97-628Council File � `���
Ordinance #
Green Sheet # �?���
,- �-.
Presented
1
2
3
Referred To
RESOLUTIOW
SAINT PAUL, MWNESOTA
Committees Date
�b
RESOLVED: �lication (ID #59113) for a Pazldng Lot/Ramp License by Jmperial Parking Inc. DBA
Imperial Pazldng (Paul Schnettler, Regional Manager) at 175 Sth Sireet East be and the same is
herebY apPrwed.
4
5 Requested by Department of:
6 Y a� Navs Absent
7 B a __3_/
8 Bostrom �7�- Of£'ce of Licenae YnsR.ections and
9 arr.zs Fnvironmenta� Protection
10 Me a� �
11 ��y,1,�_ �-
12 unTh e
13 or on
14 ����1-.`^""^'^." 3 ` 7 1� - ��X/C �
15
16 Adopted by Council: Date B Y' —�-
17
18 Adoption Certified by Council ecretary
19 Form Approved by City Attorney
20 � 2i By: a ✓ � g
22 /J By: � .,i: l \� u-Ir..- -
23 Approved by Ma� . Date <- �I�/�'
24
25 Approved by Mayor for Submission to
26 By: � Council
27
Bye
G�-to?�
�����
UER�RiMENTqFFlCHCOUNCIL DATE INITIATED J I J`"F `{
LIEP/Licensin G REEN SH EE
CONTACT PERSON & PNONE INITIAVOATE INITIAVDATE
�OEPARTMENTDIRECTOR �qTYCOUNCIL
Christine Rozek, 266-9108 A���N OCfTYATfORNEY �qTYCLERK
NUNBERFON
biUST BE ON CqUNCf� AGENDA BY (DATEj pp�NG O BUDGEf DIRECTOR � FIN. & MGT. SERVICE$ Dlfl.
For hearin ;��--� �� OflDEP O MqYOR (OF7ASSISTAt� �
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION RE�UESTED:
Imperial Parking Inc. Imperial Parking requests Council approval of its application for a
Parking Lot/Ramp License located at 175 Sth Street East (ID �I59113).
PECOMMENDAiIONS Approve (A) or iieject (R) PERSONAL SEHVICE CONTFiACTS MUST ANSWEFi THE FOLLOWING �UESTIONS:
_ PLPNNING COMMISSION � C��IL SERVICE COMMISSION �� Has this person/firm ever worked under a contract for this department?
_ CIB fAMMI7TEE _ ' YES NO
2. Has this personttirm ever been a city employee?
_ STAFF __ YES NO
_ DISiRICiCOURr , 3. Does this personlfirm passess a skill not nortnally possessed by any curtent ciry employee?
SUPPORT$ WHICH COUNCIL O&IECTNE? YES NO
Explain ell yes answers o� separate sheet antl attach W green sheet �'�
����": r9, qi
INITIATING PROBLEM, ISSUE, OPPORTUNIN (Who, What, When, Where, W�y): c '' �", °" �
AFR 29 1997
��'� � ������ EY
ADVANTAGESIFAPPROVED.
DISAOVANTAGES IF APPflOVED:
�i::� :, � = eeasJ�
__— _ " -� --_,-�a�
DISAOVANTAGES IP NOT APPROVED:
TOTAL AMOUN7 OFTRANSAC710N $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIfdG SOURCE AC7IVITV NUMBER
FINANCIAI INFORhSATION. (EXPLAIN)
Greensneet # 37944 L.I.E.P. REVIEW CHECKLIST Date: 4/25197 ��� bZSS
In Tracker? npp'n Flecerved / app'n arocessed
License ID # 59113 License Type: Parking Lot/Ramp
Company Name: Imperial ParkinQ Inc. DBA: Imnerial Parkine _____
Business Addresss: 175 Sth Street East Business Phone: 341-8000
Contact NamefAddr2ss: Paul Schnettler, 8572 Chanhassen Hi11-Ipme Phone: 934-9904
Drive South, Chanhassen, 55317
Date to Council Research:
Pubiic Hearing Date: � 28 Labels Ordered: /��
Notice Sent to Applica�t: District Council #: `�
Notice Sent to Public: ` �� Y�� Ward #: o`
Department/ Date Inspections Comments
,
Ciry Attorney
f" '�'r�l�— Q.
