT'S HOME PHONE NUMBER <br /> <br />, for and in behalf of '~', <br /> {name of individual) <br /> <br />{names of partner~) <br />or /"'),tC /'~,dtl~,-/'''r'' /(..) _.~ / ~'~ ~,/,d .,~.~ '-~'_,4/ ~. , trade name <br />{name of corporation) <br /> <br />make application for RENEWAL of Off-Sale intoxicating liquor license located at: <br />(street address -- or -- lot and block num~oer) <br /> <br />, Zip Code ~.~Z._-~c').~. <br />, 19 ,~'/ · and ending <br /> <br /> commencing ~?/~/ ~.~ <br /> ~Check ( V ) box if no changes since last applying for renewal of license. If there has been a change; that is, change in owner- <br />Onership; addition of partner; administrator or administratrix to an estate named; change of officers, directors or stockholders <br />corporation; change of location; or new liquor establishment, then form PS 9136, Application for Off-Bale Intoxicating Liquor <br />License, must be executed instead of this form (see your city clerk for form PS 9136). <br /> Will applicant be granted On-Sale ' Sunday On-Sale Intoxicating Liquor License in conjunction <br /> {Yes or No) (Yes or No) · ' ' ' <br /> with the Off-Sale Intoxicating Liquor License for this location7 . <br /> <br />PART II .. ..... <br /> <br />FOR CORPORATION: ............. - <br /> - IW . <br />names of officers, directors and stockholders) <br /> <br />[Oved <br /> <br /> <br />