94-1400 Council File # '� v
�I��-TlTUT� . I a �/� y
Green sheet ,� � 9���
RESOLUTION
CITY OF AINT PAUL, MINNESOTA � 1
oR�GiNA�
Presented By
Referred To Committee: Date
RESOLVED: That application (I.D. # 2567) for an On Sale Liquor-A, Sunday On Sale
Liquor, Restaurant-B and Entertainment-III License applied for by Campus
Sports Grill & Nightclub Inc. DBA Campus Sports Grill (Martin R. Bertzyk,
President) at 2554 Como venue be and the same is hereby approved.
Requested by Department of:
Ye Nays Ab ent
a e Office of License, InsAections and
r.zrrrm
uerin Environmental Protection
arr.zs
e ar
e man �' _ Q p
un e �/ /�
By:
Adopted b Council: e ��,+
Form Approved by City Attorney
Adopt' n Certified y o c'1 Secret ry Y
B � � •��
By:
Approved by or: Date 6- Approved by Mayor for Submisaion to
Council
By:
By:
**NEED COPY IrIl�tEDIATELY** � •I �:
' DE ENT IL DA INRIATED � � � + `� �
',, LIEP - Licensing Q��E� .��ET �
CONT PER80N 6 PFIONE � DEPJIHY#AENT DiRE �� � CITY COUNCII � "�
�I Christine Rozek/266-9114 N [] cm�rro�v � cmc�K ��
Musr ee oN �w er c > En F� � euoaEr o�ccroR ��. a ru�ar. seRV�ES aa. �'
For flearin : Q Z� Q � wu►roA coR nsa�sra�m ❑ �
,,
� T�TAL # OF SKiNATURE PAGES (CU ALt LOCATIONS FOR 8KiNATURE) F
I ACTION RECUESTED: . . �
I � � � � � ����=
{ Application (I.D. �72567) for a Liqu On Sale (A), Liquor On Sale-Sunday, Restauraat (B) _�
j and Entertainment-�lass IV License , �
RECO�NDATIONB: Appow tAl'or Rysct (R) RSONAL SEqVICE Ct1NTRACT8 �MJ�? Rl�8WER TNE F�LOWIN�i QUtS710N=: �
� PLANNINO COMMISSION _ CIVIL SERVICE COMMI8310N Has this psMOn/flrm evsr worked undaf a COI1treCt fOr thla d9pardnentT �
' _ C� COMMITTEE _ � � �
HH8 thi8 pePt�'1Ritm' 9VM blM18 Cil�t 9npb�Me? ;
__ STAFF �
� _ ?
ves No ,
_ DIBTRICT C�1R7 _ Doee 1Ms penonRirm poetNS.a ski� �ot rwrtr�Ny poe�easd by anX �e�M CRy amployes? � a
', SuPPOR'TS wFiICH c�uMCIL OBJECnvE4 YES NO �
plate all �►q �Mw�rs oa Np�nb sM�t � att�h t0 ��wn �hMt :�
, , �:
� ' ,:
INITMTINO PROBI.EM.'iSBUE� OPPOWTUNITY (YVIq. Whet. When. Whsro,
, 't
, Campus Sports Grill & Nightclub Inc. BA Campus Sparts Grill (Martin R. Bertzyk, Preside ) ��
requests Council approval of its appl c�ion for a Liquor On Sale (A), Liquor On Sale-Su ay, ��
Restaurant (B) , and Entertainment-C1 s�`,Z'1f License at 2554 Camo Avenue. All applications ��
and fees have been submitted. All r uired departments have reviewed �.ad approved this i�'
: application. ;�;
f �
�
' ADVAMA(iE8 IF APPROVED: _ :�
i
', �
' C�unG�r Research Cerrter �
'� � � � � AUG 11 �94 ; �
� :�
,
j DIBADVANTAOE8IF APPHOVED: : �-
_t
' _ �.
•�
' ; :�.
j�
' � �'
� :i
,, :�
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DISADVANTAQES IF NOT APPROVE�: ` �
`�
;:�
� � � � � � ��
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I
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� �� � � �
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'; TOTAL AMOtINT OF TRANSACTION : COS7/REYHNUE WDOETEO (CIRCLE ON8) YES Np 3
d
• ! FIINDINd SOURCE ACTIVITY NUMdER � �
' FINANCIAL INFORMATION: (EXPlA1N) �
�
=3
�
NOTE: COMPLETE DIRECTIONS �1RE lNGL1R3ED IN THE OREEN SHEET INSTRUCTIONAL
MANUAL AVA�LABLEYN THE PUR�IfiASING O�FICE (PHONE NO. 298-4225). �
ROUTING ORDER:
Bebw are correct roud�s tor �e th►e most Iroquent lyp�s ot documents:
CONTRACTS (assumes sutho�ized budpet exfsts) COUNCiL RESOlC1�hON (Amsnd Budpsb/Atx�pt. Onnts)
i. Outsids Agency . 1. �pei►Ontent Direc�
2. Department Director 2. Budpet Directcx •
3. City Attorney 3. Ciy Attomey
4. Mayor (for contrects over s16,000) 4. MayoNAssismnt
5. Humen Rights (for c�Mracts ovsr 550,000) 5. Ciry Counai
8. Finance and Managemsnt Ssrvk:es Dtrector 6. Ch�t Acxountant, FinanoB�and M�a�ner�t Servioes
7. Finance Accounii�g
ADMINISTRATIVE OHDERS {Budgst Revision) COUNCIL RESf)IUTIQN (�N othsrs. end Ordinanoss)
1. Activity Maneger 1. Dspartment Olrector
2. Department Acoountant 2. CNy Attornsy
3. Department �irector 3. Mayor AasiataM
4. Budget Director 4. qtyCouncil
5. City Clerk
6. Chief Accountant, Finance snd Mana�emsM Servkes
ADMINISTRATIVE OROERS (all others)
1. OepaMment Dlrector
2. Ciy Attorne�r
3. Finance and Management Services Qirector
4. City Clerk
TOTAL NUMBER OF SIGNATURE PACiES
indicate the #of pages on which aignatures are roquired and papsrcllP or flay
�ech ot th�se payes.
ACTION REOUESTEO
Describe what ths projectfrequeat aseks to accompNah 1n sither chronologi-
cal order or order ot importance, whir.hever fs most appropriate for the
issue. Do not write comptete santeix:es. Begin each item in your list with
a ve►b.
RECOMMENDATIONS
Complete H the Ipsue h� : qusi�bn. has been Prosbnted betore any body, public
or private.
SUPPORTS WHtCH COU�Cft. OBJE�T1ifE7?
�nd�caee wnfcn ca,nci� obJst:t{�+e(st your projecthequest supports by �Isting
the key wocd(a) (HOUSINO, RECREATION, NEIaH60RHOODS, ECONOMIC DEVELOPMENT,
BUD(3ET, SEWER SEPARATION). (SEE COMPLETE LI6T IN INSTFiUCTIONAL MANUAL.)
PERSONAL SERVICE CONTRACTS:
This intormatfon will bs uaed to determine the dtyls Uab�ity Ior workers compenaation claima, taxes and propsr civil ssrvke hUk�p rules. '
INITIATtNG PROBLEM, ISStlE, OPPORTUNITY
Explain the situallon or conditions that created e �eed fo► �rou� project
or request.
ADVAN'i'A(3ES IF APPROVED
Indicate whether this is simply an annuel budget proceduro required by lawl
charter or whsther there are specific ways in which the Ciy of Saint Paul
and its citizens will beneNt trom thls projecUactbn.
DISADVANTAGES IF APPRQVED
What negaNve effecis w major chanqes 10 existing or paat processes might
this project/requsst produce if it is pesa4c! (e.g.. trafffc delays. noise,
tax increases or as=essments)? To Whom'� When? For how long?
DiSADVANTAGES If NOT APPROVEO
What witl be the nsgatnre conasquences if ttte promised actfon is not
approved? Inability to deflver senrice? Continued high tra(fic, noise,
accident rate� Loss of revenue? '�
FINANCIAL IMPAGT
Although you must tailor the informat�on you provide here to the issue you
are,addressing. in general you rt►ust ans.wer taro quastions: F�bw much fs ft
going to costT Who is going to pey? ,
3
' ' Council File # ��"i�
_ 0 R I G I N A L Green Sheet � 29515
RESOLUTION
CITY OF AINT PAUL, MINNESOTA
Presented By Q��
Referred To Committee: Date
RESOLVED: That application I.D. # 2567) for a Liqubr On Sale (A), Liquor On Sale-
Sunday, Restaurant B), nd Entertainment-Class IV License applied for by
Campus Sports Grill Ni htclub Inc. DBA Campus Sports Grill (Martin R.
Bertzyk, President) a 2 54 Como Avenue be and the same is hereby approved.
�
Requested by Department of:
Yeas Nays Ab nt
a e Office of License, Inspections and
rimm
uerin Environmental Protection
arris
�
e man /1 � /�
une r ' ��
By:
Adopted by Council: Date
Form Ap ved by Cit Attorney
Adoption Certified by Council Secret y .
B : (,� • O -' � ' �f (f'
By:
Approved by Mayor: Date Approved by Mayor for Submission to
Council
By:
By:
. . q��l�b
Greensheet # 29515 L.I.E.P REVIEW HE KLI T Date: 8/1/94 / s/�/94
In Tracker? App'n Received / App'n Processed
Ucense ID # 72567
Company Name: Cam us S orts Grill & N htclub Inc pBq: Campus Sports Grill
Business Addresss: 2554 Como Ave Business Phone: 646-1339
Contact Name/Address: �rtin R Bertz k Home Phone: 653-3670
2554 Como Ave
Date to Council Research: g�� 7/y7/�j�
Public Hearing Date: d Labels Ordered: �
Notice Sent to ApplicaM: Dist�ict Council #: 12
Notice Sent to Public: Ward #: 04
Department/ Date Inspections Commerrts
�
City Attorney
�� � � � �} I�-�
Environmental
Health G� � �
� � � ����
J� 0
Fire � �
; �� �7 ��
License Site Plan Received
� �' D � Lease Received•
Police � �� � �
Zoning � � � � � i.�
, . �����
CiTY 0 5;::;T P;UL, MI:�ti�SOTA
OFFICE OF L?C��SE, Iti PEC::O�S r�� E��I�O:i`;ENTAL PROTECTION
,
AP?LZC,TION F0� 0 S:.L� INTOXICATI�G LIQUOR LIC=�SE
SU��AY OV SA E i�:^XIC:�TItiG LIQL'�OR LICE?r5E
Iti?CXIC. TI'�:: CLU3 L:QLO� LIC�!�SE
OFF S:.z .. NTG:=::C:�TZ�'G LZQL•OR LICE\S�
GV S?L Y=.� ? BEVE�.:G� LICE\SE
0: S: ? _ u?\� LZCE\SE _
Directions. 7:�IS FO:�'i !�USi �E f 1LLE Ou? �I � a TY?��.�ITe.� 0� BY P�i'�TI�G IN I�K 3Y T:iE
SOL� Ct�'��R, 3Y E=C:i .: � NE�, �Y E.`-.C:i PE�SOy Gr.O N_?S ItiTE�=ST I:J �XC�SS Or S�.
l:� l:,.. CC���i�.?tSCV e=��� � r.::vCIallO:� I:V �;;TC� 1.:.. !�': *:� C: l.... L�Ct\�.P. r� ,
.,.. 1$��.�L�.
T:-�S -�=Z �C�?�J\ S �' _T�Ci �0 ?�EVIra 3Y 1H� t'L'��LTC - -
1) �pplica�:on for (ty�e of l�ce-se �l,/ J ' � ��` ���-<
> �_ � j �� / . .
2� T OC�i.cd 'eL �tiJL'S]^25S e�GT255 �
$1.�.`.:! : 1L'7.�cr ;�'e'2 1�'�2 �1TcCi.lOi1
� t� �(�c � ��
3 �usfr.ess '�a-:e ii �� _.
. z c� ^, �ar�r.e:sii�, c: So� rro r�e�ors�,�
� �;
.
��, TI b1:5?:^.c55 15 �'CO:7CZc�cd� j��' Cc�c OI 1^COI�OTe�1Ci1 � � ��� t
5)� Doir.g 3usir.ess :.s (�t��2 .5 /` 3usiness ?`:c�e � —� 3�
6�_ vd?1 LO nGC�25S �1L Cli:cic^L �i' � ti JU51;1255 dCCTcSS�
$i�� :l : �L`':�u2r 1c7%' ly D! TECi.l011
�izy sca;.z (�r�l{/ Z �o�z
7) `.'our "�a-e ar.d ?itle /' �4.� /,� /�' �GY'vlE��' �
(Fi.st) (:;iddle) (,`�aicen) (Las�) (Title)
8) Hor_e :.cc_ess
�7� �b��� a��� - r���z _ .���-����
ST?c�?. �L:.�er Na' .e T��; e �i*ec�icn
� ' C,i� �lJ .�S r3�
�i ��r S�e �2 Z1? C0�2
9) Dste of 3irc� G �`Z � Place of 3irth � Ut���
,`4oncn , Day , � 1'e r
1�� r?Ze �'OU d Clt? ZE1 O� L�"12 l.�^1LEd $ fit25?'^` ��fitlti@ ?�
Is" natur�lized, please submit pro f cf na r�liz�tion or valid docL:,entation o=
residen� a3ien status. *(In �ccor �-:ce �:ith yinr.eso=a Statute 3�0.�02A, \o On Sale or
Off Sale L:quor Lice;�se rr.�y be issu d to �nyor.e �:ho is r.o� a L'�nited Sta=es citizen or
resident alien.) ,
11) liarried? � If sr.s::er s"yes", lisc ns^e �nd address of spouse.
.�Yi ��� �� �, ,�-�,� �sz� 3"�
, , _/��' �T_ �
12� }?cY2 }GU ever bee� tCT:�'_CtEd OI I�:7} _=�0^y� CTlfi2� Or V101cL107 OL "e:ly C1Lj� OIG�i1e7:C2 -
other ti:zz trafiic? Y=S !�0 �
Date of arrest , 1° 1.�:zre
Charge
COi�V1CL1G:1 $cT1L'c*iC2 •
Date of �rrest ?? l.nere
�
Gharge
Co;:vic �ic� Scf:LEi
13� I.15i. �td :�c'c5 c^d =c51Cc^Cc5 O L�'S:c°_ �cTSCi?S �:1L�12T1 �1�2 "c�TO nTc2 Or r'�OOd :'OTel
-- -�-- '�' � '= Or L'_�cT'+Clell li�LErcS�cd 1:1 i.�:2 ��E'�1525 Or
ch�rac��r, r:o� r�_«ed co �..e a pl_ca . y
bL'Sl::E55� �t0 rey �2 T2i2TTcd � c5 �J L±.2 c��11CcT:L�S ClleTct�Ef.
�•. vi_, :.�17�F$$
, 1C�' � C�c �/Sr;-,1 7� c � c;���.
i ; �' �77� ' /1� -
1�+� ??SL 11G�^Sc5 ��1C}l,�'C:1 C`,::Ic�:t y�i��.�., OT I�T^ET1�' �2�d� OT f:.cy �"I�y2 c:1 1PLcZESt 11.
• G /'L
15� ::cV2 c'y G- i.}:2 1�Cc�.5c5 1?s�ed by �J'.. lil 10. 1� EVET } Jccil Tc�°Oi:cC� v�5 :�O y(
1
II 575�2Z 15 ��jES��� �?SL Li�2 Cc ES c'u Z2e50i:5 '
��� �72 }'CU bO1T:� �O O.cZe:2 ��:5 �J 51'c55 r?=50�.2�1y� �5 If i:0i.� •:i�0 .:ill OYt'fii.2 2��
�� �2 ::C..2 :.CC:c55 I:.Oi:2
��� i:T2 �'O'1 r�02^F� �O }ic�'2 2:'c7?c�cT i0� c55?5�8::� lil ��15 �L'S2-:c55� �,.+U .
1= c:15-c_ 15 ° �'E5, r�l�'2 �e.^..2, T:T:2 cCCrc55, 8'•d �fiL2 OI ti Jllt}l.
���..� .-.G�C:ESS
'r::or.e �=.e of 3irzn
�8� 1. �'CUT T�ZcSc:lC. �L`S1�c55 EG:��G�-:ci1�, L'}�eL business/ c!]'i�1C�i:.cilt }:cV2 �'G1
follo_ed for tne pasL ii•:e �•«r ?
Bvs i;,e s s/r-�t oti•-.ent Addre s s
�•/ �•�/ •(, I� � {/ � � '
��G'/C W C( . C✓ /7�.'
.
, . , q�,.,i�}oo
19) List all other officers of the 'orpo:ation.
�
NAME TITLE (Office Held) ::C`SE ADDRESS HOME PHONE BUSINESS PHONE
/ ' � T�' -`71�i:�- - �C ��
/� v ..� � � I ' �� t ' C�.
�/2 CU�' l
-� /� ��z ��� 7Y: - ��•► 4� � �-��� -- � �� f�'�'�!
20) If business i�s partnership list psr�-er(s), address, home snd business phone number.
Nane ::ccress ,
Hone Phone B�_s:,^.ess Phone
Name �.c�ress
Home Phone � 3•_s:^ess Phor.e
I
21) Liquor will be served in the fo low:-:g �re�s (roorns) � Y (�',�
22) Between uhat cross streets is b sir.ess locet2d? lT_���i0 �c'�✓��_
G�ich side of street?
(
23 Are renises now occu�ied? ��;�a� �ype oi busir.ess? �l `r ���►'
) P • .
Y.ow long? � V��
24) Closest 3.2 Place C=��rch JC)'�4_ lv�.�C1�� ,tj3chool (�� � � 7il�-
C��S
25) Closes� intoxicating liquor pl� e. C:� Sale 1���„ Ofi Sale
�
26) You will be required to obtain Retail Liq�.:or Dealers Tsx Stanp. (See Att�ched)
Pti FALSIFICAT ON G: r�'S«�:cS GIVEN 0� !�L�TERIAL
SliSMITTED WILL R UL? IV DE\I=L OF THIS APPLICATION
I hereby state under oath Lhat I h�v �-s�ered all oi the above questions, �nd that the
information contained herein is true anc correcc �o the best oL my kr.o«ledge ar.d belief.
I hereby state further ur.der oath th t I h�ve received no r,.oney or o�hzr consideration, by
uay o= loan, gift, cor.tribution, or the_•-ise, o��er tha� already disclosed in the
application anich I here�i�n subm�tt d.
State of Minr.esota)
)
County of R�nsey )
Subscribed and sworn to before me th s, G/�G�
Signature Applicant / Date
� day of , . 19 ��i � c '
` ` l � ��i��'u �' ��t/�—
, > 'T - 1 (. .,� . V�...�; �
:.•vN/.�J+N'.nNv`,t��ti`�N�NJ�M�\K'�NV1/\/`hr'�`J� r.
Notary Public �._.�c ��-�?�_ County, MN s%'``4•�. Kn ;ST�';�, L VANNORN �
� r �� ' `�: �� I TARY Pl;3LiGfJ!NNES'�� ..
•. R . ' :.; ,� �`,
Rev. 5/92 " " "
. , , a� ���o�
CITY OF S=i 1 P:.L'�L, MI��=SOTA
OFFICE OF LICEtiSE, INSPEc:s ° NS :» E:��►IRO:�MENT�?L PROTECTION
�
n??LIC�TIOV F0� ON S=L ItiTOXICaTI:�C LIQUOR LICE.ySE
SliN�AY Oy SALE I�: XIC�TI�G LIQUOR LICENSE
INTOXICATITG Lli3 L?QliO� LICE!�SE
OFF S,LE INTGi:Z ?Ti1�G L?QL•OR LICENSE
OV SALE 1�L=.� �£V��.;G� LICc:�SE
0:� S:.L: uIN� LICE\SE .
irections; THIS FOR`f t�:USi BE FILLED Ou= 'ITH if?E�.:�ITE� 0� BY P�itiTI�'G IN I\K BY THE
SOLE 01.'?��R, 3Y "t?.CH ?: RTNE�, Y E.=.CH PE�SGy u'}i0 N_=.S I!�TE��ST IN EXCESS OF 5�.
I*l TH� C0�?0�.�?ICy ���/0� .:�� CI=?iG:i Iy �riIC:� T;'.E I� _�!� Oi TH? LICE�SE UILL
3� ISSL'�_�.
t
T;,iS =�YLIC�1 �0� IS 5:' JECT :0 REVIE'�J 3Y THE Pt;��L?C - •
A lica�ion for (t e o= lice�se) (� Gt,'� �`� � � � �� ���"��"�'
) PP Y?
�n � '(� � � �
) I.ocated at (
business azdress) S-S W� � S � � , ` `
. Si�EE?: �L,_ :�a-e Type Directio�
_ ��
1 �<<� �` � �
,� G�,w•. �� o�IS r� � *
5usiness ?�ar,.e
COIiO:c�1C': �eT�i.cr5:1!�, Gr $0�2 t�TO?T?c�OT5h1�
�). If busir.ess is i::cor�oraced, give �a�= ot ir.corporac±e� ����' � 19 �
�)' Doing 3usir.ess As �.y�""^' US $ S����� 3usiness Yt;o�e ���� �-33�f
�)_. ?�ail to :.e�dress (i� ciiizrznt th�� b�.:siness address)
� �SS �'( h�l � cc.J � ��t..t�.- �� 5 �' �IS (9'r !` l �
STREET: '�L;�ber �ar,�a ?ypz Dir ccion
s �' G�.� 1 E't,� (�� �• ��10 �
Ciz Scaca Zip Coda
�_ y � �_ � �
� � � (..4��" v � %"es .
1) Your ?�4,..� and Ticle � � �
" - (rirs�) Ki�dle) (;�aide�) (Lasc) (Ticle)
`� � b
3) Hor�e rd�ress `t Z L LD�` h (�1 �' C'_ �e� l�11 "�LI r�:or.e = (QS� ~ 3 7C7
ST�=ET: \L;:cer ?�ane ?ype Directicn
�l Y��e �u.- ' �' � c,� � S �( a
Cicy S� �e Zi? Code
3) Date of 3irth
� aU S� Pl�ce of 3irch ��/� 1 � S '
. ,`io�Lh, Day, � 1'ear
10) Are you a citizen of the Uni�ed State ?'� �� iative ?�'atur�lized
i£ naturalized, plesse submit proof o natu alizstiort or valid docw�enLation o=
resident alien sta�us. *(In accord�nc uith `7innesota Stacute 3L0.402A, �o On Sale or
Off Sale Liquor Lfcense m�y be issued c�nyor.e �ho is noz a United SL�tes cizizen or
resident alien:) •
11) Harried? '� If �ns::er is " es", lis� nsr,.e and address of spouse.
� � � Z� � �O Ll*�� tW �� ��,�.� G✓� �'v� ���� <�
, .
. . . A�k-I� ��
12� }:21'2 }G1 ever been COi�V?CLEa O c��' _c�C�.,,'.�Y17i.2� Or v101eL10:1 OI e:1y C1Lj� OTG?i�eP.C� •
Oi.ri2r �Pe:1 tI2IIlC? �F$ �� �
Date o= arresL , 19 l.'here
Charge
COi�V1C �1C:1 Sci?i.ErC2 •
� . l0 _
D��e of �rrest , _. t��nere
Gharge
Co;:vict:ea Ser.ter.ca _
13) L?s� t':a ;�an=s �-:d resice::ces o �*:_ee r_rser.s �:it�in tne "�etro :.rea of good r..oral
C}7 �r�ccer, i:0� Tc�cL"ca LO �}:2 c�Z?Ce':= OZ I1P.ci:C?SZLj� lI7LETc5�cd 1:1 ��':2 �:2'1525 Or
bL'5:..^.255� 1�L0 T�cy �2 T2i2Zrcd � c5 :J �i:2 c��11CeT:L�S CflcTcC�Er.
�._v,r r..� / J �
,_ YJ
� r�� � � L � 1 r � � �� � �. ��,� � � �»�z
1G) Lfs� 1lCE:1525 �:hicn.yeu curre::t y h.;?d, cr for-erly heid, or ra r. �ve a� inte.-est in.
� � C,C� (--t �C ' Gl.� °�s " � a'.'`--�j � v
15� ::nV2 fi::�' OT_ �}:2 I1Cc:.5c5 �15�Ed b�' �J'1 �:1 10, l�i EVET �Jcc:1 TcVO}:cC� �'c5 ^O �-
TI Si15�2I 15 "jES�� � � 15� L}:2 Cc ES c'� reaso,.s
�b� �T8 �'Ol� b017:� �O O_cie�2 �l1:5 ti J'S?Lc55 r°r50^cll�'� �� If i:OL� •:i�0 .:ill O�cTE�2 1�7
�• '- l �:-%�� 1�,,, l�- =o ..� = «: � 5 S �� �� ���- C., �-c, i- 0�:2 �-�� `3 � � d
� _z ��� �<
1�� t�+.:2 }'0'1 ��=T'•F�. CO ::c':2 2::cTicj2ri Or ccci5�c::� -'1 ��25 �JL'S1^c55� � .
Ii �r.s-er is "�•es, �iva r.a^e, T-e acc:ess, ar.�d cace cL birth.
Aa,::e r�c:ess
'rnor.e �a:e oi 3?rth
, , _ , : �� ;��, o,�-�n� r.���2 y o�
8� 1^G�l'.a? ycur prese GL`S1'c55 cT:��C'�..c�� �'}:ct bU5 ��ES c� �
folloved ior the p�sc five year ?
�usiress/F-�iov-.ent A�dress
�� � •,
�, l ,S ���-� !' U � L �- c���. � � �� ( L�-��
, � � . �M�-14
9) List all other officers of the corpo ation. 1
g TITLE (Office Held) 'OME :.DDRESS HOME PHONE BUSINESS PHONE
N,� � �% (�,,''�he� ��3 -36 �o.
c� I�� rz-� � l c- ���� � b ��f
� v l��- .�71� c �' ' �G J �1��`� �
-
20) If business i�s partnership list parc:er(s), �ddress, home snd business phone number.
Name Ac'ress •
Home Phone �' B�•� Phona
Name ? 'ress
Home ,Phone • B sir.ess Phone
• ' n , � v - I 5�ri 1 I�►v��Kl L�� �
21) Liquor will bz served in the follou -:g �reas (roorns) S1�
22) Between uhat cross streets is busir.
ss loc�ted? �/I � a'Ov �C�l�'�� -
�,fiich sidz of street? � ,_ �
23 Are remises nov occu�ied? t.�at cy�e ot busir.ess? �G�V �' �S ���'�'�
) P -\� �
HoW long? � � °"''�
I �oa K( (� 1n a� Sf ��J ��vs
24) Closest 3.2 Place ::urch SB �� �k� �-N 1School
y�� (� Off Sala
25) Closest intoxicating liquor place. Gn Sale /r1��W�f� �?
26) You�will be required to obtain a Re �il Liquor Dealers Tax St�mp. (See �ttached)
p.NY FALSIFICATION :?NSUcRS GIVEN OR MATERIAL
SUBMITTED WILL RESUL i`� DEN?=.L OF THIS APPLICaTION
I hereb ��ate under oath that I have a��:ered all of the �bove questions, and that the
y:..
information conLained herein is true an correcc Lo che best of my knoaledge �nd belie .
I hereby state further under oach chac r�is2 rocherethan alreadyrdisclosedninath2Lion, by
way of loan, gift, concribution, or och _
spplieation which I hera�aith submitLed.l
State of Minnesota) �—
County of Ramsey ) I_ 1 �
` (
. �l� �
Subscribed and sworn to befo.re me chis,l� Si ature of'App icanc / Date
�
'��� _ day of �� �c� , 19 �I�
. �
' ,V'✓`�'�---� � ���� �� r•v !V'✓v . v�.".1�"v' , � .
' j��� KAiSTINA L. VANHORN �
Notary Public ����� County, MNI �_ NOTARYPUBLIGMiNNESOTA
" DAKOTA COUNTY
? , . F �gC9
Rev. 5/92 . < �� y i,ommiss;on �Y; res eb �2
J.. . �,