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<br />PHONE 612-296.6159 <br /> <br />MINNESOTA DEPARTMENT OF PUBLIC SAFETY <br />LIOUOR CONTROL DIVISION <br />333 SIBLEY . ST. PAUL, MN 55101 <br /> <br />APPLICATION FOR CONSUMPTION AND DISPLAY (SET.UP) PERMIT <br /> <br />PERMIT FEE $150.00 <br /> <br />5229 <br /> <br />PUBLIC <br /> <br />IF NAME AND ADDRESS SHOWN ARE <br />NOT CORRECT. MAKE CHANGES IN <br />SPACES BELOW. <br /> <br />On The Green Rest. Inc. <br />16659 St. Francis Blvd NW <br />Ramsey, MN 55303 <br /> <br />NOTE: ALL CLUB 'ON-SALE' INTOXICATING LIQUOR LICENSEE'S ARE EXEMPT FROM APPLYING. <br /> <br /> <br />BUline.~ pnone <br />161:>. 7.57-5-3/3 <br /> <br />Zip Code <br /> <br />r.J"Jo.3 <br /> <br />A ROM AN <br />ONO <br /> <br />N I SU 0 <br /> <br />IS APPL.ICATION <br />ORIGINAL C RENEWAL)2! <br /> <br />IF TRANSFER. FORMER LICENSEES NAME. AND BUSINESS TRADE NAME. <br /> <br />TRANSFER 0 <br /> <br /> <br />FOR A PUBLIC BUSINESS: <br />If 8 Partnership. State the Name and Address of Each Partner; If a Corporation, State the Name and Address of Each Officer. <br />JOfficer <br /> <br />I Oal. Clue O.,ano:oo <br /> <br />l...engtl"'lO lime 11.10 <br />At Present L..Oc.tion: <br /> <br />Does CIUtl M.mUln LOClol.en <br />For MemOers To Store LIQuor? <br /> <br />Dves <br /> <br />,..., <br />WNO <br /> <br />IuD Icerl irettor Name <br /> <br />Acoress <br /> <br />I Clue Officer/CurHlor NJme <br />I <br /> <br />Aco: reu <br /> <br />I Clue 0.heo'/0"oel0' Nam., <br /> <br />Acc:l tess <br /> <br />Has applicant; if partnership, any partner; if corporation, any officer or director; if 'Club, any club officer or director, ever <br />had a license under the Minnesota Liquor Control Act revoked or suspended or been convicted for any violation of State <br />Laws or local ordinances; if so, give date and details <br /> <br />I hereov certity that the answers ire true of my own ic.nowleage at\o unoerstanc trlat The 9iV'"9 of taiS! lntormatlon or tne failure to give pertinent u'lformation <br />constitutes c.use for revoe.tion Of this pe.mil. ANY PERMIT ISSUED HEREUNDE~ ODES NOT ALLOW THE SALE OF INTOX leATING LIQUOR. <br /> <br />NO CONSIDERATION WILL BE GIVEN TO THIS APPLICATION <br />UNLESS APPROVED AS PROVIDED BELOW: <br /> <br />IF THE BUSINESS IS LOCATED IN A COUNTY: <br /> <br /> <br />Appto....C - Cn,iroerson County 80.'0 or Represent,tlve <br /> <br />Date <br /> <br />IF A CLUB ATTACH A copy OF THE CONSTITUTION AND <br />BYLAWS OF THE CLUB AND A CURRENT LIST OF <br />MEMBERS. <br /> <br />IF THE BUSINESS IS LOCATED IN A MUNICIPALITY <br /> <br />Aoproved - Council Pres;lj~nt or Rep'furlUth,. <br /> <br />O,te <br /> <br />CAS~ 150.00 (~) <br />$- ~ 'S -68 J<. <br />CHECK <br /> <br />PS 9007 (1188) <br /> <br />3 <br />