96-836C�RIGI{�f��
Council File # �� - 8 3 `
Ordinance #
Green Sheet # ��
RESOLUTION
AINTPAUL. MIPiNESOTA
Presented By
Referred To
Committee: Date
39
1 RESOLVED: That application (ID #12627) £oi an Off Sa1e Ma1t License by Thai Vang DBA
2 Neighbor's Grocery Store (Thai vang, Owner) at 469 Anita Street be and the
3 same is hereby approved.
4
5 Requested by Department of:
6 Yea5 Nays Absent
7 B a�key �
8 Guerin
9 �H rris� —�'
10 Me ard
12 T —�
13 Bostrom ✓
15
16 Adopted by Council: Date � �
17
18 Adoption Certified by Council Secretary
19
20 /�
21 BY� � e. �- . I�
za ' ` g ��
23 Approved by Mayor: Date
24
25 `1„ _� � .d''�
26 By: t
27
office of License Inspections and
Environmental Protection
sy: �lljA•w�w " ' '- � V�.�
Form Approved by City Attorney
B �� (��(.� ��P.u.� _
Approved by Mayor for Submission to
Council
By:
°IG-�3G
DEPARTMENT/OFFICFJCOUNdL DATE INITIATED GREEN SHEE �O 3 5�2 9 9
LIEP/Licensin � iNmawnre � wmwonre
CANTACT PERSON & PHONE � DEPAFRAEM DIflECTOR � CrtY CAUNCIL
Christine Rozek 266-9108 "�'�" �anarroer+er �cmaeRK
MUST BE ON COUNCIL AGENDA BY (DATE) NUYBEP FOR ❑ BUDGET DIREGTOR � FlN. & MGf. SEPVICES DIR.
NOUtING
For hearing: 7 a �f� OpDER ❑MAYOR(ORASSISTAlIn O
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATUR�
ACTION FE�UESTED:
Thai Vang DBA Neighbox's Gsocery Store iequests Council approval of its application for an
0£f Sale Malt License at 469 Anita Street (ZD 1�12627).
AECA*1MENDA7IONS: Apprmre IA) a Reject (R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING OUESTIONS:
_ PLANNINCa COMMISSION _ CIVIL SERVICE COMMISSION �� Has this persoNfirm ever worketl under a comract for ihis tlepartment? -
_ CIB COMMII'TEE
YES NO
__ STAFf Z. Has this personffirm ever been a city employee?
— YES NO
_. OISTRIC7 COUR7 _ 3. Does this person/firm posseu a skill not normall ssessetl
y po by any arrent cily employae?
SUPPOflTS WHICH COUNCIL O&IECTIVE? YES NO
Explafn all yes answers on separata shcet and ettaeh to green sheet
INITIATING PROBIEM, ISSUE, OPPORTUNITV (NTO. What, When. Where, Why):
�tl������
N1AY 09 1996
C��� �� �1.. .<
ADVANTAGES IF APPflOVED:
DISADVANTAGES IF APPROVED:
GD�SiC� E���� �'t �i��'��
.3��. � � ���6
DISADVANTAGES IF NOT APPFOVED:
TOTAL AMOUNT OFTRANSACTION $ COST/FEVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIfdG SOURCE ACTIVITY NUMBER
FINANCIAL INFORMATION: (EXPLAIN)
Greensheet # 35299 L.I.E.P. REVIEW CHECKLIST �ate:_ s/2/96 LQ Gi' �3G
In Tracker'? App'n aeceivea J � Processed
license ID # 12627 License Type: Off Sale Malt
Company Name:Thai Vang DBA: Neiqhbor's Grocery Stores
Business Addresss: 469 Anita Street Business Phona: 292-8823
Contact Name/Address: Thai Vang, 15 Wyoming St w, 107 Home Phone: 225-1646
Date to Council Research: �,ts# /i'�•?�'�a/��Ofay
Public Hearing Date: � � ���p Labels Ordered: ���
Notice Sent to Applicant: District Council #: �
.��. _ �„
�f �'tY�� :5�"
NotiCe Sent to Public: �/6���",� � Ward #: tY
Department/ Date inspections Comments
City Attorney
s� 2� 9 b
Environmental
Health
r' •qlo �•�. •
Fire
� • 2�•9!o p. k .
License Site Plan Received: � *'
Lease Recaived: GYk •
Police
(,,. 25 •�ilo o•� .
Zoning
�• 2�-•q10 p-is •
CLASS III
LICENSE APPLICATION
CITY OF SATNT PAUL
Offix of li«nse, inspecfions
and Envuonmenul Ptotxtion
75p$LpqetSC5une30D
�•� PaW, Kvrcwa 35102
(61�]669WOfu(6R)166912/ � �� �
�1 ♦
�
TFIIS APPLICATION IS SUBJEGT TO REVIER' BY TIIE YUBLIC
PLEASE TYPE OR PRINT IN INK
Type of License(s) being applied for:
Company Name:
If business is incocporated,
Doing Business As: �
B 'ness Address• y/�
M�S �j/GC��"
�n I Pacmuship! Sole PcupriaC
date of incoipozaGon: _
;!, .�,� Gro�
1
�-
.S � r�
Phone:
usi
Stmt Addras City Sute
Between what ccass streets is the business located? �UiT/1 st ��r�ire� s St ��b side of the sueet?
Are the premises now o �° S� What T of Business? L - e
Mail To Address: 76 7 �t l'i.G �- u " 5 � �T � � � N
svac naaress c�cy su��
Applicant Information:
Name and TiBe: �
First
Middle
(Maiden)
Zip
;/ p7
��"
Tide
xo� t,aa�ss: � L' rw � sr S v�y tir �—. �
SCeet Address City Sute Zip /
Date of Bixth: �— �`� S Place of Birth: �-� Home Phone: �� S' �� yv
Have you ever been convicted of any felony, crime or violation of any ciry ordinance other than traffic? YES _ NO.�
Date of arrest: W6ere?
C6arge:
Conviction: Sentence:
List the names and residences of three pe�ons of good moral c6azacter, living wittrin the Twin Cities Metro Area, not related to the
applicant or fivancially inurested in the premises o: business, who may be referred to a¢ to the applicant's character:
NAME ADDRESS PHONE
L ,.� f (/� ,� �, _ vo�-s s �"` �`�
List licenses which you cucrenQy hold, foimerly held, or may have an interest in:
Have any of tLe bove nazned licenses evu Ueen revoked? _ YES ,�, NO If yes, list the dates and reasoas for revocauon:
Are you going to operate this business personally? YES _ NO If no4 w6o will operate it?
First Name
Home Address: Strea
Middlelnitial (M&�1 �
Ciry
Sute
Dace ot Binh
yip piwne Number
.. _.. . . -�. .� . . -�, R - - _-
Are you going to have a manager or azsistant in this business? � YES _ NO �If the manager is not the same as the oper
complete the following infomiation: . �
'a �-, � �w w.�- - /a/
First IQazne
��d �� �
Home Addras: Strut I:ame
Middle ]nitia!
List all othei officers of the corpo:ation:
OFFICER TITLE
NAME (Office Held)
s
City
HOME
ADDRESS
If business is a parmership, please include the following information for each partner (use additional pages if necessary):
Fvst Namc
Middle initial
(Maiden)
HOME
PHONE
Sute
T�p
BUSINESS
PHOAB
Isst
3G
DATE OF
BIItTH
Date of Binh
HomeAddras: SueetName City , Sta�e Zip PhoneNumber
Fvst Name MidNe Inidai (Maiden) L+st Date of Binh
Home Address: Sceet Name Ciry State Zip Phone Nutnber
MINNESOTA TAX IDFNI7f7CATION NUMBER - Pu�uant to the Laws of Minnesota, 1984, Chaptcr 502, Article 8, Section 2(270.72)
(Taz Clearance; issuance of Licenses), licensing authorities aro required to provide to the Stace of Mimesota Commissioner of Revenue,
tl�e Minnesota business taz identification number and t6e social security number of each license applicant
Under the Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974, we ue required to advise you of the following
regazding t6e use of the Minnesota Tax Identification Number:
- This info:mation may be used to deny the issuance or renewal of youc license in the event you owe Minnesota sales, employer s
withholding or motor velvcle excise taxes;
- Upon receiving this infocmation, tLe licensing authoriry will supply it only ro the Mimesota Department of Revenue. However,
under the Federal Ezchange of Infocmation Agreemenl, the Depar[ment of Revenue may supply this infoimation to tLe Sntemal
Revenue Service.
Minnesota Taz Identification Numbeis (Sales & Use Taz Nutnber) may be obtaiced from the State of Ivfinnesota, Business Records
Department, 10 River Pazk Pla�a (612-29b-6181).
social securiryxumber: �� �/�` 3 �7 � �
Minnesota Tac Iden6fication Number: � y� ����
_ If a Minnesota Tax Identification Number is not required for the business being operated, indicate so by placing an "X" in the
boz.
Please list your emplopment history for the previous five (5) yeaz period: