89-537 WHITE - CITV CLERK
PINK - FINANCE �I COIIRC11 `�/ /`J
BI.UERV - MAVORTMENT CITY O� S INT PAUL File NO. �� v� • -
� • /"'�'^-.,
ou ci esolution �#�`z
Presented By �
i
Referred To Committee: Date
Out of Committee By Date
RESOLVED: That application for he renewal of an Off Sale Liquor License
by the following pers ns at the address stated per the attachment,
be and the same is he eb approved.
COUNCIL MEMBERS Requested by Department of:
Yeas Nays �
Dimond
Lo� In Favor
Goswitz
Rettman �' B
sche;n�� _ Against Y
Sonnen
Wilson p �Q
�►R 2 g �""— Form Appr ved by City Attorney
Adopted by Council: Date ' .
Certified Pass b uncil Sec ar By �' 3 '� �
gy,
A►pprov d by Mavor. Date r ��^+� Z Approved by Mayor for Submission to Council
g BY
PUBlIS1iE9 aP� � �'19 9
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_ oiaai.urc�rt . o��..n► ,>, . wt,e�.�e,� .
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J. Carchedi ������ �i�� r�. �Q2��+�
" A'�. � . . . . � � �DEPARTMENT qRECTOR � - . IMYOR�(OR A8816TMR{� � � � � .
� �A Kris Vani�rn :� — ��.���, 3�,;�
. "°� � — ��R� ,�.,_Courrei t R�earch. _
F• & t.- �r+: �� «r A„o�,�
Renewal o# Off Sale Liquor Licen e er attacl�ed resoiution. -
nco�or►�+c�ns:p�nv�(a��.�*c�� cour� newc,�r: .
a��oowus�ow cn+�se+v�oo� n�rE« on�aur �uvsr v►io�No.
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sr� crwrci�ooMripeiw+ � _�wFO:�woe�* _��T'�i�oo��r.� ����or�'*
OISTAICT�OCX!lICIL � � � . *� . . � . � - . . . . ... . . .. .
. , -�. . . .. : . ��_..�.. .. : '. .
- .,� 8lAPOftt'i N6NOM CalMlCll Ol�4TIVE9 �. . - . . . . . . . . . , . . .. ,
. . . , . .. . . . . . . . .. . . . _ �
�RK1�iY�0lL�,:.�t1E. (WhO��w�.�IMFlsrl.VNrsfl.M��: ,... : ..
Reques:t for Council app.rpval of n, ff Sale k�iquor License per
attaefi�d.resolution. . ' _
_ . .�rrc�►taM�:�aM.+�r..�rat: . . _ , ,. :. . . _
All fees artd applications have b en submitted. A1l required ;`
depawtments_have reyiewed and ap ro ed the applicatian. �
�IWBM.wh�ra and:ro SiNwira: _ �
Any applicant not given Cot�ncil pp oval will be schedaled for
a revi.ew before a hearing office . .
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_ ', - '. Room 2 3,. City Hall ����.37
Saint Paul, Mi nesota 55102
� APPLICATION FOR RENEW 0 OFF SALE LIQUOR LICENSE
PLEASE COMPLETE LL ITEMS LISTED BELOW
�
1. Applicant/Company Name `o � w. s �r�� f �c. / �/Z� y��"_���
Telephone No.
2. Business Name /� . G i' (,cJa���..-o,,�A
3. Business Address STREET: /�Z .� �.a-� �w� ,Q�,-e ,
Number Nam Direction Type
4. Mail to Address STREET: s� , '/� � , SS��3
Number ame Direction Type
City State Zip Code
5. Name of Applicant � �C, l� !�z 3�6/ Phone Z - ����.5
�/ �
Individual/Partner/Of ic Date of Birth Area Code/Number
6. Applicant Address STREET: ZD ���
Number Name Direction Type
SG�-� ' w�� SSll3
City State Zip Code
7. Type of Business: Grocery ru Store General Liquor
8. Manager in Charge /�� ,e r /�73���
First Name Mi dle Last Date of Birth
9. Manager Home Address STREET: s
Number Name Direction Type
City State Zip Code
Tele hone - ���0
Area Code Number Orig. Date of Employment
10. Are any of the following taxes or charg s or the licensed premises unpaid or delinquent?
Real Estate Taxes Yes No � Personal Property Taxes Yes No �
Special Assessments Yes No � City Utility Bills Yes No �
11. If there have been any changes in inter st in premises or finances, or contracts between
applicant and any persons, corporation, pa tnerships, or any new loans since license was
last issued, explain in detail:
White copy - return to License & Permit Divi io �d ,��ti%��/�/ �Z�Z8�8$�
Pink copy - retain for your records Signature of Applicant Date
Rev. 11/88
. ���� � � . ��.-.�3 �
PROOF OF MORKERS' COMP NS TION INSURANCE COVERAGE
Minnesota Statute Section 116.18 equires eve�y state and local licensing
agency to withhold the is.suance or rene al of a license or permit to operate a
business in Minnesota until the� a pl ca�t presents acceptable evidence of
compliance with the workers' �compensati n nsurance coverage requirement of Section
116.181 , Subd. 2. The information requ re is: The name of the insurance company,
the policy number, and dates of covera e or the permit to self-insure. This
information will be collected by t e icensing agenc,y and put in their company
file. It will be furnished, upon reque t , to the Department of Labor and Industry
to check for compliance with Minnesota ta ute Sec. 176.181 , Subd. Z.
This information is required by la , and licenses and permits tv operate a
business may not be issued or renewed i i is not p�ovided and/or is falsely
reported. Furthermore, if this i fo ation is not provided and/or falsely
reported, it may result in a $1 ,000 pe al y assessed against the applicant by the
Commissioner , of the Department � of ab r and Industry payable to the Special
Compensation Fund. �
Provide the information specified a ov in the spaces provided, or certify the
precise reason your business is ex lu ed from compliance with the insurance
coverage requirement for workers' compe sa ion.
, �7 mp lo e ��e,r�e.� ��- � dm���s-�R���o�
_ Insurance Company Name: _ �q,p,,�-�
(NOT the insurance agent
Policy Number or Self-Insurance Pe it Number: o� 9o5a' �_
Dates of Coverage: — - —
(o )
I am not required to have workers' om ensation liability coverage because:
O I have no employees covered by �th law.
( j Other (Specify)
I HAVE READ ANO U(�DERSTAND MY RIGNTS A D OBLIGATIONS WITH REGARDS TO BUSINESS
LIC.ENSES, PERMITS AND WORKERS' COM EN ATION COVERAGE, AND I CERTIFY THAT THE
INFORMATION PROVIDE� IS TRUE AND CORREC .
/ ��. ►�117'f CJ
SIGNATURE �;�C - /
,
l'►'1�-I'�'1 �I�UO� �
JA/lc (J) 7/87 .
� ,
�. - � , . ��=y'-.537
(6121296-6430 STATE OF IN ESOTA PS 9068-04
' DEPARTMENT F P BLIC SAFETY
LIaUOR CO R DIVISION
ST.PAU M 55101
(612) 96- 0
APPLICATION FOR RENEWAL OFF- AL INTOXICATING LIQUOR LICENSE
Whoever shall knowingly and willingly falsify the answers to the f ilo ing questionnaire shali be deemed guilty of pery'ury and shall be
punished accordingly.
In answering the following questions"APPLICANTS"shall be go m as follows:For a partnership one of the partners shall execute
this application for all members of the partnership.For a corporati n o officer shall execute this application for all officers,directors
and stockholders.
PART I
BUSINESS PHONE NUMBER �7 J �— ���'S AP UC NT'S HOME PHONE NUMBER
I, a-�-� �, ��"� ^ ,f r and behalf of
Name of: �individual► Ipartner) loffieer o corporation) lnams of individuaq
Of
(names of partners)
or �.e.K n �o S i��'1 �5 ���- .
(name of corporati 1
make application for RENEWAL of Off-Sale intoxicating liquor lice se 1 cated at: ,
��0 Z �itJ e v��
(atreet address—or—lot and block number) r
City of S�t � l�a� ,Zip Code S � 3 ,County of �a��5/
commencing F��''`"�y � � , 19 ,an ending �'�`�L� 3 J � , 19� .
Check (✓1 box if no changes since last applying for rene al f license. If there has been a change; that is, change in
owner-ownership;addition of partner;administrator or administra ix t an esiate named;change of officers,directors or stockholders
in corporation; change of location; or new liquor establishment the form PS 9136, Application for Off-Sale Intoxicating Liquor
License,must be executed instead of this form(see your city cler for orm PS 91361.
Will applicant be granted On-Sale /1Jo ; Sunday On-Sal �O Intoxicating Liquor License in conjunction with the
111as or No) 1 s or No1
Off-Sale Intoxicating Liquor License for this location?'
PART II
FOR CORPORATION:
, �-a3-c�� ���-a� ��` �
��w(' /�' l��l��-��,� �'��t � s �� ,
(names of officers,directors and stockholdersl
�w��n.� Gkusfa� , ,
$�c��
f0 erl
PART III
a. State whether applicant,or any of his associates in this application,have ever had an application for a liquor license rejected by any
city or State authority;if so,give date and details �O
b. Has the applicant,or any of his associates in this application,during the five years immediately preceding this application ever had
a license under the Minnesota Liquor Control Act revoked for any violation of such laws or local ordinances;if so,give date and
details �e
c. State whether applicant,or any of his associates in this application,during the past five years were ever convicted of any Liquor
Law violation or any crime in this state,or any other state,or under Federal Laws;if so,give date and details '��'
d. During the past license year, has a summons been issued under the Liquor Civil Liability Law (Dram Shop) M.S.
340A.802. Yes �No.If yes,attach a copy of the summons.
Applicant, and his associates in this application, will strictly comply with all the Laws of the State of Minnesota governing the
taxation and the sale of intoxicating liquor;rules and regulations promulgated by the Liquor Control Director;and all ordinances of
the City;and I hereby certify that I have read the foregoing questions and thai the answers to said questions are true of my own
knowledge.
/���i� �
(aignature of applicant)
Subscribed and sworn to before me this
yof �Q'�� 19�� .
,
(Notary =
�! �� . JANET A.ODALEN
y commission expires � — tPtNESO''A
. \ rj�° DAKOTA COUPiT!
�"� WIY C0�`AM.D(PiRES AUG.21.15�31
x �
REPORT ON APPLICANT OR APPLICANTS BY POLICE DEPARTMENT
This is to certify that the applicant,or his associates,.named herein have not been co�victed within the past five years for any
violation of Laws of the State of Minnesota, or City'Ordinances relating to Intoxicating Liquor, except as hereinafter stated
-W .
POLICE DEPARTMENT
Iname of cityl �
Approved By:
� TITLE
(lf you have no police department, either the Marshal or the
Constable shall execute this report on the applicant.)
� ��i-537
� ". � • - n,; �c�e �Sr vy y Pin�►
.
�� �iii';�:�L _'e�d.E,Vf��
CITY F 5 INT PAUL NO ACTIVE WARRA(�1T5
INTERDEPART EN L MEMORANDUM
� N�am�er of Calis � � �
DA�: a��4-�� � �����-ts 3 . �
� /��vss�d l .�1.r•., f � �
T0: Chief McCutcheon � ��� � �
Police Department � E-�n��'an�°d � i
i
� Nui�n�;�.�r �f F�e�arts l'�t�ach�c� 3 �
FRO;I: Janet Odalen N«mber of F7e��i�d Re}�;rts ���
License & Permit Division
203 City Hall
A review by the Police Departmen i necessary for the renewal of an
� On Sale Li or License
, * � Off Sal L uor License -
�,:�
� .::i ;
* � On Sale i License � ._ ;
� � '" ,. � :,;
a On Sale a I,icense ---
:'J
Off Sal , M t License � ^� .
� � { � �
�� : -
* Please sign the attached State en wal application form. r,�
License ID � ��?3�
Business Name mG m L� l��}�'� � I�ba (,s� ���
�No investigation and/or en orcement activity on record.
� Investigation and/or en or ement activitq on record
(explanation attached) .
N e ��. !/�� �/-�—s-�-,�
� Saint Paul Police Department
- D te /'�«� .� /'9� 9'
PLEASE RETURN T0: License & Perm t ivision
Room 203 Citq 1 - Attention: Janet
� � �. ���.�3�
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