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1k. Liquor License Anh-Le Restaurant I r I CITYOF ---�-- is i .. 1 , 690 COULTER DRIVE • P.O. BOX 147 • CHANHASSEN, MINNESOTA 55317 (612) 937-1900 1 . I MEMORANDUM N,,I, s+ 1 TO: Don Ashworth, City Manager pate Submitted to Gimmisslon le FROM: Karen Engelhardt, Office Managerr. -- Dato submaicd to Councl IDATE: September 22 , 1988 ---2:1-2--L-44 —- SUBJ: Approval of Beer/Wine License, Anh-Le Restaurant, 566 West I78th Street I Attached please find a beer/wine license application from Chin Van Nguyen for the new oriental restaurant called Anh-Le opening in Town Square. The applicant hopes to open the restaurant on November 1, 1988. IAfter review'of the application, I find that everything is in order at this time. The Public Safety Director has conducted a Ibackground investigation on the applicant and recommends approval. The fee for this type of license is determined by state statute. I It is set at either one-half the on-sale intoxicating fee or $2 ,000 , whichever is less. In this case, the $2 ,000 fee is the least. The fee would be pro-rated rated for the number of months the restaurant is in operation during this license period (ending IApril 30 , 1989) . RECOMMENDATION IIt is the recommendation of this office to approve the beer/wine license application for the Anh-Le Restaurant contingent upon the following: I1 . Submission of liquor liability insurance. II2 . Payment of the pro-rated liquor license fee. II II I f ) 1 CITYOF 1 \i,t,..1\i,_ CHANHASSEN ,,,,,.... <_,,, ._ ,s: 690 COULTER DRIVE • P.O. BOX 147 • CHANHASSEN, MINNESOTA 55317 (612) 937-1900 I MEMORANDUM TO: Karen Engelhardt, Office Manager I FROM: Jim Chaffee, Public Safety Director I DATE: September 21 , 1988 SUBJ: Liquor License Application I Anh-Le Restaurant Pursuant to the application for an intoxicating liquor license II under the name of Anh-Le Restaurant, I have conducted a limited background investigation to include NCIC/criminal history infor- ' mation. BACKGROUND II The applicant ' s name is Chin Van Nguyen and is an officer in the Le-Nguyen Corporation. Mr. Nguyen is applying for an on-sale intoxicating liquor license on behalf of the Le-Nguyen II Corporation and its other partner , Nguyet Anh Le. The name of the restaurant is Anh-Le and will be located in the new Town Square development, 566 West 78th Street , Chanhassen, Minnesota, II 55317. The Town Square development is a strip mall located at the intersection of Laredo Drive and West 78th Street in the City of Chanhassen. It is the first project to be built within the II downtown redevelopment district. At present there is scheduled to be a Brooks Superette, Minnetonka Photo Lab and Glenrose Floral shop. ANALYSIS II The name of the corporation applying for the license is Chin V. II Nguyen Corporation, which is also the name of one of the officers in the corporation ,. Chin Van Nguyen. The name of the restaurant that is to be the recipient of the permit is Anh-Le Restaurant. II This restaurant will be an oriental restaurant located in the far eastern store of the new Town Square strip mall. The store itself will be comprised of approximately 2 , 300 square feet with a seating capacity of 64 . Hours of business will be from 11 :00 a.m. to 10 : 00 p.m. and it will employ approximately 7 people. The restaurant is scheduled to be opened 12 months during the year . II II 1 , Karen Engelhardt September 21 , 1988 Page 2 1 In the applicant ' s paperwork regarding the license and permit there was noted a few minor discrepancies . On one form the busi- ness name is listed as Le-Nguyen Corporation , Incorporated. On another form the corporation is listed as Chin V. Nguyen, Corp. Although I was able to do a criminal history and the NCIC check on Mr. Nguyen , I was not able to come up with any information at all on Nguyet-Anh T. Le who is listed as the Vice President/Treasurer. It would also appear that Nguyet-Anh T. Le is Mr. Nguyen' s wife. RECOMMENDATION Upon completing my investigation I can find no compelling reason, from a public safety standpoint , not to issue a new intoxicating on-sale liquor license to the Anh-Le Restaurant at 566 West 78th ' Street , Chanhassen, Minnesota, 55317 . 1 1 I 1 I I CHA011 [i |A007 a |. 20 i9n:_; i *� oi : :ji ,F- i` .`/ J, '�; ; 14 � �/;_;;; '/D UMW ` ' �� ' i0��l �� ��>w4�"/ 4'4|� �� - . • � CHA007 SEP 20 8 14:07: 31 A�k MESSAGE WA.ITING PRESS PA.' ' . _ �� -�I CHA012 NCI743 SEP 20 1988 14:07: 34 SEP 20 19B8 14:08: 15 1L015 CHA00700723 . 100100 /`"�������� �i;!m/�5),0 ...,.: 11.,y',•,, ' ^'� I 4COA007 SEP 20 1988 14:07: 31 ACK END OF ME3SAGE ' ;� ''��� . � ' ` . ^- - ' � ' - � � �' . � � ' � ' ' �, '^ ' � � . , ��^ � � . .. ' ^ / -'I`. . �' . , . . '' ,. ' . s -- ■ ■ - ■H A 010 NC I323 SEP 23 1988 10:09:04 SEP 23 1988 10:09:45 `+ ^^` -^i'�HA018O6190 . ^100100 '� `� � � ` ' � ^ v ` NO IDENTIFIABLE RECORD IN THE NCIC INTERSTATE IDENTIFICATION INDEX _ '' ' ^ ' '� , `. ,� � III > NAM/NGUYEN, CHIN VAN.SEX/M.RAC/A.D0B/021545. ` NOTICE -- THIS DOES NOT PRECLUDE THE POSSIBLE EXISTENCE OF MATCHING RECORDS IN LOCAL, STATE, OR FBI IDENTIFICATION DIVISION FILES THAT ARE , ' NOT INDEXED IN THE NCIC III . IF YOU DESIRE A SEARCH OF THE FBI IDENTIFICATION DIVISION FILES, A FINGERPRINT CARD SHOULD BE SUBMITTED. ' , END-' ` ' �� ' � ° § 1 END OF QUERY RESPONSE. AS OF 092388 ��� � , . �� ^ �. � END OF MESSAGE ^ I � ' � � ( ' . ' CHA011 CHA019 SEP 23 1980 10: 10:35 SEP 23 1988 10: 11 :00 01/02 . ' * ' �� --- � N� * � * ' * ` . I TXT CHIN VAN NGUYEN .. -,. ' ' I SEX/M. DOB/O21545. H6T/5O6. WGT/149. EYE/8kN.OLN/N250115839121 . OLT/C-00 1 . EXP 02159i STATUS:VALID PHOTO #: 7094057268. ISU/031207. 08/14/83 SPEED / ::::2(,.933 I .07405/82 SPEED 309632 . . SEP 23 1988 10: 10: 35 ACK PAGE WAITING PRESS PA! ' ._ �� �~ ' A011 CHA019 SEP 23 1988 10: 10: 35 SEP 23 1908 10: 11 : 08 01/02 , � 1 r� , a» ` , * .'� •. ' * . � _ I , , I MINNESOTA DEPARTMENT OF PUBLIC SAFETY PS 911411-871 PHONE(612)296-6159 LIQUOR CONTROL DIVISION 333 SIBLEY • ST. PAUL,MN 55101 IAPPLICATION FOR COUNTY OR CITY ON SALE WINE LICENSE NOT TO EXCEED 14% OF ALCOHOL BY VOLUME IEVERY QUESTION MUST BE ANSWERED. If a corporation,an officer shall execute this application. If a partnership, a partner shall execute this application. If this is a first application attach a copy of the articles of incorporation and I by-laws. 4 Applicants Name(Business,Partnership,Corporation)LE-N6 Ky 64 Trade Name or DBA C ilJ i '1�GruYF.J C.0(2 kY►,) 11- L6 ?..e6rcuoreavit ' Business Address / Business Phone Applicants Home Phone City County State Zip Code CIA AO itA 556P CA av 6a, 114 I.) 551i 7 I Is tl3is application If a transfer,give name of former owner License period LT New El Renewal ❑Transfer From Ndti I'! g 'ToAfg. /`r 20/8 If a corporation,give name,title,address and date of birth of each officer.If a partnership,give name,address and date of birth of each partner. IPartner/Officer Name and Title Address DOB CHi/ V- iJati> 'J , 7aCcr)C- 6co Wz✓rIbgtis )it. 04-Ari tAss-Sii fuh 55311 1-15145 , I Partner/Officer Name and 710 ,'rr Address / DOB GuYFii /ka3F} ,VEc � r/dw,r r,7, ,ra, Salk �-, �hti r �, 7.10 -43 artner/Officer Name and Title ( Address DOB Partner/Officer Name and Title Address DOB ICORPORATIONS State of Date of Certificate Incorporation U h tkL2 G Fa Incorporation `° , / I 0 %8' Number 6 2 - 13 2 IIs corporation authorized to do business in Minnesota? Yes ❑ No If a subsidiary of another corporation,give name and address of parent corporation THE BUILDING IName of Owners Building Owner. 1M1411b0 1 kit`itU.41€jD?At it c[i-i P Address 5775 WA7/ 1I 13111d. St,,T4 gta- Cr1.4)(+.-,, 107--,.. Has the building owner any connection fl4 h S� l G Are the property taxes deliquent? ❑ Yes t No direct or indirect, with the applicant? ❑ Yes o I Describe the premises to be licensed 2 300 S Ciu,4 2 ; d r fzEri A-U tt, il' (.d CAr r Gj2 -iA) 180,1 u fcWu Alt; ic_ Cif-ofiKra, Cr4i 6g-- 1 J a►+/►,.1i-h-t ITHE RESTAURANT ■ What is the ``//__ During what hours will Number of people Seating capacity? 64- food be available? l i ' ) /6 ?M restaurant will employ? How many months per year 1 2 Will food service be the princip — will the restaurant be open? 1 business of the restaurant? Yes ❑ No I If this restaurant is in conjunction with another business (resort,etc.),describe the business. I I OTHER INFORMATION I 1. Have the applicant or associates been granted anpn-sale non-intoxicating malt beverage (3.2)and/or a "set-up"license in conjunction with this wine license? ❑ Yes C"No 2. Is the applicant or any of the associates in this application a member of the county board or the city council which will I issue this license? CI Yes Ly1 No If yes, in what capacity? . (If the applicant is the spouse of a member of the governing body, or another family relationship exists,the member shall not vote on this application.) 3. During the past license year has a summons been issued under the liquor civil liability law (Dram Shop) (MS. 340A 802). ❑ Yes ❑ No If yes attach a copy of the summons. 4. Has the applicant or any of the associates in this application been convicted daring the past five years of any violation of federal,state or local liquor laws in this state or any other state? ❑ Yes VIVo If yes,give date and details. I 5. Does any person other than the,Aapplicants, have any right,title or interest in the furniture,fixtures or equipment in the licensed premises? ❑ Yes No If yes give names and details. 6. Have the applicants any interests, directly or indirectly, in any other liquor establishments in Minnesota? ❑ Yes E No I If yes, give name and address of the establishment. I I CERTIFY THAT I HAVE READ THE ABOVE QUESTIONS AND THAT THE ANSWERS ARE TRUE AND CORRECT OF MY OWN KNOWLEDGE. Cu is v. w41/41 ,,., G//7 iSY I Signature of Applicant Date IF LICENSE IS ISSUED BY THE COUNTY BOARD; REPORT OF COUNTY ATTORNEY I certify that to the best of my knowledge the applicants named above are eligible to be licensed. ❑ Yes ❑ No I If no, state reason. I Signature County Attorney County Date REPORT BY POLICE OR SHERIFF'S DEPARTMENT This is to certify that the applicant,and the associates,named herein have not been convicted within the past five years for any violation of Laws of the State of Minnesota, Municipal or County. Ordinances relating to Intoxicating Liquor, except as follows Police,Sheriff Department Name Title Signature ' v C-hA,J se.4 Pt4.6C+`� —(4Fe-rx O„ee c-02 4,.„ % , 1 , , INOTICE Pursuant to Laws of Minnesota, 1984, Chapter 502, Article 8, Section 2 (270.72) (Tax I Clearance; Issuance of Licenses), the licensing authority is required to provide to the Minnesota Commissioner of Revenue your Minnesota business tax identification num- ber and the social security number of each license applicant. IUnder the Minnesota Government Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you of the following regarding the use of this infor- mation: ' 1. This information may be used to deny the issuance or renewal of your license in the event you owe Minnesota sales, employer's withholding or Imotor vehicle excise taxes; 2. Upon receiving this information, the licensing authority will supply it only I to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Agreement the Department of Revenue may supply this information to the Internal Revenue Service; I 3. FAILURE TO SUPPLY THIS INFORMATION MAY JEOPARDIZE OR DELAY THE PROCESSING OF YOUR LICENSE ISSUANCE OR RENEWAL APPLICATION. IPlease supply the following information and return along with your application to the licensing authority. I Applicant's Last Name First Name Middle Initial I NuyrJ C-HIN V, Applicant's Address - City, State, Zip Code goo Uk1�S 6Zk' _i-. Cr1 A0 ss ij �'1/i /3 6-6317 Applicant's LE, - ki GUYGO I - P-? _ L� � Business Address City, State, Zip Code 6-‘6 ' 4 '' '9 ' .57 Ir-e,Q.f of /lm HASS iu /I1,J 5-C3/ 7 Minnesota Tax Identification Number A- V1, f I I -'IL I Signa ure Date I ., ! Y • • I • • APPLICATION FOR INTOXICATING LIQUOR LICENSE - I NEW AND RENEWAL Dc ��. _TO THE HONORABLE CITY COUNCIL, ' GENTLEMEN: I CH i ,J VAJ tJ C1 UYem Ot as Nam (Individual 1 (Name of person making application) G • t;ual owner, officer, . or partner) ' for and in behalf of (h ' J j 1\) y�7_NJJ 1. L L, _Vyj & i� • (myself, names of partners, name of corporation or II association) hereby submit in duplicate this application for a 0A) SALE (On Sale or Club) Intoxicating Liquor License for the ,4 jV H _ I r t (Name of restaurant, hotel , or club) located atV/ g I/ LA4CO0 G'HANIIAsSEtJ 11/1N X73i7 for the sale (Street address /and or / plat /and parcel number ' of intoxicating liquor in accordance with the provisions of Minnesota Statutes, Chapter 340, and the City of Chanhassen Intoxicating Liquor I Ordinances, commencing (JC) V 0.5 19 -� $i' and ending "etc, In support of said application and in accordance with the requirement as set forth in said Ordinance, there is attached hereto, in duplicate; The Part I - General Information Form, Part II - Personal Information II Forms, the Bond, license fee, and investigation fee. • l �` It _ Fort r! iJ4UV ! ./i�J1t- j. Le" Le-1\/aU Si• " ure and Ti Ie of erson` Wyse?T; names of 'paFEi ers, names making Application) of corporation or association) ' CITY OF CHANHASSEN, MINNESOTA I IN SUPPORT OF AN APPLICATION FOR ON-SALE OR CLUB INTOXICATING LIQUOR LICENSE I • Part I - General Information Directions: This form must be filled out in duplicate with typewriter or by printing in ink. If the application is by a natural I . person, by such person; if by a corporation, by an officer, thereof; if by a partnership, by one of the partners; if by an unincorporated association, by the manager or managing officer thereof. I 1. Name of applicant (name of individual, partnershi or association) ; P. co rporation I CM / lU JAS i a u Y E 2. Name under which applicant will be doing business (name of restauran? I hotel or club) , business address and telephone number: Full Name AN N - Le I . n,,'U Business Address 70 t,,,.,A, 1--/AP47-00 C If}Ni}&sEiJ .55;,7Phone '//- IIF BUSINESS IS TO BE CONDUCTED UNDER A DESIGNATION, NAME OR STYLE OTHER THAN FULL INDIVIDUAL NAME OF THE APPLICANT, ATTACH A COPY OF THE CERTIFICATE, AS REQUIRED BY CHAPTER 33: I MINNESOTA STATUTES, CERTIFIED BY THE CLERK OF THE DISTRICT COURT. I3. Type of applicant: Individual _Partnership • Corporation. Association or other 4 . Type of license applicant seeks? I �n Sale Club I 5. (a) If applicant is an individual, state full name, residence and business address and telephone numbers . • Full Name IResidence Address Phone IBusiness Address Phone (A Part II - Personal Information form must be filled out and attached for this individual) ' I -1- (b) The full name, residence address and telephone number of the manager, proprietor or other agent in charge of the individual owner 's premises to be licensed. Full Name CH \M.) i T U yctJ Residence Address 1O8 W ;�� i€512.43 i,1L,CHAPII-ASSaJ Mi?Phone 474- 1`i (A Part II - Personal Information form must be filled out and attaches for this individual) 6. (a) If applicant is a partnership, state full name, residence and business address, telephone numbers, and percentage interest of II each member of the partnership. • I. Full Name Interest Residence Address Phone Business Address Phone ' 2. Full Name Interest • Residence Address Phone Business Address Phone I 3. Full Name Interest Residence Address Phone I Business Address Phone 4 . Full Name _ - Interest $, Residence Address Phone Business Address Phone (A Part II - Personal Information form must be filled out and . 1 attached for each of these individuals) (b) The managing partner will be: (c) The full name, residence address and telephone number of the manager, proprietor or other agent in charge of the partnership's!' premises to be licensed . Full Name • 1 Residence Address Phone (A Part II - Personal Information form must be filled out and , attached for this individual) • -2 I IF THE APPLICATION IS FOR A PARTNERSHIP, ATTACH A TRUE COPY OF THE PARTNERSHIP AGREEMENT AND A COPY OF THE CERTIFICATE OF TRADE NAME UNDER PROVISIONS OF CHAPTER 333, MINNESOTA STATUTES, CERTIFIED BY THE CLERK OF DISTRICT COUP 1 7. (a) If the applicant is a corporation or association, give name of I corporation or association, Chanhassen address and phone number, and home office address and phone number. State of Incorporation r ( /� �/ _ or Association Name ..1E -td 6 u / 6/ co e,? Ti-►C- C D ft? Chanhassen Address ,5EE 7,gC cf ra,Cre Phone A)// - Home Offic e Address qO1 L:, - t LN pit. Phone 474 . (j X f I (b) The full names, residence address and telephone numbers of all . officers of said corporation or association. I . President LA i )3 UPS q v �f i\-1 L H ANN O%s S CrJ, fl J 5`7 j 4 7 Residence Address (AO kjE2c r t i)(1- CHifiraikc:Phone 4.74._ jej/ y 1 • Vice President ft JVE t4kN 1} 1•tE Residence Address 5�e liA c1-10ve., Phone / . 7c,-_ ECG 14 I . Secretary NJUrUYE j_A14 LL IResidence Address --C(ziem;z Cis (ut,,,,,1. - Phone (.if )(IL , j�'Iy v Treasurer \ (,i-UY6 I , j}jJ ?-I i , LL IResidence Address _ \f,A,, rzn ck.1i o Lice. Phone 1-1'.?(4- - t q t I (A Part II - Personal Information form must be filled out and attached for these individuals) • I (c) The full names, residence address and telephone number of all persons who singly or together with their spouse and his or her parents, brothers, sisters or children, own or control an interest in said corporation or association in excess of 5% . 1 . Full Name L:.---JIM OM (Lki U YEK) Interest 5 0 OM % IResidence Address/00 Phone e `-74'79-_ !mil ti 2 . Full Name - Yr;f_/ 1J F{ i .W Interest 6-0 % Residence Address -3 ouyy,x • rL ,c ✓.k- Phone . It /�.6/( I -3- IlL. I 1 I 1 I 1 1 1 1 1 1 1 4 --i 1 •e! 1 1 i linewri 11111mr• I 1 5 . Full Name Position Residence Address _ Phone 6 . Full Name Position Residence Address Phone 7. Full Name Position Residence Phone 8 . Full Name Position Residence Address Phone ' 9 . Full Name Position Residence Address Phone 10 . Full Name _ Position Residence Address Phone (A Part II - Personal Information form must be filled out and 1 attached for each of these individuals) (b) The full name, residence address and telephone number of the manager, proprietor or other agent in charge of the club' s premises to be licensed. Full Name Residence Address Phone ' (A Part II - Personal Information form must be filled out and attached for this individual) ' IF THIS APPLICATION IS FOR A CLUB, INCLUDE A TRUE COPY OF THE ARTICLES OF INCORPORATION AND BY-LAWS. THERE MUST BE SUBMITTED A SWORN STATEMENT THAT THE CLUB HAS BEEN IN EXISTENCE FOR MORE THAN FIFTEEN YEARS OR, IN THE EVENT THAT THE APPLICANT IS A CONGRESSIONALLY CHARTEREI VETERANS ' ORGANIZATION, IN EXISTENCE FOR MORE THAN TEN YEARS . THE STATEMENT SHALL BE MADE BY A PERSON WHO HAS PERSONAL KNOWLEDGE OF THE FACTS STATED THEREIN. IN THE EVENT THAT NO PERSON CAN MAKE SUCH A STATEMENT, SATISFACTO' DOCUMENTARY PROOF MAY BE SUBMITTED IN SUPPORT OF SUCH FACT: • • 11 -5- • 9 . State the exact legal description of the premises to he licensed. (Applicant must also submit a plat plan of the area showing dimensi. location of buildings, street access , parking facilities and the locations of and distances to the nearest church building and pull school grounds. ) • ( 1HA )P14 I}]� iii4/3 5 )6c_ • i1 - Lvi 4 C F, r J r.itv-. C/ikm 5•1 •7�� I 10 . How are the premises classified under the Chanhassen zoning ordina 0 11. State full name, residence and business address and telephone numb of owner or owners of the building wherein the licensed business wig be located, if owner is other than the applicant. Full Name 01 taii1SVW 1 Ri L L/,)1116) ?p,g , GK.si+i? go o `1 nm kJ{u kuJ- Residence Address K/" Phone Ar ' - Mir) f • .Business Address 7 7 C W AY2A►A g i v e t r. (.6 i .,r ppr *Phone 5 S 210.2 Full Name Residence Address Phone Business Address Phone 12. Where building is owned by other than applicant, state in summary I conditions of lease arrangements- term of years, monthly rental, etc. (A true copy of the lease shall be attached) . 13 . If building is owned by individual applicant, partnership, corporat or association, state: a) Date purchased b) Name and address of person 11 purchased from c) Who currently .holds mortgage? d) Who currently holds Contract for Deed? • e) Term of Mortgage _ f) Term of Contract for Deed g) State the rate at which mortgage and/or Contract for Deed is bell liquidated -6- ' 1 • • Ii) Are the payments on Mortgage and/or Contract for Deed up-to-date? 14 . State separately the amount of the investment that the applicant hay in the business premises , fixtures , furniture, stock in trade, and attach supporting proof of the source of such money: 11 Business Premises $ % ; Fixtures $ * ; Furniture $ ; Stock in Trade $ , ; Other $ To vc i1,, A iLeA 15 . Give full name, address, telephone number and the nature of the interest, amount thereof , terms for payment or other reimbursement, of all persons, other than the applicant, who have any financial interest in the business, buildings, premises, fixtures, furniture, or stock in trade. (This shall include, but not be limited to, any I lessees, lessors, mortgagees, mortgagors, lendors , lien holders, trustees , trustors and persons who have co-signed notes or otherwise loaned, pledged, or extended security for any indebtedness of the applicant. ) N A}ki 415- r /U4, I; f�n;r.�mil'l�'i(� C, 9-Lc r-_s Inr+i�l �c,{6� .f f S 5r 5 _ 2,1 u 2 \,.,J A 2n TA 13 A A t. Q�a-A IT'LL - 3 L A f t—► f A N `'� �'° • 1 IF THIS APPLICATION IS FOR PREMISES EITHER PLANNED OR UNDER CONSTRUCTION OR UNDERGOING SUBSTANTIAL ALTERATION, THE APPLICATION SHALL BE ACCOMPANIED BY A SET OF PRELIMINAF PLANS SHOWING THE DESIGN OF THE PROPOSED PREMISES TO BE LICENSED. -7- I 23 . 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 o: the City of Chanhassen; 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 fe( not to exceed $500.00 may be charged an applicant by the City if till investigation is conducted within the State, or the cost not to exceed $10, 000. 00 if the investigation is required outside the stat( - 1 • STATE OF VVIlj } ) ss . COUNTY OF 14-co h e ) ( j.3 J 6.LfY , being first duly sworn., upon his oath deposes and says that he is the person who has executed t' I above application and that the statements made therein are true of his own knowledge and belief. (/4h G'. II HAROLD E.NEB,,N1. MUM Pusuc•MINNESOTA HENNEPIN COUNTY, My CoQMnbsion Expires Aug.18,1990 Subscribed and sworn to before • • ' me this f7t1 day of k 044-cr , 19 a L `s I • . I • . I - CITY OF CHANHASSEN, MINNESOTA IN SUPPORT OF AN I APPLICATION FOR ON-SALE OR CLUB INTOXICATING LIQUOR LICENSE IPart II - Personal Information Directions: This form must be filled out in duplicate with type- ' writer or by printing in ink by the sole owner, by each partner, by each officer, or director, by each manager, proprietor or other agent in charge of the premises, by - 111 eea_ch person who by combined ownership or control has an