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PS 09068~2 <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 /> <br />In answering the following questions "APPLICANTS" shall be governed as follows: For a partnership one of the partners shall <br />execute this application for all members of the partnership. For a corporation one officer shall execute this application for all <br />officers, directors and stockholders. <br /> <br />PART I <br /> <br />BUSINESS PHONE NUMBER <br /> <br /> Name of: (individual) (partner) (officer <br /> <br />or <br /> (names of partners) <br /> <br />APPLICANT'S HOME PHONE NUMBER <br /> <br /> (name of ind[vio~ual) <br /> <br />or <br /> <br />(name of corporation) <br /> <br />.tradename ~)'~"~ ~ Lfq~_~ <br /> <br />make application for RENEWAL of Off-Sale intoxicating liquor license located a{: ' <br /> <br /> - <br />(street address -- or -- Ior and block number) <br /> <br />commencing <br /> <br /> · Zip Code <br /> <br />, 19 , and ending <br /> <br />[] Check { ,/) box if no changes since last applying for renewal of license. If there has been a change; that is, change in owner- <br />. ownership; addition of partner; administrator or administratrix to an estate named; change of officers, directors or stockholdE <br />in corporation; change of location; or new liquor establishment, then form PS 9136, Application for Off-Sale Intoxicating Liq <br />License, must be executed instead of this form (see your city clerk for form PS 9136). <br /> <br />Will applicant be granted On-Sale ; Sunday On-Sale <br /> (Yes or No) . ' ' <br />with the Off-Sale Intoxicating Liquor License for this location? <br /> <br />(Yes or No) <br /> <br />Intoxicating Liquor License in conjunction <br /> <br />PART II . <br /> <br />FOR CORPORATION: <br /> <br />(names of officers, directors and stockholders) <br /> <br />(Over) <br /> <br /> <br />