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98-93Council File�� OR1GiNAL RESOLUTfON Presented By Referred To Green Sheet # LP60012 Coaunittee: Date RESOLVSD: 1 That application (ID t19960000053) for a Restaurant (B) - more 2 than 12 seats, Liquor On Sale - Sunday, Liquor On Sale - Over 3 100 seats (B), Food Vehicle, Caterinq (C) - Add On License(s) 4 by SARURA RESTAURANT INC DBA SAICURA JAPANESE RESTAURANT at 350 5 ST PETER ST SUITE 195 be and the same is hereby approved. Yeas II Nays II Absent Adopted by Council: Date ��^.. � ��q.R� Adoption Certified by Council Secretary By: Appx By: Ordinance $ MINNESOTA Requested by Department of: office o£ License, Inspectiona and Environmental Protection gy: \yJ�-�v.si"` � ►`-"'1.�--/ Form A roved b Ci y Attorney . . � � u-9� By: Approved by Mayor for Submission to Council sy: • • • ] DEPARTMENT/OFFICE/COUNCIL Da7E INfiwTED � u - ` �' uEP'u�,°`"° y GREENSHEET No.tpsoo�s ONTACT PERSON 8 PHONE " �,maumts �nuro�e� OZEK CHRISTINE (672)2669106 � ��, ST BE N COUNCIL AGENDA BY (OATE) �� ` y� / tA�ERFOR � CwndlReswrch RW1T@IG ORDER TOTAL 1f OF SIGNATURE PAGES (CUP ALL LOCATIONS FOR SNiNATURE) ACTION REQUESTEO: Canctl approvel of the fdbwing license applkaCan: Lkertse #` 1998000DD53, for SAKURA RESTAURANT INC, Ddng Business As SAKURA JAPANESE RESTAURAN7, at 350 S7 PETER ST SUITE 195, Uiefuding the fdW�viny business type(s): Resmurant (B) - rtare than 12 s�ts, Lquor On SaN - SurWay, RECOMMENDATIONS:Ap{xove(A)Rej2Gt(R) ERSONnLSeRV�CECONTRACTSMUSTANSWERTMEFOLLOWINGWE5710NS: 1. Has thk Pe�rtn sver �wrked un0er a ooniraG !or dd� dapartrtenl? _ PLANNING COMMISSION yES F�p _ CIB COMMITTEE 2, h�ae mk pereoMim ever eaen a dry empqee9 CIVfL SVC CINN, YES NO . Doec this pen«Krm pos+eaa a sldn nd nonnalb Poacweed DY anr a+mM d�Y �mpapa4 YES MO . b thia pereoMrrn a tarpeted wndoY! —� YES NO F�cplain all yea answers on xparrte sheet an0 attach to prcen sheet INI7IATING PROBLEM, ISSUE, OPPORTUNITY (WM, What, When, Where, Why): Requesting Cou�il approval Fa Sakura Restaurant Ina DBA Sakura Japanese RestauraM fof a Food Vehicie, Liquor On-Sala Sunday, Liquor On-Sale (B), RestauraM (B) & Catering Licenses at 35p St. Peter Sveet. ADVANTAGESiFAPPROVED: bzu i �r: <�, rti! 'wr �r .:�F`, �C e� l� , "-.1' ISADVANTAGES IF APPROVED: DISADYANTAGES IF NOT APPROVED: TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETED (CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER F{NANC{AL INFORMAT{ON: (EXPLAIN) . JRN-E9-1998 15�19 CITY OF S- PRL1L LIEP CL?,SS III LICENSE APPLICt�TIQN Ti-IISAP?idCA'I'O*7I St7R3F.CTTO?2EV��BYTI�P'JBI.SC PLEASE TYPE OR PRTNT IN ;Y�C T;�pe of Liceuse(s) beicg appfiai.