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97-634Council File # �_ `=`� � Ordinance # Green Sheet # � / �� ,�-°, ° � � : F\ �. . . . ,` =� : i ai :i_ Presented By Referred To RESOLUTION CITY OF SAINT PAUL, MINNESOTA Committee: Date � 1 2 3 RESOLVED: That application (ID t(46066) for a Gas Station, Kestaurant-C, Grocery-C, and Cigarette License by Super America Group Division of Ashland DBA SuperAmerica #4413 (Clint E�wim, Manager) at 2051 Grand Avenue be and the same is hereby agproved. 4 5 Requested by Department of: 6 Yeas Nays sen 7 B a ey 8 Bostrom Off�ce of License Insgections a�7d 9 Har -�– 10 M ar �` nvironmental Protect�on 12 T une � 14 Morton �/� 15 By: � �^�..l.A��v�/ f� �� 16 Adopted by Council: Date �� \9 � 17 }�—� 18 Adoption Certified by Council Secretary 19 Form Approved by City Attorney 20 {� 21 BY: a– \ \� �- 22 � ` — 8Y. `'C'G'_' '-� 23 Approved by Mayor: Date �F �( }� 24 25 Approved by Mayor for Submission to Z6 BY: . Council 27 Bya ��b3H ��»�.,,��N�� DATEINITIATEO GREEN SHEE s � �� r LIEP/Licensin CONTACiPEp50N8PHONE �DEPAflTMENTDIRECfOR �CRYCOUNCIL �NITIAV�ATE Christine Rozek, 266-9108 N OCITYATlORNEY aCINCLERK MUST BE ON COUNCILA6ENM BV (DAT qOUTING � BUDGET DIRECTOfl � FIN. & MGT. SERVICES DIR. For hearin : � Zb �� R O�YOR(OflA$SISTANTJ � TOTAL # OF SIGNATURE PAGES (CUP ALL IOCAT(ONS FOR SIGNATURE) ACifON REQUESTED: The SuperAmerica Group Division of Ashland DBA SuperAmerica �f4413 requests Council approval of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License located at 2051 Grand Avenue (ID 1146066). FEGOMMENDATIONS: Approve (A) ar Rejett (R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING �UESTIONS: _ PLANNING COMMISSION _ CIVII SERVICE COMMISSION �� Has this person/Firm ever worked under a contrect for this department? _ CIB COMMffTEE _ VES NO _ S7AFF 2_ Has ihis personhrtm ever baen a ciTy employee? — YES NO _ o�S7Rlc7 COUFi _ 3. Does this personRirm possess a skill not normally possessed by any curcent ciry employea? SUPPORTS WHIGH COUNpL O&IECTIVE? YES NO Explain all yes answers on separate sheet and attach to graen sMcet INITIATING PROBLEM.ISSUE, OPP�RTUNIN(Who, Whet, Whan, Where, Why). AOYANTAGESIFAPPROVED. DISADVANTAGES IF APPROVED DISAOVANTAGES IF PiOT APPROVED: V"��.�.v(�9 ��a`(i+a5!Yde� p�f�y�i� �'y: ? :� 6�� TO7AL AMOUNT OF TRANSAC710N $ COST/REVENUE BUDGE7ED (CIRCLE ONE) YES NO FUNDIfiG SOUfiCE ACTIVIiY NUMBER FINANCIAL INFORhfATION: (EXPLAIN) Greensneet # 37936 L.I.E.P. REVIEW CHECKLIST Date: 3/z7/97 i`�� In Tracken app•n Receaed / aap Processed L3censelD # 46066 LiCense Type: Gas Station, Restaurant-C, Grocerv-C, and Cigaret_e 7.ice Company Name:SuperAmerica Group Division of Ashland _ DBA: SuperAmerica 9i4413 Business Addresss: z051 Grand Avenue Business Phone: 698-9384 Comact Name/Address: Clint Egwim, 2051 Grand Avenue, 105 }iome Phone: Date to Council Research: Public Hearing Date: � �?� �� Notice Sent to Appiicant: /' �� a� Notice Sent to Public:_ __ �"" / �� Labels Ordered: District Council #: � _ Ward #: 7' Department/ Date Inspections Commenis City Attorney �•z -9 � o. K . Environmental Health 1� �t� • Fire 5�•2•��- O� . License �� an �� Lease Received: �� j �� e �� Poiice 5 • � ' `� �- r�. K, • Zoning � • 2 •`� �- O .1C, . MAR-19-1997 11�98 C CITY OF ST PRUL LIEP -----, • G--a� - CI.,ASS � CITY OF SAINT PAUI.. o�oru«�� LICENSE APFLICATION �� $�� 1 � T � / � �� ' ��i ; �cZO� T�+�^'�. 1 ^�- t `/T��l tau�zsssoxsac�2ss9ize �s � ` ��' S ��t�i�� f "� f '� �'r tf �f� -S '' P�.Fd SE �'YPE OR PRINT TN 7NK � of Liceose(s) beu� applied for: CompffiyName: .��}� �(� 1� WtL Kf C.`i� Corpofition l PaRnailiip ! Sok Psap+ianasL'sp If 3usiness is incorporated, give date of inwipozatioa: _ 1�oia8 $usiness As: 5,�, ��, e �1til�L � 1 GQ sc«: a.a�c ct�y Betwaa what c.ross sheet5 is the busness located7 Are the prewises aow acc� ied7 �fsa1 Type G of Busiuess? Ma� To P.ddcess: ,_„� V O V 7c1 ��VU i L.e ��c�m �Ad�a. . �o,� n«. z, Whick si& of the su�eet? h•�^ 7,;p x� � r,��: �i (�-�7/If�—J u3? �t.ra� c: v.q�w�s �tA�t�sl�t � �w�. s�u :a,am� m�am� I.�., rek x�aaa��: � C� Q f��/U D d' �� Date of Binh: l I �(e � V'� Place of $irth: Home Phone:�a6 b 3 S�1 :? Z i3 Have }rov ever bcea comicted of anq fclotcy, aime or violation of any city ordinance other than traffic1 YES NO _� Date of srcest: Where7 Charge: Coavictio¢: 5rntaicr I.istihe nam�s �d n�sidences of tbree peisons o€good moral chazacter, &ving within ihe Twin Cities Metro Area, not Klatod to the applicant or 5nxnaially interested ia the premises otbnsiness, who msy ix rc�'ared to as to the applicants chsrader. NAME ADDRESS PHONE �Aa�1 /I�eR�t,►S - ty��0-yaND S7.�S . �l�-}��- G,l�-`13L-.s3a7 ��L:7.�l�aa��i ii�LO1?.� C u ��'.i"`�#�.�'.�! ..�, .�"'�� •c�a i� 1 .i►J.i ��. ._.�_�:�� .:.� �� 612 266 s ��i� � s bj�:d G � AiGw Rn � w1 _.luv L t]. have an iAteCe �t in: YES � xo If yes, lise th� daus �d re.awns Sor moearioa: ?/18N9 MRR-19-1997 11�08 CITY pF ST PAUL LIEP 612 266 9124 P.04/06 , c�Z b3� Are � ou going .o opermc this business pasonallp? � YES _./G� NO If aot, �rho w9U npaste �'�IPER AMSRICAGROtI�' y �,s�ess/Emoto�a�cat Address is firavme far each pazma (use addisional FaBes if nxzsss�`)= A+� Hv'e Add+cu� Saecc \xine Crty S�c Z�P �� ``'mm�' Fi�a\mc !�ddfcffiiial 4��) Last D�of9ash HxuAd&+w� Saea'.'.mu CflY Suu Zip Phone!.`wsbet MINI�SO7A I'AX IDENI7FICATION NUMBER - P�usuant w the Isw•s of Nfia.+iesota, i 984, Chapur SQ2, Articic $, Sxtioa 2(270.72} (Ta�c Ckeraace; tssuance of Licenses), &ansing surhorities are requued W provide to the State of Msnuesota Commissioaer of Revmue, the Mmnaotabusinessta�c id�uufificationn�mtbtt aAdthe sfleisi stcuzirya�ber of cachlic.euse appficent Uuder tLe M�aaesotz Govec�ent Data Piac2ices Aa and tbe federal Pricacy Ad of 1974, we sre requSr�d to advise you ofthe follaw�ing regar3mg the use ofthe MnmesotsT�cIdeoti�cafionl3tuaber. - Ilvs infamation may be usaS �o &enp the issvaaa a renewsI of yo� 2ic�c in the rveat you owe Mumesots sales, emPloS'ei s witbhold'uig a m0� vd�icle exase t�ce� - UP°n �ei�'m8 this izff�rms¢aa, tlie licensiag sathairy w�71 svpply it oaly to tiu Muureswa 7kParmxat o£Reveoue. Hawevec, undct the Fedecat £sc3�g� of Info:mation A�� the Depa:tmmt of Reveaue maY ?'��P�S this int'orma5on m t7� Smaaa3 Aevecue Seiifix ' ^ �a Yax IdmtiSr�iatNumbas (Sa�es & ISse Tax Numlxr) maybe obtamed &om tbe State of M�nnaota, Business Records Depaztmes�t. SOAivaParkPlaza(612-296-6181} __.. . _. sa;� s�ri rr,��: �� /- G/.��5 U_��u r� ram�u� rr�t�: �� 7.3 �s ffa Mmnesota Tsx IdrntiScacoa Numba ss aot rcguired for 4a businas being opaated, indieau so by placing aa'X' ia ihe box ", e �, PSrzu listyour emplo;mwt histmy for tfie prc��iau five (5) cear pmod: Lis� z11 otha o�5cecs of the caporation ��SCEX 'iTTS.E gO?vtE H0� BUSL.rESS DAT£ OF �*et,.tc �[Y,ficrT-ietrll . AD�R�SS PHOVE PHOA� BIRTH Ate rw �3to �tce a�mz3er oresss.z�c in ilvs bvsiness? YES ;v0 If tbe msaaga is not the szme ts the opaator, Pleuc waaPlece che follouing iaf�xmation: Council File # �_ `=`� � Ordinance # Green Sheet # � / �� ,�-°, ° � � : F\ �. . . . ,` =� : i ai :i_ Presented By Referred To RESOLUTION CITY OF SAINT PAUL, MINNESOTA Committee: Date � 1 2 3 RESOLVED: That application (ID t(46066) for a Gas Station, Kestaurant-C, Grocery-C, and Cigarette License by Super America Group Division of Ashland DBA SuperAmerica #4413 (Clint E�wim, Manager) at 2051 Grand Avenue be and the same is hereby agproved. 4 5 Requested by Department of: 6 Yeas Nays sen 7 B a ey 8 Bostrom Off�ce of License Insgections a�7d 9 Har -�– 10 M ar �` nvironmental Protect�on 12 T une � 14 Morton �/� 15 By: � �^�..l.A��v�/ f� �� 16 Adopted by Council: Date �� \9 � 17 }�—� 18 Adoption Certified by Council Secretary 19 Form Approved by City Attorney 20 {� 21 BY: a– \ \� �- 22 � ` — 8Y. `'C'G'_' '-� 23 Approved by Mayor: Date �F �( }� 24 25 Approved by Mayor for Submission to Z6 BY: . Council 27 Bya ��b3H ��»�.,,��N�� DATEINITIATEO GREEN SHEE s � �� r LIEP/Licensin CONTACiPEp50N8PHONE �DEPAflTMENTDIRECfOR �CRYCOUNCIL �NITIAV�ATE Christine Rozek, 266-9108 N OCITYATlORNEY aCINCLERK MUST BE ON COUNCILA6ENM BV (DAT qOUTING � BUDGET DIRECTOfl � FIN. & MGT. SERVICES DIR. For hearin : � Zb �� R O�YOR(OflA$SISTANTJ � TOTAL # OF SIGNATURE PAGES (CUP ALL IOCAT(ONS FOR SIGNATURE) ACifON REQUESTED: The SuperAmerica Group Division of Ashland DBA SuperAmerica �f4413 requests Council approval of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License located at 2051 Grand Avenue (ID 1146066). FEGOMMENDATIONS: Approve (A) ar Rejett (R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING �UESTIONS: _ PLANNING COMMISSION _ CIVII SERVICE COMMISSION �� Has this person/Firm ever worked under a contrect for this department? _ CIB COMMffTEE _ VES NO _ S7AFF 2_ Has ihis personhrtm ever baen a ciTy employee? — YES NO _ o�S7Rlc7 COUFi _ 3. Does this personRirm possess a skill not normally possessed by any curcent ciry employea? SUPPORTS WHIGH COUNpL O&IECTIVE? YES NO Explain all yes answers on separate sheet and attach to graen sMcet INITIATING PROBLEM.ISSUE, OPP�RTUNIN(Who, Whet, Whan, Where, Why). AOYANTAGESIFAPPROVED. DISADVANTAGES IF APPROVED DISAOVANTAGES IF PiOT APPROVED: V"��.�.v(�9 ��a`(i+a5!Yde� p�f�y�i� �'y: ? :� 6�� TO7AL AMOUNT OF TRANSAC710N $ COST/REVENUE BUDGE7ED (CIRCLE ONE) YES NO FUNDIfiG SOUfiCE ACTIVIiY NUMBER FINANCIAL INFORhfATION: (EXPLAIN) Greensneet # 37936 L.I.E.P. REVIEW CHECKLIST Date: 3/z7/97 i`�� In Tracken app•n Receaed / aap Processed L3censelD # 46066 LiCense Type: Gas Station, Restaurant-C, Grocerv-C, and Cigaret_e 7.ice Company Name:SuperAmerica Group Division of Ashland _ DBA: SuperAmerica 9i4413 Business Addresss: z051 Grand Avenue Business Phone: 698-9384 Comact Name/Address: Clint Egwim, 2051 Grand Avenue, 105 }iome Phone: Date to Council Research: Public Hearing Date: � �?� �� Notice Sent to Appiicant: /' �� a� Notice Sent to Public:_ __ �"" / �� Labels Ordered: District Council #: � _ Ward #: 7' Department/ Date Inspections Commenis City Attorney �•z -9 � o. K . Environmental Health 1� �t� • Fire 5�•2•��- O� . License �� an �� Lease Received: �� j �� e �� Poiice 5 • � ' `� �- r�. K, • Zoning � • 2 •`� �- O .1C, . MAR-19-1997 11�98 C CITY OF ST PRUL LIEP -----, • G--a� - CI.,ASS � CITY OF SAINT PAUI.. o�oru«�� LICENSE APFLICATION �� $�� 1 � T � / � �� ' ��i ; �cZO� T�+�^'�. 1 ^�- t `/T��l tau�zsssoxsac�2ss9ize �s � ` ��' S ��t�i�� f "� f '� �'r tf �f� -S '' P�.Fd SE �'YPE OR PRINT TN 7NK � of Liceose(s) beu� applied for: CompffiyName: .��}� �(� 1� WtL Kf C.`i� Corpofition l PaRnailiip ! Sok Psap+ianasL'sp If 3usiness is incorporated, give date of inwipozatioa: _ 1�oia8 $usiness As: 5,�, ��, e �1til�L � 1 GQ sc«: a.a�c ct�y Betwaa what c.ross sheet5 is the busness located7 Are the prewises aow acc� ied7 �fsa1 Type G of Busiuess? Ma� To P.ddcess: ,_„� V O V 7c1 ��VU i L.e ��c�m �Ad�a. . �o,� n«. z, Whick si& of the su�eet? h•�^ 7,;p x� � r,��: �i (�-�7/If�—J u3? �t.ra� c: v.q�w�s �tA�t�sl�t � �w�. s�u :a,am� m�am� I.�., rek x�aaa��: � C� Q f��/U D d' �� Date of Binh: l I �(e � V'� Place of $irth: Home Phone:�a6 b 3 S�1 :? Z i3 Have }rov ever bcea comicted of anq fclotcy, aime or violation of any city ordinance other than traffic1 YES NO _� Date of srcest: Where7 Charge: Coavictio¢: 5rntaicr I.istihe nam�s �d n�sidences of tbree peisons o€good moral chazacter, &ving within ihe Twin Cities Metro Area, not Klatod to the applicant or 5nxnaially interested ia the premises otbnsiness, who msy ix rc�'ared to as to the applicants chsrader. NAME ADDRESS PHONE �Aa�1 /I�eR�t,►S - ty��0-yaND S7.�S . �l�-}��- G,l�-`13L-.s3a7 ��L:7.�l�aa��i ii�LO1?.� C u ��'.i"`�#�.�'.�! ..�, .�"'�� •c�a i� 1 .i►J.i ��. ._.�_�:�� .:.� �� 612 266 s ��i� � s bj�:d G � AiGw Rn � w1 _.luv L t]. have an iAteCe �t in: YES � xo If yes, lise th� daus �d re.awns Sor moearioa: ?/18N9 MRR-19-1997 11�08 CITY pF ST PAUL LIEP 612 266 9124 P.04/06 , c�Z b3� Are � ou going .o opermc this business pasonallp? � YES _./G� NO If aot, �rho w9U npaste �'�IPER AMSRICAGROtI�' y �,s�ess/Emoto�a�cat Address is firavme far each pazma (use addisional FaBes if nxzsss�`)= A+� Hv'e Add+cu� Saecc \xine Crty S�c Z�P �� ``'mm�' Fi�a\mc !�ddfcffiiial 4��) Last D�of9ash HxuAd&+w� Saea'.'.mu CflY Suu Zip Phone!.`wsbet MINI�SO7A I'AX IDENI7FICATION NUMBER - P�usuant w the Isw•s of Nfia.+iesota, i 984, Chapur SQ2, Articic $, Sxtioa 2(270.72} (Ta�c Ckeraace; tssuance of Licenses), &ansing surhorities are requued W provide to the State of Msnuesota Commissioaer of Revmue, the Mmnaotabusinessta�c id�uufificationn�mtbtt aAdthe sfleisi stcuzirya�ber of cachlic.euse appficent Uuder tLe M�aaesotz Govec�ent Data Piac2ices Aa and tbe federal Pricacy Ad of 1974, we sre requSr�d to advise you ofthe follaw�ing regar3mg the use ofthe MnmesotsT�cIdeoti�cafionl3tuaber. - Ilvs infamation may be usaS �o &enp the issvaaa a renewsI of yo� 2ic�c in the rveat you owe Mumesots sales, emPloS'ei s witbhold'uig a m0� vd�icle exase t�ce� - UP°n �ei�'m8 this izff�rms¢aa, tlie licensiag sathairy w�71 svpply it oaly to tiu Muureswa 7kParmxat o£Reveoue. Hawevec, undct the Fedecat £sc3�g� of Info:mation A�� the Depa:tmmt of Reveaue maY ?'��P�S this int'orma5on m t7� Smaaa3 Aevecue Seiifix ' ^ �a Yax IdmtiSr�iatNumbas (Sa�es & ISse Tax Numlxr) maybe obtamed &om tbe State of M�nnaota, Business Records Depaztmes�t. SOAivaParkPlaza(612-296-6181} __.. . _. sa;� s�ri rr,��: �� /- G/.��5 U_��u r� ram�u� rr�t�: �� 7.3 �s ffa Mmnesota Tsx IdrntiScacoa Numba ss aot rcguired for 4a businas being opaated, indieau so by placing aa'X' ia ihe box ", e �, PSrzu listyour emplo;mwt histmy for tfie prc��iau five (5) cear pmod: Lis� z11 otha o�5cecs of the caporation ��SCEX 'iTTS.E gO?vtE H0� BUSL.rESS DAT£ OF �*et,.tc �[Y,ficrT-ietrll . AD�R�SS PHOVE PHOA� BIRTH Ate rw �3to �tce a�mz3er oresss.z�c in ilvs bvsiness? YES ;v0 If tbe msaaga is not the szme ts the opaator, Pleuc waaPlece che follouing iaf�xmation: Council File # �_ `=`� � Ordinance # Green Sheet # � / �� ,�-°, ° � � : F\ �. . . . ,` =� : i ai :i_ Presented By Referred To RESOLUTION CITY OF SAINT PAUL, MINNESOTA Committee: Date � 1 2 3 RESOLVED: That application (ID t(46066) for a Gas Station, Kestaurant-C, Grocery-C, and Cigarette License by Super America Group Division of Ashland DBA SuperAmerica #4413 (Clint E�wim, Manager) at 2051 Grand Avenue be and the same is hereby agproved. 4 5 Requested by Department of: 6 Yeas Nays sen 7 B a ey 8 Bostrom Off�ce of License Insgections a�7d 9 Har -�– 10 M ar �` nvironmental Protect�on 12 T une � 14 Morton �/� 15 By: � �^�..l.A��v�/ f� �� 16 Adopted by Council: Date �� \9 � 17 }�—� 18 Adoption Certified by Council Secretary 19 Form Approved by City Attorney 20 {� 21 BY: a– \ \� �- 22 � ` — 8Y. `'C'G'_' '-� 23 Approved by Mayor: Date �F �( }� 24 25 Approved by Mayor for Submission to Z6 BY: . Council 27 Bya ��b3H ��»�.,,��N�� DATEINITIATEO GREEN SHEE s � �� r LIEP/Licensin