Application for On-Sale Intoxicating Liquor License
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This form was prepared by the Minnesota Bureau of Criminal Apprehension,
Department of Public Safety, pursuant of background investigation. It
does not supercede any laws, rules or regulations of the Division of
Liquor Control regarding the issuance of liquor licenses. Failure to
provide information requested may result in denial of the application.

Trade Name________________________________  Date of Application_______
Licensing period__________________________
1. Type of application    ___New ___Renewal ___Transfer
2. Name of applicant__________________________  Phone_________________
3. Home address_______________________________________________________
   City_____________________________  State_________________
4. Date of birth______________  Place of birth________________________
5. Address of business location_______________________________________
6. Legal description__________________________________________________
7. List of owners of building or premise to be licensed:______________
   ___________________________________________________________________
   ___________________________________________________________________
8. Corporate or partnership title_____________________________________
9. Corporate of partnership address___________________________________
10. List all partners, officers or directors, if corporation:
    Name                  Address                     Date of Birth
    ____________________  _________________________   ________________

    ____________________  _________________________   ________________

    ____________________  _________________________   ________________

    ____________________  _________________________   ________________

    ____________________  _________________________   ________________
11. If this is a transfer application give name, address, or persons,
    partnership or corporation holding license for the past year.
    __________________________________________________________________
    __________________________________________________________________
12. Who owns the tavern fixtures?_____________________________________
13. What vending or mechanical amusement company has or will have
    machines on the licensed premise?_________________________________
14. Are you a Minnesota resident? (__)Yes (__)No  
    dates of residency  from______to________
    if not, where resident:___________________________________________
15. Have you ever been convicted of violating Federal, State or Local
    liquor laws and/or regulations? (__)Yes (__)No
    If yes, explain fully on a separate sheet of paper.
16. Applicant, and his associates in this application, will strictly
    comply with all the Laws of the State of Minnesota governing the
    taxation and the sale of intoxicating liquor; rules and regulations
    promulgated by the Liquor Control Commissioner; and all ordinances
    of the municipality; and I hereby certify that I have read the
    foregoing questions and that the answers to said questions are true
    of my own knowledge. I further understand that an investigation fee
    not to exceed $500.00 shall be charged an applicant by the city or
    county if the investigation is conducted within the state, or the
    cost not to exceed $10,000.00 if the investigation is required
    outside the state.
     
                       Signature of Applicant_________________________

Subscribed and sworn to before me this
____________day of______________20___
Notary public_________________________
My commision expires__________________