Environmental
Health
N�� �
Fire
5 -� •`��- ���, .
License Site Plan Received:_
Lease Received:
� {�� l a� b ��
Police
5 • � -`� �- o.� .
Zoning
� � �`� �' O . � •
l/
CLASS III
LIGENSE APPLICATION
P yevia�rs�y /����
THIS APPLICATION IS SUBJECT TO RE�W BY TI-IE PUBLIC
PLEASE TYPE OR PRINT IN INK
s) being applied for:
CITY OF SAINT PAUL
office atL��nse, l,upenions
ana En.iramnrnw Proun;on
350 A Pqc R Smk 300
�.+�Paut�timesob SSI03
C611)2Eb9p9p !sx(6111166-91:d
S :3 I `1. L�>
s
Company Nazne:
/ Partnetahip / Sole
If business is incorporated, give date of incorporation:
Doing Business As:
Business Address:
BusinessPhone: 6/z 3y/
HAI S�5'�IO Z_
�./��,J bfe � � City Slate Zip
Behveen what cross streets is the business loc�ed? J+ckso✓ sTK• � S- �/� �. W}uch side of the street7 L��I
Are the premises now occupied7 � What TyPe of Business9 /'�k�n�� �.�s!/.'
Mail To Address: � 0 Sa�nr �� S�✓�'t �5..� k 7/� /y�/5 .�jn/ SS'`� 2.
ApQlicant Infom
Name and TiUe:
Home Address:
sv� aaa.�
c�,✓l Gc
F� :waai�
�7Z_ C'�«,�SSP.
Sc ��„
.�
(Maiden)
� s�« rp
P� ��aG,.,�, ! �MG r:
—_�
iU.l('�.��,I�c, S ��lN SS 7 (
Stsxt Addreas Cily
Date of B'uth: I�-' Z 1`�� P1ace of Birth:�v�✓P� v. I( P. ��^/�
�
Have you ever been ameicted of any felony, crime or violation of any ciry ordinance other than traffic
Date of azrest:
Chazge: !
Comiclion:
Srntrnce:
State Zip
HomePhone�' �`j3 /— I �
7 YES _ NO �/
Lisl tHe names and residences of three persons of good moral chazacter, living within the Twin Cities Meiro Are� not related to the applicant
or financially interested in the premises or business, who may be refeaed to as to the applicanYs character:
NA ADDRESS / (� PHONE
��/ Y`��` I'rk� b 7)V �.c �7f�5�M lJ�'/ �N4✓h4�i"` %3(tJ'�7��V�
��.,.� w;�45+., �� ���� ci..�.�.�;s�.. r-�.��is /�c.�, k4s�e 93��- �797
�
✓•t� �r�vr�� `(LI ��Gue�.<P 1/,�-uP �iS //�'°�atS 571 �SC��.
List icenses which you currendy hold, fo�merly held, or may have an interest in:
Ha�•e any of the above named licenses ever been revoked7 YES NO If yes, list the dates and reasons for revocation:
Wherel
2/18i97
,.,.. _�-, � ._ ' � -
Are you going to operue this business personaqy7 V YES NO Sf not, uho «�ill operate it?
Fi�at .�'�e
Are you
piease c
SSSeeI \ame
to ha��e a managa aravistam in this business?
:te the following infonnation:
�. �, . T � ,.
T�.''*..,. � 9a 9 P
Cih
���
I,alt
Stale
��; �'p ��
'�b'?$ •
DsuafBirth � :� ��
PF�on< Num6cr
NO If the manager is not the sazne as the operator,
FurtName Middleinitid Q.Sniden) Last deteofBirth
�0�?� 1ZD(3t1J54tJ�,t1�� tD (2ff[�l� �� SS�3'� 3��'�
I3omc Addttss: StxxeeName City Stale Zip Phone \w�ba
Please list your emplo}mrnt history for the pre��ious five (5) } eu period:
Address
> 0 5�.✓dZ
List all other officers of the carporation:
OFFICER TITLE HOME
NAME (O�'ice Held) ADDRESS
_ :1 �/� ,l•, r, 1
IJ SS�DZ
HOME BUSINESS DATE OF
PHOIdE PHONE BIRTH
If business is a partnerslrip, please include the following informataon for each partner (use additional pages if necessary):
F'uri Ivame Middle lnitiel (Maiden) Last Datc of Bvth
HomeAddrcv: SixetNeme City Stete Zip Phon�Number
Fintt�ame MiddleInitiel (4laidrn) Lest Dete
Home Addteaa: Street Neme Gty Stn4 Zip P6one Number
MINNESOTA TAX IDENTff ICATION NtJMBER - Pursuant to ttte Laws of Minnesot� 1984, Chapter 502, Article &, Seclion 2(270J2)
(fa� Cleazance; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the
Minnesota business tae identification number and the social security number of each license applicant.
Under the Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following
regarding the use of the Mumesota Tax Identification Number:
- This information may be used to deny the issuance or renewal of your license in the event you ome Minnesota sales, employei s
witl�holding or motor vehicle �cise taxes;
- Upon receiving tivs infoimation, 4�e licensin$ authority v.�31 supply it only to the Minnesota Departrnent of Revenue. However,
uztder the Federal Exchange of tnformation Agreemrnt, the Departrnent of Revenue may supply this infomiation to the Internal
Revenue Service.
Ivvnnesata Ta�c Identificarion Numbers (Sales & Use Ta�r Number) may be obtained from the State of Minne�o�a, $usiness Records Department,
10 Rieer Park Plaza (612-296-6181).
Minnesota Tax IdentiScation Number: G�� ��� "`
Social Security Number:
If a Minnesota Tax Idenlification I3umber is not required for the business being operateci, indicate so by placing an "X" in the box.
2/78.'97
Council File � `���
Ordinance #
Green Sheet # �?���
,- �-.
Presented
1
2
3
Referred To
RESOLUTIOW
SAINT PAUL, MWNESOTA
Committees Date
�b
RESOLVED: �lication (ID #59113) for a Pazldng Lot/Ramp License by Jmperial Parking Inc. DBA
Imperial Pazldng (Paul Schnettler, Regional Manager) at 175 Sth Sireet East be and the same is
herebY apPrwed.
4
5 Requested by Department of:
6 Y a� Navs Absent
7 B a __3_/
8 Bostrom �7�- Of£'ce of Licenae YnsR.ections and
9 arr.zs Fnvironmenta� Protection
10 Me a� �
11 ��y,1,�_ �-
12 unTh e
13 or on
14 ����1-.`^""^'^." 3 ` 7 1� - ��X/C �
15
16 Adopted by Council: Date B Y' —�-
17
18 Adoption Certified by Council ecretary
19 Form Approved by City Attorney
20 � 2i By: a ✓ � g
22 /J By: � .,i: l \� u-Ir..- -
23 Approved by Ma� . Date <- �I�/�'
24
25 Approved by Mayor for Submission to
26 By: � Council
27
Bye
G�-to?�
�����
UER�RiMENTqFFlCHCOUNCIL DATE INITIATED J I J`"F `{
LIEP/Licensin G REEN SH EE
CONTACT PERSON & PNONE INITIAVOATE INITIAVDATE
�OEPARTMENTDIRECTOR �qTYCOUNCIL
Christine Rozek, 266-9108 A���N OCfTYATfORNEY �qTYCLERK
NUNBERFON
biUST BE ON CqUNCf� AGENDA BY (DATEj pp�NG O BUDGEf DIRECTOR � FIN. & MGT. SERVICE$ Dlfl.
For hearin ;��--� �� OflDEP O MqYOR (OF7ASSISTAt� �
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION RE�UESTED:
Imperial Parking Inc. Imperial Parking requests Council approval of its application for a
Parking Lot/Ramp License located at 175 Sth Street East (ID �I59113).
PECOMMENDAiIONS Approve (A) or iieject (R) PERSONAL SEHVICE CONTFiACTS MUST ANSWEFi THE FOLLOWING �UESTIONS:
_ PLPNNING COMMISSION � C��IL SERVICE COMMISSION �� Has this person/firm ever worked under a contract for this department?
_ CIB fAMMI7TEE _ ' YES NO
2. Has this personttirm ever been a city employee?
_ STAFF __ YES NO
_ DISiRICiCOURr , 3. Does this personlfirm passess a skill not nortnally possessed by any curtent ciry employee?
SUPPORT$ WHICH COUNCIL O&IECTNE? YES NO
Explain ell yes answers o� separate sheet antl attach W green sheet �'�
����": r9, qi
INITIATING PROBLEM, ISSUE, OPPORTUNIN (Who, What, When, Where, W�y): c '' �", °" �
AFR 29 1997
��'� � ������ EY
ADVANTAGESIFAPPROVED.
DISAOVANTAGES IF APPflOVED:
�i::� :, � = eeasJ�
__— _ " -� --_,-�a�
DISAOVANTAGES IP NOT APPROVED:
TOTAL AMOUN7 OFTRANSAC710N $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIfdG SOURCE AC7IVITV NUMBER
FINANCIAI INFORhSATION. (EXPLAIN)
l/
CLASS III
LIGENSE APPLICATION
P yevia�rs�y /����
THIS APPLICATION IS SUBJECT TO RE�W BY TI-IE PUBLIC
PLEASE TYPE OR PRINT IN INK
s) being applied for:
CITY OF SAINT PAUL
office atL��nse, l,upenions
ana En.iramnrnw Proun;on
350 A Pqc R Smk 300
�.+�Paut�timesob SSI03
C611)2Eb9p9p !sx(6111166-91:d
S :3 I `1. L�>
s
Company Nazne:
/ Partnetahip / Sole
If business is incorporated, give date of incorporation:
Doing Business As:
Business Address:
BusinessPhone: 6/z 3y/
HAI S�5'�IO Z_
�./��,J bfe � � City Slate Zip
Behveen what cross streets is the business loc�ed? J+ckso✓ sTK• � S- �/� �. W}uch side of the street7 L��I
Are the premises now occupied7 � What TyPe of Business9 /'�k�n�� �.�s!/.'
Mail To Address: � 0 Sa�nr �� S�✓�'t �5..� k 7/� /y�/5 .�jn/ SS'`� 2.
ApQlicant Infom
Name and TiUe:
Home Address:
sv� aaa.�
c�,✓l Gc
F� :waai�
�7Z_ C'�«,�SSP.
Sc ��„
.�
(Maiden)
� s�« rp
P� ��aG,.,�, ! �MG r:
—_�
iU.l('�.��,I�c, S ��lN SS 7 (
Stsxt Addreas Cily
Date of B'uth: I�-' Z 1`�� P1ace of Birth:�v�✓P� v. I( P. ��^/�
�
Have you ever been ameicted of any felony, crime or violation of any ciry ordinance other than traffic
Date of azrest:
Chazge: !
Comiclion:
Srntrnce:
State Zip
HomePhone�' �`j3 /— I �
7 YES _ NO �/
Lisl tHe names and residences of three persons of good moral chazacter, living within the Twin Cities Meiro Are� not related to the applicant
or financially interested in the premises or business, who may be refeaed to as to the applicanYs character:
NA ADDRESS / (� PHONE
��/ Y`��` I'rk� b 7)V �.c �7f�5�M lJ�'/ �N4✓h4�i"` %3(tJ'�7��V�
��.,.� w;�45+., �� ���� ci..�.�.�;s�.. r-�.��is /�c.�, k4s�e 93��- �797
�
✓•t� �r�vr�� `(LI ��Gue�.<P 1/,�-uP �iS //�'°�atS 571 �SC��.
List icenses which you currendy hold, fo�merly held, or may have an interest in:
Ha�•e any of the above named licenses ever been revoked7 YES NO If yes, list the dates and reasons for revocation:
Wherel
2/18i97
,.,.. _�-, � ._ ' � -
Are you going to operue this business personaqy7 V YES NO Sf not, uho «�ill operate it?
Fi�at .�'�e
Are you
piease c
SSSeeI \ame
to ha��e a managa aravistam in this business?
:te the following infonnation:
�. �, . T � ,.
T�.''*..,. � 9a 9 P
Cih
���
I,alt
Stale
��; �'p ��
'�b'?$ •
DsuafBirth � :� ��
PF�on< Num6cr
NO If the manager is not the sazne as the operator,
FurtName Middleinitid Q.Sniden) Last deteofBirth
�0�?� 1ZD(3t1J54tJ�,t1�� tD (2ff[�l� �� SS�3'� 3��'�
I3omc Addttss: StxxeeName City Stale Zip Phone \w�ba
Please list your emplo}mrnt history for the pre��ious five (5) } eu period:
Address
> 0 5�.✓dZ
List all other officers of the carporation:
OFFICER TITLE HOME
NAME (O�'ice Held) ADDRESS
_ :1 �/� ,l•, r, 1
IJ SS�DZ
HOME BUSINESS DATE OF
PHOIdE PHONE BIRTH
If business is a partnerslrip, please include the following informataon for each partner (use additional pages if necessary):
F'uri Ivame Middle lnitiel (Maiden) Last Datc of Bvth
HomeAddrcv: SixetNeme City Stete Zip Phon�Number
Fintt�ame MiddleInitiel (4laidrn) Lest Dete
Home Addteaa: Street Neme Gty Stn4 Zip P6one Number
MINNESOTA TAX IDENTff ICATION NtJMBER - Pursuant to ttte Laws of Minnesot� 1984, Chapter 502, Article &, Seclion 2(270J2)
(fa� Cleazance; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the
Minnesota business tae identification number and the social security number of each license applicant.
Under the Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following
regarding the use of the Mumesota Tax Identification Number:
- This information may be used to deny the issuance or renewal of your license in the event you ome Minnesota sales, employei s
witl�holding or motor vehicle �cise taxes;
- Upon receiving tivs infoimation, 4�e licensin$ authority v.�31 supply it only to the Minnesota Departrnent of Revenue. However,
uztder the Federal Exchange of tnformation Agreemrnt, the Departrnent of Revenue may supply this infomiation to the Internal
Revenue Service.
Ivvnnesata Ta�c Identificarion Numbers (Sales & Use Ta�r Number) may be obtained from the State of Minne�o�a, $usiness Records Department,
10 Rieer Park Plaza (612-296-6181).
Minnesota Tax IdentiScation Number: G�� ��� "`
Social Security Number:
If a Minnesota Tax Idenlification I3umber is not required for the business being operateci, indicate so by placing an "X" in the box.
2/78.'97
Council File � `���
Ordinance #
Green Sheet # �?���
,- �-.
Presented
1
2
3
Referred To
RESOLUTIOW
SAINT PAUL, MWNESOTA
Committees Date
�b
RESOLVED: �lication (ID #59113) for a Pazldng Lot/Ramp License by Jmperial Parking Inc. DBA
Imperial Pazldng (Paul Schnettler, Regional Manager) at 175 Sth Sireet East be and the same is
herebY apPrwed.
4
5 Requested by Department of:
6 Y a� Navs Absent
7 B a __3_/
8 Bostrom �7�- Of£'ce of Licenae YnsR.ections and
9 arr.zs Fnvironmenta� Protection
10 Me a� �
11 ��y,1,�_ �-
12 unTh e
13 or on
14 ����1-.`^""^'^." 3 ` 7 1� - ��X/C �
15
16 Adopted by Council: Date B Y' —�-
17
18 Adoption Certified by Council ecretary
19 Form Approved by City Attorney
20 � 2i By: a ✓ � g
22 /J By: � .,i: l \� u-Ir..- -
23 Approved by Ma� . Date <- �I�/�'
24
25 Approved by Mayor for Submission to
26 By: � Council
27
Bye
G�-to?�
�����
UER�RiMENTqFFlCHCOUNCIL DATE INITIATED J I J`"F `{
LIEP/Licensin G REEN SH EE
CONTACT PERSON & PNONE INITIAVOATE INITIAVDATE
�OEPARTMENTDIRECTOR �qTYCOUNCIL
Christine Rozek, 266-9108 A���N OCfTYATfORNEY �qTYCLERK
NUNBERFON
biUST BE ON CqUNCf� AGENDA BY (DATEj pp�NG O BUDGEf DIRECTOR � FIN. & MGT. SERVICE$ Dlfl.
For hearin ;��--� �� OflDEP O MqYOR (OF7ASSISTAt� �
TOTAL # OF SIGNATURE PAGES (CLIP ALL LOCATIONS FOR SIGNATURE)
ACTION RE�UESTED:
Imperial Parking Inc. Imperial Parking requests Council approval of its application for a
Parking Lot/Ramp License located at 175 Sth Street East (ID �I59113).
PECOMMENDAiIONS Approve (A) or iieject (R) PERSONAL SEHVICE CONTFiACTS MUST ANSWEFi THE FOLLOWING �UESTIONS:
_ PLPNNING COMMISSION � C��IL SERVICE COMMISSION �� Has this person/firm ever worked under a contract for this department?
_ CIB fAMMI7TEE _ ' YES NO
2. Has this personttirm ever been a city employee?
_ STAFF __ YES NO
_ DISiRICiCOURr , 3. Does this personlfirm passess a skill not nortnally possessed by any curtent ciry employee?
SUPPORT$ WHICH COUNCIL O&IECTNE? YES NO
Explain ell yes answers o� separate sheet antl attach W green sheet �'�
����": r9, qi
INITIATING PROBLEM, ISSUE, OPPORTUNIN (Who, What, When, Where, W�y): c '' �", °" �
AFR 29 1997
��'� � ������ EY
ADVANTAGESIFAPPROVED.
DISAOVANTAGES IF APPflOVED:
�i::� :, � = eeasJ�
__— _ " -� --_,-�a�
DISAOVANTAGES IP NOT APPROVED:
TOTAL AMOUN7 OFTRANSAC710N $ COST/REVENUE BUDGETED (CIRCLE ONE) YES NO
FUNDIfdG SOURCE AC7IVITV NUMBER
FINANCIAI INFORhSATION. (EXPLAIN)
Greensneet # 37944 L.I.E.P. REVIEW CHECKLIST Date: 4/25197 ��� bZSS
In Tracker? npp'n Flecerved / app'n arocessed
License ID # 59113 License Type: Parking Lot/Ramp
Company Name: Imperial ParkinQ Inc. DBA: Imnerial Parkine _____
Business Addresss: 175 Sth Street East Business Phone: 341-8000
Contact NamefAddr2ss: Paul Schnettler, 8572 Chanhassen Hi11-Ipme Phone: 934-9904
Drive South, Chanhassen, 55317
Date to Council Research:
Pubiic Hearing Date: � 28 Labels Ordered: /��
Notice Sent to Applica�t: District Council #: `�
Notice Sent to Public: ` �� Y�� Ward #: o`
Department/ Date Inspections Comments
,
Ciry Attorney
f" '�'r�l�— Q.
Environmental
Health
N�� �
Fire
5 -� •`��- ���, .
License Site Plan Received:_
Lease Received:
� {�� l a� b ��
Police
5 • � -`� �- o.� .
Zoning
� � �`� �' O . � •
l/
CLASS III
LIGENSE APPLICATION
P yevia�rs�y /����
THIS APPLICATION IS SUBJECT TO RE�W BY TI-IE PUBLIC
PLEASE TYPE OR PRINT IN INK
s) being applied for:
CITY OF SAINT PAUL
office atL��nse, l,upenions
ana En.iramnrnw Proun;on
350 A Pqc R Smk 300
�.+�Paut�timesob SSI03
C611)2Eb9p9p !sx(6111166-91:d
S :3 I `1. L�>
s
Company Nazne:
/ Partnetahip / Sole
If business is incorporated, give date of incorporation:
Doing Business As:
Business Address:
BusinessPhone: 6/z 3y/
HAI S�5'�IO Z_
�./��,J bfe � � City Slate Zip
Behveen what cross streets is the business loc�ed? J+ckso✓ sTK• � S- �/� �. W}uch side of the street7 L��I
Are the premises now occupied7 � What TyPe of Business9 /'�k�n�� �.�s!/.'
Mail To Address: � 0 Sa�nr �� S�✓�'t �5..� k 7/� /y�/5 .�jn/ SS'`� 2.
ApQlicant Infom
Name and TiUe:
Home Address:
sv� aaa.�
c�,✓l Gc
F� :waai�
�7Z_ C'�«,�SSP.
Sc ��„
.�
(Maiden)
� s�« rp
P� ��aG,.,�, ! �MG r:
—_�
iU.l('�.��,I�c, S ��lN SS 7 (
Stsxt Addreas Cily
Date of B'uth: I�-' Z 1`�� P1ace of Birth:�v�✓P� v. I( P. ��^/�
�
Have you ever been ameicted of any felony, crime or violation of any ciry ordinance other than traffic
Date of azrest:
Chazge: !
Comiclion:
Srntrnce:
State Zip
HomePhone�' �`j3 /— I �
7 YES _ NO �/
Lisl tHe names and residences of three persons of good moral chazacter, living within the Twin Cities Meiro Are� not related to the applicant
or financially interested in the premises or business, who may be refeaed to as to the applicanYs character:
NA ADDRESS / (� PHONE
��/ Y`��` I'rk� b 7)V �.c �7f�5�M lJ�'/ �N4✓h4�i"` %3(tJ'�7��V�
��.,.� w;�45+., �� ���� ci..�.�.�;s�.. r-�.��is /�c.�, k4s�e 93��- �797
�
✓•t� �r�vr�� `(LI ��Gue�.<P 1/,�-uP �iS //�'°�atS 571 �SC��.
List icenses which you currendy hold, fo�merly held, or may have an interest in:
Ha�•e any of the above named licenses ever been revoked7 YES NO If yes, list the dates and reasons for revocation:
Wherel
2/18i97
,.,.. _�-, � ._ ' � -
Are you going to operue this business personaqy7 V YES NO Sf not, uho «�ill operate it?
Fi�at .�'�e
Are you
piease c
SSSeeI \ame
to ha��e a managa aravistam in this business?
:te the following infonnation:
�. �, . T � ,.
T�.''*..,. � 9a 9 P
Cih
���
I,alt
Stale
��; �'p ��
'�b'?$ •
DsuafBirth � :� ��
PF�on< Num6cr
NO If the manager is not the sazne as the operator,
FurtName Middleinitid Q.Sniden) Last deteofBirth
�0�?� 1ZD(3t1J54tJ�,t1�� tD (2ff[�l� �� SS�3'� 3��'�
I3omc Addttss: StxxeeName City Stale Zip Phone \w�ba
Please list your emplo}mrnt history for the pre��ious five (5) } eu period:
Address
> 0 5�.✓dZ
List all other officers of the carporation:
OFFICER TITLE HOME
NAME (O�'ice Held) ADDRESS
_ :1 �/� ,l•, r, 1
IJ SS�DZ
HOME BUSINESS DATE OF
PHOIdE PHONE BIRTH
If business is a partnerslrip, please include the following informataon for each partner (use additional pages if necessary):
F'uri Ivame Middle lnitiel (Maiden) Last Datc of Bvth
HomeAddrcv: SixetNeme City Stete Zip Phon�Number
Fintt�ame MiddleInitiel (4laidrn) Lest Dete
Home Addteaa: Street Neme Gty Stn4 Zip P6one Number
MINNESOTA TAX IDENTff ICATION NtJMBER - Pursuant to ttte Laws of Minnesot� 1984, Chapter 502, Article &, Seclion 2(270J2)
(fa� Cleazance; Issuance of Licenses), licensing authorities are required to provide to the State of Minnesota Commissioner of Revenue, the
Minnesota business tae identification number and the social security number of each license applicant.
Under the Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following
regarding the use of the Mumesota Tax Identification Number:
- This information may be used to deny the issuance or renewal of your license in the event you ome Minnesota sales, employei s
witl�holding or motor vehicle �cise taxes;
- Upon receiving tivs infoimation, 4�e licensin$ authority v.�31 supply it only to the Minnesota Departrnent of Revenue. However,
uztder the Federal Exchange of tnformation Agreemrnt, the Departrnent of Revenue may supply this infomiation to the Internal
Revenue Service.
Ivvnnesata Ta�c Identificarion Numbers (Sales & Use Ta�r Number) may be obtained from the State of Minne�o�a, $usiness Records Department,
10 Rieer Park Plaza (612-296-6181).
Minnesota Tax IdentiScation Number: G�� ��� "`
Social Security Number:
If a Minnesota Tax Idenlification I3umber is not required for the business being operateci, indicate so by placing an "X" in the box.
2/78.'97