`or { {� �J !ti COII1�'1ALfIVffiSC: -`)!J NLUY0. � tl<.xyZ<A�:-\'0 Cc�p�ntiem 7 Fmincstup / Sdic Pmye'efmu'P If busiaess is iaaraporated, give date a`'iiicoipMAffOn: ,_� poing Bi:suiess As: �/� K UR `� � ,�.Y..�= ,. 1 Sisinn,ssAddress: .�iJ� Sl �?7 .ST. �-S� 612 266 5124 P.64 CITY OF SAII9'1' PALL �j g- 9 3 o�« �eu«�, �� uw �;��, � �� s�cnttc-usm ssta (6.A25690i0 &tC6121�66a:Za S � �.�. m� S � ��,. o� s � ca•z� S _ dWl-✓ry 4YJ 5_ ��.00� �JF�� Business ' sMec nddsm � cicy SsaR tip Betweea what cross streas is the oasiaess located2 .$�Q�_ 1�i'Ye z� Which sir.i� of the streat? Acethepremisesnawoccupiod? nl� WhatTgpeofBusineas? N� ro aaare�a: 35d 57� (�e�+.+. .�4 �5��. i 45 S� iYl t� 5 S � oZ scarz 'k'drcu Appiica�Y Infomsation: Aame s„a Tius: c;ri � Fiome Address: smm zy+ sceet,laateea � cery xca vy I)steofEirth: /�—� '�� PinceofSirth:�,�,nCY� HoraePhoaal�� //5��' Have yau ever bezn rr�yq r� of any felony, orime or violatian of aay oity ordin�ncc othcr ehan tra@'ic? YES � N01� Dste of atrest: Wherr? Charge: i G�nviction: �� \ ��: last the names azui z�i2encaa of threz persons of good mora! chaxa�ter, Gving utithin ihe Tw�.n Cities Mekn Area, aot related to the applicsn! os Cmmiciatly intesesred ssi the precuses cu business, u�ho msy be ra''crred to as to the appL•"caat's character: �� I3,ave aap of thc a6w mamec iicenses ever beEn resnked? YES ..�� NO Syes. list the dates and;easons fo* n'�vocaYion: W� 2718/97 I.ist licenses which you c�d, formerly field, as may have ar. inte�est in: _ ..�,�� _,. Y' „n �._ �.- - . S�d-C�9-1998 15�19 CIT� OF S` PRLL LIEP l+.ro you $ning to °Fetaze tLis bus�ess petsonally? �/ y� _ 612 266 ?124 P.05 NO IFIIOL, R'}'A Wyj� p�y,j� jj'7 ��'—`�3 - �-,�*� u�� c.�,,t�5 r,�e n.k�e� .,��...� ci�y _s� �a � x� �� $g' � tbis bnsiaes�7 YES 1r0 If ;hz macegr, is : ct dx saFec as the operator, '�€ ` ' v' .�6 sa �� s� � a ' . . � �r� �� ` S"s jI7 �� 5-oi.�3 .(yo' ��' stWc z;P h�6a q iScL'�vva W0.�f l.:'j�'�� 'O..n�o-�. (YIQi 551 1 Z !o t 2�. � U i`�� r empIayme�t lu�.orq f� t�eFrevjcus fise (5) year p:riM: � � /R4D - 144� List al3 dcli« officers of tbe catpozation: �FFI�R TZT�' H�� HOME BUS�SS DATE OF ;V.4ME (OfficeF�ddJ ADDRESS PHONE PHONP BIATH _', n C'h1or, t�9 t�a`�ura�. ic��iz�.Uih �s�.e> /6�.z��?�5'-a��3" �/ I If buaiacss is a P��, Please inc2ude the following uxFurmstiun for e�h pattntr (use adclitioaal pages ifnecessery); Lmi 2ip wn Lati :'AL�R�'Es"OTA TAX IDENTIFICATIO?�* NfJN,gER • pussuaut 2o t3te?.aws a''hY�,�3pta, t 985, Chxpter 502, A-tic(c 8, Sec7ort 2 270.72 {1'a� C?tm'emcq Isssauce aFLiaaises), fiteesing authorities are requv-ed toprovide to the State �'Nfinnesora Co�aicsi�c oP'?2cvenue, the Mir�nesota business tax idec�cstion nuailxs aad the s�c;al sec,,u;ty numL�r oFeacf: license applicaut. Uader tlxe �?ina�soffi Govemment Dsta PracL:xs Act and the Federel P:zvacy Act of 1974, we aze requi_�d m advise you o£the following regsr3ing thc vse aFthe M�anasota Tae Ideatificetiaa Number: - This infor,nat{on may be uscd to cie�. t�ye isyya�se Qy r�ewai of your Iicensa ia the eveni you owc 4finnesota sales, e¢iploy��g withhotdi�� or motot vchic�e excise taxes; • Upon iaceiving ihis iaformuCon, the licemsicg ac#horiiy will �upply it oaty ta itw Minnewia Dspare�t of Revenve. However, undez the F�eral Ek:haoge af Informa*aon A�eemrnt, ttu Dcpa-t�at of Revenue maq ysppiy ehis ia;onnation to the Iutemat Revrlue Savix. t,�s�ta �sx ldQntifieati�s h�nbes(Sa1rs & U�e Tax Nunb�) m.�y bc cbtnir.edfrom fhe Sua:e ef Minacsats. Bnssess fteconls Depanmeat, 761;iverPazkPlaza (b12-296.61$1). � s�,�� s��:��b�: �/�- 9� - 49� 9 �"`�� Miac�oc9 7ex Id�;i£catiar. Yttt�bcr: 121 g3 � 7S 1)P,�-J -3� _^ I f a Mi'siesota Tax 1�L+5caaan N.amber zs not itir;:ur�d fo- tnc business beins operated, m3icatc so $:� 1�y Ptacing an"X" ia the box 2/18/97 Council File�� OR1GiNAL RESOLUTfON Presented By Referred To Green Sheet # LP60012 Coaunittee: Date RESOLVSD: 1 That application (ID t19960000053) for a Restaurant (B) - more 2 than 12 seats, Liquor On Sale - Sunday, Liquor On Sale - Over 3 100 seats (B), Food Vehicle, Caterinq (C) - Add On License(s) 4 by SARURA RESTAURANT INC DBA SAICURA JAPANESE RESTAURANT at 350 5 ST PETER ST SUITE 195 be and the same is hereby approved. Yeas II Nays II Absent Adopted by Council: Date ��^.. � ��q.R� Adoption Certified by Council Secretary By: Appx By: Ordinance $ MINNESOTA Requested by Department of: office o£ License, Inspectiona and Environmental Protection gy: \yJ�-�v.si"` � ►`-"'1.�--/ Form A roved b Ci y Attorney . . � � u-9� By: Approved by Mayor for Submission to Council sy: • • • ] DEPARTMENT/OFFICE/COUNCIL Da7E INfiwTED � u - ` �' uEP'u�,°`"° y GREENSHEET No.tpsoo�s ONTACT PERSON 8 PHONE " �,maumts �nuro�e� OZEK CHRISTINE (672)2669106 � ��, ST BE N COUNCIL AGENDA BY (OATE) �� ` y� / tA�ERFOR � CwndlReswrch RW1T@IG ORDER TOTAL 1f OF SIGNATURE PAGES (CUP ALL LOCATIONS FOR SNiNATURE) ACTION REQUESTEO: Canctl approvel of the fdbwing license applkaCan: Lkertse #` 1998000DD53, for SAKURA RESTAURANT INC, Ddng Business As SAKURA JAPANESE RESTAURAN7, at 350 S7 PETER ST SUITE 195, Uiefuding the fdW�viny business type(s): Resmurant (B) - rtare than 12 s�ts, Lquor On SaN - SurWay, RECOMMENDATIONS:Ap{xove(A)Rej2Gt(R) ERSONnLSeRV�CECONTRACTSMUSTANSWERTMEFOLLOWINGWE5710NS: 1. Has thk Pe�rtn sver �wrked un0er a ooniraG !or dd� dapartrtenl? _ PLANNING COMMISSION yES F�p _ CIB COMMITTEE 2, h�ae mk pereoMim ever eaen a dry empqee9 CIVfL SVC CINN, YES NO . Doec this pen«Krm pos+eaa a sldn nd nonnalb Poacweed DY anr a+mM d�Y �mpapa4 YES MO . b thia pereoMrrn a tarpeted wndoY! —� YES NO F�cplain all yea answers on xparrte sheet an0 attach to prcen sheet INI7IATING PROBLEM, ISSUE, OPPORTUNITY (WM, What, When, Where, Why): Requesting Cou�il approval Fa Sakura Restaurant Ina DBA Sakura Japanese RestauraM fof a Food Vehicie, Liquor On-Sala Sunday, Liquor On-Sale (B), RestauraM (B) & Catering Licenses at 35p St. Peter Sveet. ADVANTAGESiFAPPROVED: bzu i �r: <�, rti! 'wr �r .:�F`, �C e� l� , "-.1' ISADVANTAGES IF APPROVED: DISADYANTAGES IF NOT APPROVED: TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETED (CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER F{NANC{AL INFORMAT{ON: (EXPLAIN) . JRN-E9-1998 15�19 CITY OF S- PRL1L LIEP CL?,SS III LICENSE APPLICt�TIQN Ti-IISAP?idCA'I'O*7I St7R3F.CTTO?2EV��BYTI�P'JBI.SC PLEASE TYPE OR PRTNT IN ;Y�C T;�pe of Liceuse(s) beicg appfiai.`or { {� �J !ti COII1�'1ALfIVffiSC: -`)!J NLUY0. � tl<.xyZ<A�:-\'0 Cc�p�ntiem 7 Fmincstup / Sdic Pmye'efmu'P If busiaess is iaaraporated, give date a`'iiicoipMAffOn: ,_� poing Bi:suiess As: �/� K UR `� � ,�.Y..�= ,. 1 Sisinn,ssAddress: .�iJ� Sl �?7 .ST. �-S� 612 266 5124 P.64 CITY OF SAII9'1' PALL �j g- 9 3 o�« �eu«�, �� uw �;��, � �� s�cnttc-usm ssta (6.A25690i0 &tC6121�66a:Za S � �.�. m� S � ��,. o� s � ca•z� S _ dWl-✓ry 4YJ 5_ ��.00� �JF�� Business ' sMec nddsm � cicy SsaR tip Betweea what cross streas is the oasiaess located2 .$�Q�_ 1�i'Ye z� Which sir.i� of the streat? Acethepremisesnawoccupiod? nl� WhatTgpeofBusineas? N� ro aaare�a: 35d 57� (�e�+.+. .�4 �5��. i 45 S� iYl t� 5 S � oZ scarz 'k'drcu Appiica�Y Infomsation: Aame s„a Tius: c;ri � Fiome Address: smm zy+ sceet,laateea � cery xca vy I)steofEirth: /�—� '�� PinceofSirth:�,�,nCY� HoraePhoaal�� //5��' Have yau ever bezn rr�yq r� of any felony, orime or violatian of aay oity ordin�ncc othcr ehan tra@'ic? YES � N01� Dste of atrest: Wherr? Charge: i G�nviction: �� \ ��: last the names azui z�i2encaa of threz persons of good mora! chaxa�ter, Gving utithin ihe Tw�.n Cities Mekn Area, aot related to the applicsn! os Cmmiciatly intesesred ssi the precuses cu business, u�ho msy be ra''crred to as to the appL•"caat's character: �� I3,ave aap of thc a6w mamec iicenses ever beEn resnked? YES ..�� NO Syes. list the dates and;easons fo* n'�vocaYion: W� 2718/97 I.ist licenses which you c�d, formerly field, as may have ar. inte�est in: _ ..�,�� _,. Y' „n �._ �.- - . S�d-C�9-1998 15�19 CIT� OF S` PRLL LIEP l+.ro you $ning to °Fetaze tLis bus�ess petsonally? �/ y� _ 612 266 ?124 P.05 NO IFIIOL, R'}'A Wyj� p�y,j� jj'7 ��'—`�3 - �-,�*� u�� c.�,,t�5 r,�e n.k�e� .,��...� ci�y _s� �a � x� �� $g' � tbis bnsiaes�7 YES 1r0 If ;hz macegr, is : ct dx saFec as the operator, '�€ ` ' v' .�6 sa �� s� � a ' . . � �r� �� ` S"s jI7 �� 5-oi.�3 .(yo' ��' stWc z;P h�6a q iScL'�vva W0.�f l.:'j�'�� 'O..n�o-�. (YIQi 551 1 Z !o t 2�. � U i`�� r empIayme�t lu�.orq f� t�eFrevjcus fise (5) year p:riM: � � /R4D - 144� List al3 dcli« officers of tbe catpozation: �FFI�R TZT�' H�� HOME BUS�SS DATE OF ;V.4ME (OfficeF�ddJ ADDRESS PHONE PHONP BIATH _', n C'h1or, t�9 t�a`�ura�. ic��iz�.Uih �s�.e> /6�.z��?�5'-a��3" �/ I If buaiacss is a P��, Please inc2ude the following uxFurmstiun for e�h pattntr (use adclitioaal pages ifnecessery); Lmi 2ip wn Lati :'AL�R�'Es"OTA TAX IDENTIFICATIO?�* NfJN,gER • pussuaut 2o t3te?.aws a''hY�,�3pta, t 985, Chxpter 502, A-tic(c 8, Sec7ort 2 270.72 {1'a� C?tm'emcq Isssauce aFLiaaises), fiteesing authorities are requv-ed toprovide to the State �'Nfinnesora Co�aicsi�c oP'?2cvenue, the Mir�nesota business tax idec�cstion nuailxs aad the s�c;al sec,,u;ty numL�r oFeacf: license applicaut. Uader tlxe �?ina�soffi Govemment Dsta PracL:xs Act and the Federel P:zvacy Act of 1974, we aze requi_�d m advise you o£the following regsr3ing thc vse aFthe M�anasota Tae Ideatificetiaa Number: - This infor,nat{on may be uscd to cie�. t�ye isyya�se Qy r�ewai of your Iicensa ia the eveni you owc 4finnesota sales, e¢iploy��g withhotdi�� or motot vchic�e excise taxes; • Upon iaceiving ihis iaformuCon, the licemsicg ac#horiiy will �upply it oaty ta itw Minnewia Dspare�t of Revenve. However, undez the F�eral Ek:haoge af Informa*aon A�eemrnt, ttu Dcpa-t�at of Revenue maq ysppiy ehis ia;onnation to the Iutemat Revrlue Savix. t,�s�ta �sx ldQntifieati�s h�nbes(Sa1rs & U�e Tax Nunb�) m.�y bc cbtnir.edfrom fhe Sua:e ef Minacsats. Bnssess fteconls Depanmeat, 761;iverPazkPlaza (b12-296.61$1). � s�,�� s��:��b�: �/�- 9� - 49� 9 �"`�� Miac�oc9 7ex Id�;i£catiar. Yttt�bcr: 121 g3 � 7S 1)P,�-J -3� _^ I f a Mi'siesota Tax 1�L+5caaan N.amber zs not itir;:ur�d fo- tnc business beins operated, m3icatc so $:� 1�y Ptacing an"X" ia the box 2/18/97 Council File�� OR1GiNAL RESOLUTfON Presented By Referred To Green Sheet # LP60012 Coaunittee: Date RESOLVSD: 1 That application (ID t19960000053) for a Restaurant (B) - more 2 than 12 seats, Liquor On Sale - Sunday, Liquor On Sale - Over 3 100 seats (B), Food Vehicle, Caterinq (C) - Add On License(s) 4 by SARURA RESTAURANT INC DBA SAICURA JAPANESE RESTAURANT at 350 5 ST PETER ST SUITE 195 be and the same is hereby approved. Yeas II Nays II Absent Adopted by Council: Date ��^.. � ��q.R� Adoption Certified by Council Secretary By: Appx By: Ordinance $ MINNESOTA Requested by Department of: office o£ License, Inspectiona and Environmental Protection gy: \yJ�-�v.si"` � ►`-"'1.�--/ Form A roved b Ci y Attorney . . � � u-9� By: Approved by Mayor for Submission to Council sy: • • • ] DEPARTMENT/OFFICE/COUNCIL Da7E INfiwTED � u - ` �' uEP'u�,°`"° y GREENSHEET No.tpsoo�s ONTACT PERSON 8 PHONE " �,maumts �nuro�e� OZEK CHRISTINE (672)2669106 � ��, ST BE N COUNCIL AGENDA BY (OATE) �� ` y� / tA�ERFOR � CwndlReswrch RW1T@IG ORDER TOTAL 1f OF SIGNATURE PAGES (CUP ALL LOCATIONS FOR SNiNATURE) ACTION REQUESTEO: Canctl approvel of the fdbwing license applkaCan: Lkertse #` 1998000DD53, for SAKURA RESTAURANT INC, Ddng Business As SAKURA JAPANESE RESTAURAN7, at 350 S7 PETER ST SUITE 195, Uiefuding the fdW�viny business type(s): Resmurant (B) - rtare than 12 s�ts, Lquor On SaN - SurWay, RECOMMENDATIONS:Ap{xove(A)Rej2Gt(R) ERSONnLSeRV�CECONTRACTSMUSTANSWERTMEFOLLOWINGWE5710NS: 1. Has thk Pe�rtn sver �wrked un0er a ooniraG !or dd� dapartrtenl? _ PLANNING COMMISSION yES F�p _ CIB COMMITTEE 2, h�ae mk pereoMim ever eaen a dry empqee9 CIVfL SVC CINN, YES NO . Doec this pen«Krm pos+eaa a sldn nd nonnalb Poacweed DY anr a+mM d�Y �mpapa4 YES MO . b thia pereoMrrn a tarpeted wndoY! —� YES NO F�cplain all yea answers on xparrte sheet an0 attach to prcen sheet INI7IATING PROBLEM, ISSUE, OPPORTUNITY (WM, What, When, Where, Why): Requesting Cou�il approval Fa Sakura Restaurant Ina DBA Sakura Japanese RestauraM fof a Food Vehicie, Liquor On-Sala Sunday, Liquor On-Sale (B), RestauraM (B) & Catering Licenses at 35p St. Peter Sveet. ADVANTAGESiFAPPROVED: bzu i �r: <�, rti! 'wr �r .:�F`, �C e� l� , "-.1' ISADVANTAGES IF APPROVED: DISADYANTAGES IF NOT APPROVED: TOTAL AMOUNT OF TRANSACTION S COST/REVENUE BUDGETED (CIRCLE ONE) YES NO FUNDING SOURCE ACTIVITY NUMBER F{NANC{AL INFORMAT{ON: (EXPLAIN) . JRN-E9-1998 15�19 CITY OF S- PRL1L LIEP CL?,SS III LICENSE APPLICt�TIQN Ti-IISAP?idCA'I'O*7I St7R3F.CTTO?2EV��BYTI�P'JBI.SC PLEASE TYPE OR PRTNT IN ;Y�C T;�pe of Liceuse(s) beicg appfiai.`or { {� �J !ti COII1�'1ALfIVffiSC: -`)!J NLUY0. � tl<.xyZ<A�:-\'0 Cc�p�ntiem 7 Fmincstup / Sdic Pmye'efmu'P If busiaess is iaaraporated, give date a`'iiicoipMAffOn: ,_� poing Bi:suiess As: �/� K UR `� � ,�.Y..�= ,. 1 Sisinn,ssAddress: .�iJ� Sl �?7 .ST. �-S� 612 266 5124 P.64 CITY OF SAII9'1' PALL �j g- 9 3 o�« �eu«�, �� uw �;��, � �� s�cnttc-usm ssta (6.A25690i0 &tC6121�66a:Za S � �.�. m� S � ��,. o� s � ca•z� S _ dWl-✓ry 4YJ 5_ ��.00� �JF�� Business ' sMec nddsm � cicy SsaR tip Betweea what cross streas is the oasiaess located2 .$�Q�_ 1�i'Ye z� Which sir.i� of the streat? Acethepremisesnawoccupiod? nl� WhatTgpeofBusineas? N� ro aaare�a: 35d 57� (�e�+.+. .�4 �5��. i 45 S� iYl t� 5 S � oZ scarz 'k'drcu Appiica�Y Infomsation: Aame s„a Tius: c;ri � Fiome Address: smm zy+ sceet,laateea � cery xca vy I)steofEirth: /�—� '�� PinceofSirth:�,�,nCY� HoraePhoaal�� //5��' Have yau ever bezn rr�yq r� of any felony, orime or violatian of aay oity ordin�ncc othcr ehan tra@'ic? YES � N01� Dste of atrest: Wherr? Charge: i G�nviction: �� \ ��: last the names azui z�i2encaa of threz persons of good mora! chaxa�ter, Gving utithin ihe Tw�.n Cities Mekn Area, aot related to the applicsn! os Cmmiciatly intesesred ssi the precuses cu business, u�ho msy be ra''crred to as to the appL•"caat's character: �� I3,ave aap of thc a6w mamec iicenses ever beEn resnked? YES ..�� NO Syes. list the dates and;easons fo* n'�vocaYion: W� 2718/97 I.ist licenses which you c�d, formerly field, as may have ar. inte�est in: _ ..�,�� _,. Y' „n �._ �.- - . S�d-C�9-1998 15�19 CIT� OF S` PRLL LIEP l+.ro you $ning to °Fetaze tLis bus�ess petsonally? �/ y� _ 612 266 ?124 P.05 NO IFIIOL, R'}'A Wyj� p�y,j� jj'7 ��'—`�3 - �-,�*� u�� c.�,,t�5 r,�e n.k�e� .,��...� ci�y _s� �a � x� �� $g' � tbis bnsiaes�7 YES 1r0 If ;hz macegr, is : ct dx saFec as the operator, '�€ ` ' v' .�6 sa �� s� � a ' . . � �r� �� ` S"s jI7 �� 5-oi.�3 .(yo' ��' stWc z;P h�6a q iScL'�vva W0.�f l.:'j�'�� 'O..n�o-�. (YIQi 551 1 Z !o t 2�. � U i`�� r empIayme�t lu�.orq f� t�eFrevjcus fise (5) year p:riM: � � /R4D - 144� List al3 dcli« officers of tbe catpozation: �FFI�R TZT�' H�� HOME BUS�SS DATE OF ;V.4ME (OfficeF�ddJ ADDRESS PHONE PHONP BIATH _', n C'h1or, t�9 t�a`�ura�. ic��iz�.Uih �s�.e> /6�.z��?�5'-a��3" �/ I If buaiacss is a P��, Please inc2ude the following uxFurmstiun for e�h pattntr (use adclitioaal pages ifnecessery); Lmi 2ip wn Lati :'AL�R�'Es"OTA TAX IDENTIFICATIO?�* NfJN,gER • pussuaut 2o t3te?.aws a''hY�,�3pta, t 985, Chxpter 502, A-tic(c 8, Sec7ort 2 270.72 {1'a� C?tm'emcq Isssauce aFLiaaises), fiteesing authorities are requv-ed toprovide to the State �'Nfinnesora Co�aicsi�c oP'?2cvenue, the Mir�nesota business tax idec�cstion nuailxs aad the s�c;al sec,,u;ty numL�r oFeacf: license applicaut. Uader tlxe �?ina�soffi Govemment Dsta PracL:xs Act and the Federel P:zvacy Act of 1974, we aze requi_�d m advise you o£the following regsr3ing thc vse aFthe M�anasota Tae Ideatificetiaa Number: - This infor,nat{on may be uscd to cie�. t�ye isyya�se Qy r�ewai of your Iicensa ia the eveni you owc 4finnesota sales, e¢iploy��g withhotdi�� or motot vchic�e excise taxes; • Upon iaceiving ihis iaformuCon, the licemsicg ac#horiiy will �upply it oaty ta itw Minnewia Dspare�t of Revenve. However, undez the F�eral Ek:haoge af Informa*aon A�eemrnt, ttu Dcpa-t�at of Revenue maq ysppiy ehis ia;onnation to the Iutemat Revrlue Savix. t,�s�ta �sx ldQntifieati�s h�nbes(Sa1rs & U�e Tax Nunb�) m.�y bc cbtnir.edfrom fhe Sua:e ef Minacsats. Bnssess fteconls Depanmeat, 761;iverPazkPlaza (b12-296.61$1). � s�,�� s��:��b�: �/�- 9� - 49� 9 �"`�� Miac�oc9 7ex Id�;i£catiar. Yttt�bcr: 121 g3 � 7S 1)P,�-J -3� _^ I f a Mi'siesota Tax 1�L+5caaan N.amber zs not itir;:ur�d fo- tnc business beins operated, m3icatc so $:� 1�y Ptacing an"X" ia the box 2/18/97