CONTACiPEp50N8PHONE �DEPAflTMENTDIRECfOR �CRYCOUNCIL �NITIAV�ATE Christine Rozek, 266-9108 N OCITYATlORNEY aCINCLERK MUST BE ON COUNCILA6ENM BV (DAT qOUTING � BUDGET DIRECTOfl � FIN. & MGT. SERVICES DIR. For hearin : � Zb �� R O�YOR(OflA$SISTANTJ � TOTAL # OF SIGNATURE PAGES (CUP ALL IOCAT(ONS FOR SIGNATURE) ACifON REQUESTED: The SuperAmerica Group Division of Ashland DBA SuperAmerica �f4413 requests Council approval of its application for a Gas Station, Restaurant-C, Grocery-C, and Cigarette License located at 2051 Grand Avenue (ID 1146066). FEGOMMENDATIONS: Approve (A) ar Rejett (R) pERSONAL SERVICE CONTRACTS MUST ANSWER THE FOLLOWING �UESTIONS: _ PLANNING COMMISSION _ CIVII SERVICE COMMISSION �� Has this person/Firm ever worked under a contrect for this department? _ CIB COMMffTEE _ VES NO _ S7AFF 2_ Has ihis personhrtm ever baen a ciTy employee? — YES NO _ o�S7Rlc7 COUFi _ 3. Does this personRirm possess a skill not normally possessed by any curcent ciry employea? SUPPORTS WHIGH COUNpL O&IECTIVE? YES NO Explain all yes answers on separate sheet and attach to graen sMcet INITIATING PROBLEM.ISSUE, OPP�RTUNIN(Who, Whet, Whan, Where, Why). AOYANTAGESIFAPPROVED. DISADVANTAGES IF APPROVED DISAOVANTAGES IF PiOT APPROVED: V"��.�.v(�9 ��a`(i+a5!Yde� p�f�y�i� �'y: ? :� 6�� TO7AL AMOUNT OF TRANSAC710N $ COST/REVENUE BUDGE7ED (CIRCLE ONE) YES NO FUNDIfiG SOUfiCE ACTIVIiY NUMBER FINANCIAL INFORhfATION: (EXPLAIN) Greensneet # 37936 L.I.E.P. REVIEW CHECKLIST Date: 3/z7/97 i`�� In Tracken app•n Receaed / aap Processed L3censelD # 46066 LiCense Type: Gas Station, Restaurant-C, Grocerv-C, and Cigaret_e 7.ice Company Name:SuperAmerica Group Division of Ashland _ DBA: SuperAmerica 9i4413 Business Addresss: z051 Grand Avenue Business Phone: 698-9384 Comact Name/Address: Clint Egwim, 2051 Grand Avenue, 105 }iome Phone: Date to Council Research: Public Hearing Date: � �?� �� Notice Sent to Appiicant: /' �� a� Notice Sent to Public:_ __ �"" / �� Labels Ordered: District Council #: � _ Ward #: 7' Department/ Date Inspections Commenis City Attorney �•z -9 � o. K . Environmental Health 1� �t� • Fire 5�•2•��- O� . License �� an �� Lease Received: �� j �� e �� Poiice 5 • � ' `� �- r�. K, • Zoning � • 2 •`� �- O .1C, . MAR-19-1997 11�98 C CITY OF ST PRUL LIEP -----, • G--a� - CI.,ASS � CITY OF SAINT PAUI.. o�oru«�� LICENSE APFLICATION �� $�� 1 � T � / � �� ' ��i ; �cZO� T�+�^'�. 1 ^�- t `/T��l tau�zsssoxsac�2ss9ize �s � ` ��' S ��t�i�� f "� f '� �'r tf �f� -S '' P�.Fd SE �'YPE OR PRINT TN 7NK � of Liceose(s) beu� applied for: CompffiyName: .��}� �(� 1� WtL Kf C.`i� Corpofition l PaRnailiip ! Sok Psap+ianasL'sp If 3usiness is incorporated, give date of inwipozatioa: _ 1�oia8 $usiness As: 5,�, ��, e �1til�L � 1 GQ sc«: a.a�c ct�y Betwaa what c.ross sheet5 is the busness located7 Are the prewises aow acc� ied7 �fsa1 Type G of Busiuess? Ma� To P.ddcess: ,_„� V O V 7c1 ��VU i L.e ��c�m �Ad�a. . �o,� n«. z, Whick si& of the su�eet? h•�^ 7,;p x� � r,��: �i (�-�7/If�—J u3? �t.ra� c: v.q�w�s �tA�t�sl�t � �w�. s�u :a,am� m�am� I.�., rek x�aaa��: � C� Q f��/U D d' �� Date of Binh: l I �(e � V'� Place of $irth: Home Phone:�a6 b 3 S�1 :? Z i3 Have }rov ever bcea comicted of anq fclotcy, aime or violation of any city ordinance other than traffic1 YES NO _� Date of srcest: Where7 Charge: Coavictio¢: 5rntaicr I.istihe nam�s �d n�sidences of tbree peisons o€good moral chazacter, &ving within ihe Twin Cities Metro Area, not Klatod to the applicant or 5nxnaially interested ia the premises otbnsiness, who msy ix rc�'ared to as to the applicants chsrader. NAME ADDRESS PHONE �Aa�1 /I�eR�t,►S - ty��0-yaND S7.�S . �l�-}��- G,l�-`13L-.s3a7 ��L:7.�l�aa��i ii�LO1?.� C u ��'.i"`�#�.�'.�! ..�, .�"'�� •c�a i� 1 .i►J.i ��. ._.�_�:�� .:.� �� 612 266 s ��i� � s bj�:d G � AiGw Rn � w1 _.luv L t]. have an iAteCe �t in: YES � xo If yes, lise th� daus �d re.awns Sor moearioa: ?/18N9 MRR-19-1997 11�08 CITY pF ST PAUL LIEP 612 266 9124 P.04/06 , c�Z b3� Are � ou going .o opermc this business pasonallp? � YES _./G� NO If aot, �rho w9U npaste �'�IPER AMSRICAGROtI�' y �,s�ess/Emoto�a�cat Address is firavme far each pazma (use addisional FaBes if nxzsss�`)= A+� Hv'e Add+cu� Saecc \xine Crty S�c Z�P �� ``'mm�' Fi�a\mc !�ddfcffiiial 4��) Last D�of9ash HxuAd&+w� Saea'.'.mu CflY Suu Zip Phone!.`wsbet MINI�SO7A I'AX IDENI7FICATION NUMBER - P�usuant w the Isw•s of Nfia.+iesota, i 984, Chapur SQ2, Articic $, Sxtioa 2(270.72} (Ta�c Ckeraace; tssuance of Licenses), &ansing surhorities are requued W provide to the State of Msnuesota Commissioaer of Revmue, the Mmnaotabusinessta�c id�uufificationn�mtbtt aAdthe sfleisi stcuzirya�ber of cachlic.euse appficent Uuder tLe M�aaesotz Govec�ent Data Piac2ices Aa and tbe federal Pricacy Ad of 1974, we sre requSr�d to advise you ofthe follaw�ing regar3mg the use ofthe MnmesotsT�cIdeoti�cafionl3tuaber. - Ilvs infamation may be usaS �o &enp the issvaaa a renewsI of yo� 2ic�c in the rveat you owe Mumesots sales, emPloS'ei s witbhold'uig a m0� vd�icle exase t�ce� - UP°n �ei�'m8 this izff�rms¢aa, tlie licensiag sathairy w�71 svpply it oaly to tiu Muureswa 7kParmxat o£Reveoue. Hawevec, undct the Fedecat £sc3�g� of Info:mation A�� the Depa:tmmt of Reveaue maY ?'��P�S this int'orma5on m t7� Smaaa3 Aevecue Seiifix ' ^ �a Yax IdmtiSr�iatNumbas (Sa�es & ISse Tax Numlxr) maybe obtamed &om tbe State of M�nnaota, Business Records Depaztmes�t. SOAivaParkPlaza(612-296-6181} __.. . _. sa;� s�ri rr,��: �� /- G/.��5 U_��u r� ram�u� rr�t�: �� 7.3 �s ffa Mmnesota Tsx IdrntiScacoa Numba ss aot rcguired for 4a businas being opaated, indieau so by placing aa'X' ia ihe box ", e �, PSrzu listyour emplo;mwt histmy for tfie prc��iau five (5) cear pmod: Lis� z11 otha o�5cecs of the caporation ��SCEX 'iTTS.E gO?vtE H0� BUSL.rESS DAT£ OF �*et,.tc �[Y,ficrT-ietrll . AD�R�SS PHOVE PHOA� BIRTH Ate rw �3to �tce a�mz3er oresss.z�c in ilvs bvsiness? YES ;v0 If tbe msaaga is not the szme ts the opaator, Pleuc waaPlece che follouing iaf�xmation: