259115 ORI6INAL;'+O CITY CL[RK ������
CITY O ST. PAUL � tioE���� NO.
'�c�;rrs� c r;�; OFFICE OF T E CITY CLERK
COUN L RESOLUTI N—GENERAL RM
PRESENTED BY
COMMISSIONE tF .TunP. i�} 1�9
RESOLV�:D: That Application M 2121 for e an.sfer of Off Sale Liquor License No.
2569, expiring January 31, 1.973, 'ssued to Steine 's Selby Liquors, Inc.
at 416 Selby Avenue, be and the s e is hereby tra,risferred to Norm's Liquors,
Inc. AND Steiner's Selby Liquors, nc. at the same address.
� \
Off Sale L quor Lstablishment
NEW j
SFER orporation to Corporation�
Inf rmall approved by Council
May lf, 72 '
Old Loca ion
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JUN 22 1972
COUNCILMEN Adopted k�y the Counci� 19—
Yeas � Nays
�� JUN 2 3 1972
��C KONOPATZKI ( pprovp� 19—
Levine �� vor
,��erediti�r---�-
Sprafka U Mayor
Tedesco A Sa' st
Mr. President, � BUTLER pU6Ll HED JUL �; � 72
� ��
. � •
• CITY OF AINT PAUL � �� �'�'
� Capital o Minnesota
� �� //.S�
aUe aHt�nevct o u��`'c �a et
p �
ADMINISTRATION Tenth and Mi rieSOtA StTe8t8 FIBB PROTECTION
ror.icg DEAN MER.EDI H,Commiasioner HEALTH
RALPH G.MEBAIL DeDaty Commissioner
DANIEL P.McLAUG LIN.Lteenss Itupector
r�ay 16, 19T2
Honorable I�Iayor and City Cou cil
Saint Fa.ul, i�linnesota
Gentlemen anci �adam:
Norm's Liquors, Inc. 's joined by St iner's
Selby Liquors, Inc. in makin�: applicu.tion fo the tran.sfer
of Off Sale Liquor License Td . 2569, expirin January 31,
1973, from the licensee Stei r's Selby Liqu r°s, Inc. at
416 Selby Avenue to Norm's Li uors, Inc. AND Steiner's
Selby Liquors, Inc. �,t the s e address.
Steiner's Selby Liquo s, Inc. have h ld this
license since I�Iay, 1965. ,
^lhis est��li�hr:!er_t is located on the soutn side of
the street between Arundel an j�;estern.
Officers of Norm's Li uors, Inc. are Gertrude E.
�ongstad, President a.�d Treas rer; and T;orman M. Ron�stad,
Vice-I'resident and Secretary. Gertrud.e E. Rqngstad. is the
sole stoc�,holder of Norr.i's Li uors, Inc.
Officers of Steiner's Selby Liquors, Inc. are
Lawrence N1. Steiner, Fresiden ; Louise Steinar, Vice-
President a,rd Vincent Courtne , Secretary-Trc�asurer.
ery truly yours,
� � /��C
��:
License Inspector
��'? u� -�
;
f
� F�,
�
STRINGER� D� NNELL . ALLEN & ShIAROOD
ATTO R N E 5 AT LAW
1200 NOFTHWESTERN N TIONAL BANK BtJILOPNG
PHIIIP STRtN6ER .. � 55 EAST PI TH STREET . TEl[PHONE 227-7784
ARTMUR J. DONNEILY SAINT PAUL, MI NES�TA 55101 AREA CODE 612 �
CIAUDE H. ALLEN � �
R.PAYLSHAROOD � .
� VINCENT P.COLlRTNEY
NENRY H.COWIE,JR. � .
. RICMAFD A.ROHlEOEFf �
� � CHAFLES A.FLINN,JR. ' , .
A.JAMES OICKINSON � �
� JAMES S.LYNDEN � �
M y 2 , 1972
�
� ?
� �
. � � ;�
License Division ,
Public Safety Building
101 E. 1Qth Street
St. Paul, Minnesota 5510
Attention: Ralph Merrill
Re: Addition of Nor 's. Liquors , . nc.
to Off-Sale Lic nse of Stein r's
Selb Li uors , nc. = 416 Se b Ave.
Gentlemen:
In the' above matter e enclose St Pau1 Applica-
tion, duplicate Minnesota pplication nd Surety Bond,
all executed by Norm' s Li uors, Inc. his office
represents Steiner' s Selb Liquors, In . , and we are
requesting that Norm' s Li uors, Inc. , �1 Minnesota
corporation; be added as additional licensee on
the current license. Mr. Howard Malmon, 1031 Osborn
Bldg. , St. Paul, Minnesot , represents Norm' s Liquors,
• Inc. , and if there is any question you can call this
office or Mr. Malmon. Th nks for your cooperation.
ours very truly,
�STRINGER DONNELLY ALLEN & SHAROOD
� ,
� 'I � ' ' �
��:r.r p�,t/`��-�'�'
Y
Vincent P'. Courtney
VPC:pm . `
CC Howard I. Malmon
Attorney at Law
Enclosures
,
� ' • e���T ,�_�� s�� r��� ���L::
' tJy,e-.'�11ii1�<<••�tii �i i,.V:.:�'L3.L �.7.ili.Y�11
. �,I��T,:;�� T9 VItiI�i� -7
' �ate �� 19 / 2
1. Applicaticn for O �T�- �� ��� License
� � ,(� V.���.
2. PJa.rn� o� app�i�ant S � u � S ��' '�/��/PM N �-
3. �3usin��� ue��r�;ss � ( G ��� �eu�iclence 2 V UV � �('�
4. Trade name, if �.n�r
5. Retail Beer FederaZ Tax �tar�p_��etail i�iuor I'eder.1 �ax Stamp X �tirill be used.
6. On �yhat f2oor locater� � �fi F�-0 d ?:ux�aer of ro9 ms used �
]�,� ,r A.' ��( �J '
7. i�et��reen t�pzat cross streets J'�1 L, N �rIV� W� � ich side of street S � 4 r�
. . J� �A`�� F-Iow long u N KIJ'OUITi�
8. Are premises no�� occupied � S'6�I7at busine s
9. Are premises noae.� unoccupf�� ?�o.r lon� v cant Previous Use
l0a Are you a nQw oc,rner_ �+�ris ��av� yo� J�een i a similar business before
—�--
Where P��n _
11. Are you �oing to operate this business pe sc�n�.11y y �.-S
i
If not' ivho s�ill operate it
12. Are �rou in any other busines� at the pres�nt time l�► �
13. Have there been any complaints �,�;ainst yo r operation of this type of place {v�
When Wh�re
�
I4. Have you ever had any license revolced���ihat reasonl and date
,
15. Are you a citizen of_ ths� Unit�d States SNative��Naturali�ed
16. Where were you born ST���L- Dat� of birth��� � ��
17, I am marri�d. �1y �i�ife's) ( ) r�ame and address is
C'�r�.0 o b �7�s��-
18. (If married female) my i�ai�en n�.me is
.
19. How long hav� you lived in Sf. F�au3. S
20. dIave you ever been arr�st�d 'V 0 '�30Ic'2.$lbn c�f avl�at crim nal laitir or ordinance
21. Are you a re�istered v�-�er an the City o� 15t o �aul �► �S °�'es No
(Answer full an� cm���et�l�. ihe�e a Ii ations are tho ou hI checked and an
falsafic���on ��sll be cause for denialo
� ��DV�.::)
I
, � a
22. Plumber of' 3.2 �s��.c�� :ya�;lyim t��.To bloc'.�s J�/�1/i/� •
23. Closeu� an�o�icatan� lir�azor p3.ace. On Sa�e Off Sale s�� ��"OCf�
��. rlearest Churcll "� M �� r�ezreNt �chool � ��`Z�
25. PJu.�ber of �c�ths �r.�al�� CIiairs �tools
26. tiV4�at occupatioY� fl��vc �rats �'o�Zo�°�ec: ior ti:e ;a�t !'ive yearN. (�ive nar�es of employers
and dates so emplayec�.) .
1V1h�. (�►1� R SD'7� � �1i�I � �I UF��,�/,G�-
� � �1�l Tr� �-tn�� (�t � � . f�oM 7�c�1.� 14 7� fo
D��;n��� c q�l � o c�a1 d r ���uo,� ���
+
27. Give name� ara�'. ��c?;'retises of vitio persons� re�i��nts oi' at. Faul, T>�inn., Et*ho can give
inform�tion coi�c�rMin,� �ou.
h��.me UM ::ddr�;�s V M G�S /�I �� W�� ,�u��JA�/�'"
Pdaane � Q ��ddres� 2 ���p �� (��
� ,
,�'�nature of t'1 i nt
S�ate of A:inraesota)
)��
County of P�.�msey )
U� M' U bein� first duly ��sorra, r�eposes and says
u�aon oath ti�at Ize has reac� �Ile �ore�oan�; �tr tement bearin� his signature �.nd i�noda�s
the content� thereof 9 and tpaat the s�.r�e is true oF IaiN oti�•n l�nowled�;e except as to
those matters therein .���ated u�on information and belief and as �to tl�aose matters
h� bel.feves them to be truee
Sig ture of �ppli ant
Subscribed and sworn to before me
this 2 day of 19 �2"�
Notary P'ub ics Ramsey Count � 4inne ota
My Commission exyafres
(Noteo These statement forms are in dupZic�.te. BotP� copies must be fully filled
ou�t' no�tarized� �.nd returned to tdae License �3i�rision. )
HOWARD 1. MWLMOIY,
8-23-71 NO��' Public, Ramsey County, Minn.
� ���ission Expires May li, 1975
:'.�� �I�J���IT �Y �'��'P�,IC�41�T�'
. �
P�T'�yL �� �<'� (?l� I�U�� �IC�I'?�E
Re: O��ale L.( 6��dR License
t1a�:e of ag�a�.ic��n�t � M ' � T�' �a�
/ � � o� S' C .
is�zsiness adclres� 10
Are you the sole oirner oi this �uui��N�?�. I� r.o�, is i� a partners�.ip?
corporation? � � � o�?:er?
Others an��r�s��ec� i:� 3�u�ine�s9 ir_e�uc�e t�.o�e � �.o�aa csf :;1one;�, property or other�vise:
����e��_��uD� �, �aN�T� 20 6 � C �.o�,; S o�. S�I�� � ° .
S'�1u��2's S'�t��. U (�uu�;.�c . ��r. 2�� ��.�
�
�
If a corporation' �ive its n�.rie S T �
Are you interested in any c���.y> i� an;T other ret il beer or lic�u�r busines�? /V (/
As sole o�tmer`? �artner? ��oca.?�o3der?
Otherti�ise? (Thro�gh loan of r;�n�;�"9 C�:C• �pl in)
� c�' r c- " �... . .. . . . .
Address of suc�� F�u,�a�ae�� anc� nu�ure o.c interes in N��r�
c
, L�
I �igna ure of �.pplica t
State of I�Iinnesota)
)�s
County of R�r�sey ) Y � I���
M w
�eing first duly sl�orn� d�poses ancl says upon oath
that h has rea the fore�;oing a:fffdavit beari g his signature and t�no�as the contents
thereof; that th� sam� is true oY his otrn �.noi.� ecige� except �.� to those ma�ters therein
stated upon in�'or�ation and belief und as to t4ose m�.tters kne believes them to be true.
�
�
� gnature of ap�l ca
Subs rib and ���rorra t "'o e me '
this� da of � 19 7 Z I�
H�WARD I. MALMON,
No}ary p blic, Ramsey County, Mino.
My Comrr�ission �xpires May 11, 1975
Notary Public9 ey o 9 A7in �so��
hiy commission expires 19 'I
�
i -
STATE OF MINN�SOTA)
)SS �
COtJNTY OF RAMSEY ) �
��� i V ►`�v � being first ly sworn9 doth depose
and say that he makes this affidavi in connection ith appli�cation for
"�Sa.le" liquar license (" Sale" r�alt be� rage license) in the
City of Saint Paul� Minnesota; that y�ur affiant is a resident of the State
of Minnesota and has resided therein or ��_ ears� months9
and is now and has been for the time bove mentioned bona fid� resident of
said State and that he noiv resides t L � gV ��SC�
� � � Address
� M nneso�;aa
City or To��un ,
�,
I�
�,
Subscribed and s:rorn to b fore r�e '
this � �da of ' " 1� 19 �
Y
Notary Pub i 9 sey County9 A�inneso a '
Pfy commissiQn expires
HOWARD i. M�qLMON,
Notary Pubiic, Ramsey County. Minn.
My Commission E�ires May 11, 1g75
8-23-71
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- � � � cz��T f�:�� s���r��� n1.LL
i�'.'1��2��'�i C� �'U'�.'LIC 5..�LTY
� • LI�n?::�.i D�VISI0IW h� -� -�
' �at� �"��' lg / �
�– — j� l � `n
--�--
I. Applicaticn �'�r I '� � "' �IK- I��a/ �� License
� P� J�ID�JIA S L� - ��e �''- ��Ao
2, iVa.rne o� zg�pri.�atat
3. �usin�s� �c��r�s� V �1�(i � �?e��ic�en 2� !1 � `'�"�.� r/4"
�
4. Trade n�iane� if �.ny
5. ,Retail Eeer rederai Tax Star�p )C I�et�il �,icguor �'ederal �x Stamp�Eti*iIl be used.
6. On what floor located � Sr ���- I.'ur..t�er o rooms used 2
7. I3et6tireen what cross streets �U'I��� �D "�/� � ich side of street��-
8. Are premises nosa occupiec� �STbJla�t bu�ineSs � f�(�� Flos� long ����d��
9. Are �remises no�r unoccup�i�er� I3o.�r lc�ng v cant Pr�vious Use
l0o Are you a nsw oeaner ��Sa�ave you been i a similar bus'nes� before
�—
Where �hen _
11. Are you going to operate this business pe sonally �U
.
If not, ��rho i+�ill operate it N � M � , (} S�
12. Are �Tou in any other bus3ness at tlie �nres nt tiune �V �
13. I3ave there been any complaints a�ainst yo r operation of this type of place � (�
When : Wh re _.
14. Have you ever had any l ic�n;�e revol�ed ��� 1Vhat reason and date
15. Are you a citizen o� th� Un�.t�d States /�i�Native�_Naturalized
16. Where were you born ,�_!�LsrG'r..`"'�� Dat� of birth_�?y��� JT /�2. �j
�
I7. I am marri�d. r1y (�'.,°�,s? (husband'�fi) r�ame and addre�s is
Z SC
18. (If marri�d female) rr.y cnai�en name is u � l�
19. Hosa long hav� you lived in St. Paul �^ -
20. kiave you ever been arrested � o V'3olat�.on c�f i�r�at crir�inal laiT or ordinance
��
i
21. Are you a rega.stered v��er in �he City of' Ste Paul Yes No
(Answer full.y an� co�nF�et�ly. ii�zese appl�.cations are thqroughly checl�ed and any
falsification will be c�.zxsL fa� deni�.i�
�i�t�':)
I
� � . .
22. PJur�zber of 3.2 �lace� :,�ii,��an ti��o bloc..s � � N� .
23. Closest intoxicating liquor pla.ce. Qn S��.e 0�£f Sale ��� u��
24. 1�leares�t Church � /� '�
=tie.:�reut �chool � � ��
25. Plusnb�r of ��s�,���N �r�bl�� �iz�ir� Stools
26. {Vhat occupa�ion la�ve �rou �'o�4oc.ec'� ior ti:e j��:�t five ye�s�u. (Give names of employers
and date:� ,�o �mg��.oyeck,)
U s,E W�F�E
27. Give names an�? ��c?;:re�se� o� �tYo ��r�ons� residents of St. Paul� iuinn.9 tiLTho can give
infornation co�icernin�; you.
�
T��me ��S�� � {��� 1 l. �xddress �b �l9 �•f C�-
1�ar�1e ��1�— SLfi r�dc�re�s I 3 � / ���/�/� l !
_ �/ �'U�� � . ����
�a�na�u e of t'�pplicant
Sta�e of AEiraa�a��ota)
)ss
County of 1���.an�ey� )
_ V �1`�� F�V� fJ . 1`�N�-���n being first duly sti�orn' deposes and sa s
upon oath ti�at �e l�as reac�i tl�e foregoing statement be�rin�; �ii,� si�;nature and I nows
the content� tl�ercof9 and tdaat t&ae ��r!e is true of lzi� oi��n l�noti�rl�d�;� except as to
those matters ther�in „�atec� u�on information and belief and as to those matters
he believ,es them to be truee
� �vr�e. !z. �- .'�O�aL
Sig ture of Applicant
Subscribed and sworn to before me
this day of I -` 19 �
�
Notary P 1 c9 Ramsey un y� hlinnesota �WAhD � �
Nota ►��LI4101V,
ry Putrlic, Ramsey County, M�
My Co�ission G�,,�lY'0S My Commission Expires May 11, �9�S
(Notea These statement fmrms are in duplicate. �3ot� copi�s must be fully filled
out, notarize�.� �.nd returned to the License Division. )
8-23-71
. :. � �IDl',s1IT ��'�PPLIC1�hT�
. y�
��.�:,yL li,n� �rt ��uc�� �zc�rTU�
�e: � ale �( (�.v.s�Q License
, . �2��uo� . �26 Gs� o�- /�_ �� '�E�s
P,1ame of a�g��.�c�.n-� — C:�E r.nle f.tfAO
/ "
3�zsiness 1c�c'dre�:
Are you the soFe oti,�er s,�' thi� t�u�iness? /V U, I� no�;, i� i� a ��,rtnerslzip?
corporation? y'� � 19 ot?�er?
Qthers ant�res�ed i:a Uu�ire:�sg a�ic��zel� t�yc�Ne � Ioan of r.ionef property or ot�er`�rise:
P�1ar�e NVi�-�'I� ��1� �U/Wll�.�ic�ress ��� J-��T�1 I�ot�r Mi� •"���
T�i�,e' w .
I(l S S�(.F3� U UG�'_ i,��,c}/� p���"�..�ic �u na�i�.
=� y
c.-o��/
If a corp�orationy give its na�e /uV � /� C�� u��� C .
Are you interested in any ���ay� ia �n�* oi.i�er ret kiI beer or lic? r business? � �
As sole otti�ner? P�r�ner:? S�oc����olci�pr`?
Qtherivise? (Throu�h 3o�an of �!�ar���~9 etc, :�ml � in)
� +
Address of �ucP� �usi�ne�:� anc� nuture of intere�� ir� �ar�e
�
I
' �/� �, 2�v-��-,���
,�i�;. ature of agplicant
State of I�Iinnesata)
)ss
County of Rarisey ) '
GC� � � �N/��
U�-�u l✓ �� V��`�eing first duly s�vorn� deposes and says upon oath
that he has read ti�e forc�oing afficiavit bearir� his si�nature and l.noc,rs the contents
thereof; �hat the sam� is true of his otan ��noa��lledge� except as to those ma.tters t�aerein
stated u�on information �.nd beli�f and as to thlose matters he believes them to be true.
, O �
.�mi.oC
� gn� ure of ap�Iicant
Subscribea �ncl ;���orn to�bg� r e
this day f /V� 19� �
Notary Public9 ey Coun�y9 .innesot� '
;,�;'.'�AhD I. MALMON,
1�1g� comrnission expires 19 yp}ary Pu�lic, tzameey c;��,^�>', M`n"'
My CommiSsian Expires t';zy '?. i975
� 1 ` „
. �
_ • � , •
•, i
t�
STATE OF NiINNF�SOT )
)SS
COUNTY OF RAMS�Y )
�
����F�[l,�� V� ei g first uly sworng doth depose
�
and say that �he makes this affidavi� in connection ith application for
�'��.e" liquar licenae ("_�ale" maZt be- erage license) in the
City of Saint Pau1� Minnesota; that ybur affiant is a resident of the State
of Minnesota and has resided therein or � ears� months*
and is now and has been for the time bove mentioned bona fid� resident of
said State an that 5 he no�v resides t �� V ��/JT��
� � �� Addre►ss
�� � M�.nneso�:aa
City or Toe,m
II
�
c��`.�'� � . 7�u����
Subscribed and sworn to before r�e
thi.s � Z�ay of � `" /T'' 19 �
�
Notary lic' sey County9 �9inneso a '
Aiy commissicn expires
HO`,+VqRp �, �LMON,
Notary public, Ramse County, Minn.
8-23-71 My Commission Expire� May 11, 1975
�
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r . .
�6, i9?2
�. Dee►t► 1►S�ex�!l.3th,
Com�r. of Publ3c Safety,
101 E. lOth. St.,
City.
At s Mr, Daniel p. McI�a�g2tlim
Deax Sir:
�he City Council toclay inPo approved the applicatio�
of ftorm's Liquors, Ine., �oined b Steiner'e Selby Liquoraf In�.�
for the transler oP OfP Sale Li r License No. 2�j6g, expirimg
January 31, 1973, from the licens e Steiner'a Selby Liquora, Ine.,
at �+16 Selby Avernxe to Nozm's Li ors, Inc., AND Steiner•s Selby
Liquors, Inc., at the eeme addres .
Will you please prepaxe the c#ustcymary reaolution?
� Very tru1.Y Y�,
�
i Cit� �'lerk
� �
�
�
�
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+ -�.� � <� � /
Form 8-•Revised 11/71 � / �
� STATE OF M NNESOTA
� LIQUOR CONTROL COMMISSIONER
APPLICATION FOR OFF SALE I OXICATING QUOR LICENSE
Thig application and the bond s all be submitte in duplicate
Whoever shall knowingly and wilfully falsify t e answera to the ollowing questionnaire shall be
deemed guilty of perjury and shall be punished accord' gly.
In answering the following questions "APPLICA TS" shall be gov rned as follows: For a Corpora-
tion one o�cer shall execute this application for all o� ers, directors and stockholders. For a partnership
one of the "APPLICANTS" shall egecute this applicati n for all members f the partnership.
EVERY QUESTION MUST BE ANSWERED.
1, I, IJorman I:. Ron�;�stacl � a Vice – President
(Individ l ownec,olhcer,or partner)
for and in behalf o T1orm's L�_�uors Inc.�= Steiner � Selb-� L�quors Incshereby apply for an Off Sale
Intoxicating Liquor License to be located at_�� �elb? �ve., St. P�.u1, P�:=_nn.
,
(Street Address and/o Lot and Block Number)
Municipality of St. Pau]- , C unty o � e
State of Minnesota, in accordance with the provisio of Minnesota Sta utes, Chapter 340, commencing
I:ay l. 197? � 19—, and ending J • l• , 1972.
2. Give applicants' date of birt�+ �• I`�x:r'ch l�;l>
(Day) (Month) (Year)
Birthdates of Partners 2�' J�� 1Q23
(Day) (Month) (Year)
or
(Lay) (Month) (YeQr)
Officers of Corporation �
(Day) (Month) (Year)
3. The residence for each of the applicanta named herei for the past five ars is as follows:
Gertr>>c�e �:. �. idor�.an 2�i. 'rir�n�-std�. 20� Itas a �ve � P;ul I:�.nn.
4. Is the applicant a citizen of the United States? �S
If naturalized at�.te date and place of naturalization_
I# a corporation, or partnership, state citizenship status f all Qfficers or pa ners.
a.11 c�t:_zens
6. The person who executes this application shall give w e's or husband's f 1 name and address
i ertrude �'u�ai iZ�nf�stad 2C:':0 I�a ca Ave. St. P ul, 2�i�_.�n.
6. What occupations have applicant and associates in thi applica,tion follow d for the past five years?
I�orr:lan 2`. �: Gertrude E �n �stad L=, S e O�:�er
Tdorn�. I:. .,,on�;stad i:acPi:szoper�.tor 3 T�, �,. �n
7. If a partnership, state name and address of each mem er of partnership
31. � this application ia for a transfer of an Off-sale License, give name of former licensee �nd state
whether any consideration, money or property has been paid,or will be paid, given or exchanged by any one,
and by whom and to whom for the purchase or transfer of the license;also atate�'the amount of consideration
I hereby verify the above statemen+
(Signature of former lice»see)
32. Applicant, and his associates in this application, will strietly comply with all the Laws of the State of
Minnesota governing the ta�ation and the sale of intoxicating liquor; rules and regulations promulgated by
the Liquor Control Commissioner; and a11 ordinances of the municipality; and I hereby certify that I have
read the foregoing questions and that the answers to said queations are true of my own knowledge.
( 'gna e of app cant)
Subscribed and sworn to before me this
��-a'� day o � 19�2-
,
�� �� ���
(NotaryPu6lic) ,,. ,.,�.ti.�;„�..�„,;�^,�.�.f����,AAAAMffi
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�� COIIlII118810A eRp1T@ C�*��' , �� � - M'�;U r?t.S0T�1
��.^`r"� �'Y
My C,n,n� 'cx,,�ra<� �+�.��� �3; 197�.?
�yNyln�nrnnnrrfr,nr�tiv�a wvW�evb�tNYb°�`!:< '
REPOftT ON APPLICANT O�t APPLICANTS BY POLICE DEPAATMENT
This is to ceriify that ihe applicant, or his associates, named herein have not been convicted within the past
five yeacs for cmy violation of Laws of the State of 1�Iinnesota, or 1(lunicipal Ordinances relating to Intoxicating
Liquor, except as hereinafter stated
pOLICE DEPART1l3ENT
(Name of city,village or borough)
APPROVED BY:
TITLE
(If you have no police department, eithec the ll�iarshal or
the Constable shall execute this report on the applicant.)