interest in a corporation or association in excess of 5%. IDate: 'VP/ S/2 1. True name: (last, first, middle) ' \,l iJ C ! �_: ILAN I2. Residence address: (number , Street, city, state) 3 . (phone) 100 i ErtiJ DA, Gl-m-N rocs //luss3, 2 744(ov, I4. Business address: (number, street, city, state) 5 . (phone) 5 6 c s _ S ir., " , ��� •A;� ti-mr i ,J 5 7'7 ,1 6 . Place of birth: (city, ccsunty, state) 7 . Date of birth: /-) 1 1 1A O' - L C f J G�- V/ 4 (mo. , day, yr. ) 8 . U.S. Citizen? Naturalized? If yes, give date and place: 1/Yes No. j/Yes No 141/1,4.1411k4,;: �c C a, 1�J81 r 1,,-..., . 9. If you have ever used or been known by a name or names other I • • than the true name given in #1 above, list such name (s)• and information concerning dates and places where used. Names Dates, Places and Circumstances . I _ I I10 . Marital status: Single Widowed Separated Married ,/ Divorced Ill. If married , true name, place and date of birth, and residence address of spouse: GE I . True name: ' (�r._ , _1- ,._ i� i • • Place and date of birth: 7/17J_ryhy L0k/Cr_ XUyEn7 Viet,J/rn 7-10 .- 4.y _ Residence Address: �4An IAJ rc2,u ISr rI14R+JfunS'r nA;.l 1,:47, 1 - i4 . . 111_ 12 you ci -1 C_'y1�tlf.:r ed Voter : ✓ .LL: - ---'-146T---- If .yes, where are you registered? - S J 11 L — Is your spouse a registered voter? �L-7Yes __ No I II f yes, where is spouse registered? 13 . Address (es) at which you have lived during preceeding ten 1 years (begin with present or last address and work back. ) No. and Street City and State Dates I r ci0.11 t� c C (rti,i )) it.. • '1 J la!'s M�1 i 6 - 16 - 7g .a ?aft/0- lqi i -317-44v-e- , 2Q1 EXU-7If»tz A CC 33l - 75 --, Ib-,b --aci 11 i 1 14 . Address (es) at which your spouse has lived during preceeding) ten years. (Begin with present or last address and work back. ) No. and Street City and State Dates 1 / 6 6 —"A' ' .(L. 0 f/1 l■1 11,'r-S-e0 11/11,) '0 4 4 ?e) Q,Z i ? --a GS% r g18 - rLd 2 ; axeel . . , 5 - s —> c 15 . Kind, name and location of every business or occupation you 1 have been engaged in during the preceeding ten years. (Begin with present or last address and work back: ) Business or occupation Location: Street address Nature of business I city and state or occupation a � - 1 6,^t, 16c1 ,`Ca`l 2�6! Ct1>j�1?lr}rrn.AY-,. 7735/ -P.L - )) 1 K V kj✓t //Win/Wit )(-i0i I-GO/rut)/ 41414, /14n)Pt o ;+tr �� h_ ilniCVOkkitit Q 1 r 1 16 . Kind, name spouse has been engaged dinoduring the epreceeding tenol (Begi your with present or last one first and work back . )preceeding years . (Begin - Business or occupation Location: street address Nature of business 1 • city and state or occupation .. J l a-kt 6Lci'L 1 wb 420- �Ytihhz��aii,' /,i Sc a J H w _ 1 -2- 1 1 3 . Full Name Interest % Residence Address Phone t . I 4 . Full Name Interest $ IResidence Address Phone (A Part II - Personal Information form must be filled out and Iattached for these individuals)• (d) The full name, residence address and telephone number of the I manager, proprietor or other agent in charge of the corporation's or association 's premises to be r�licensed. Full Name CAI i N\I4 I ) C-L'YjJ C"fj Residence Address/16 CA) 6(LiJ DA, Phonet�734.- /C/)Y I (A Part II - Personal Information form must be filled out and attached for this individual) I IF THIS APPLICATION IS FOR A CORPORATION OR ASSOCIATION, ATTACH A TRUE COPY OF THE ARTICLES OF INCORPORATION OR ASSOCIATION AGREEMENT AND BY-LAWS AND, IF A FOREIGN I CORPORATION, A CERTIFICATE OF AUTHORITY AS DESCRIBED IN CHAPTER 303, MINNESTOA STATUTES. 8. (a) If the applicant is a. club, name of Club I ;date that club was first incorporated ; Iplace of such organization ; present number of members ; the full names , position, residence address Iand phone numbers of all officers, executive committee and board of 1 • directors . 1. Full Name Position IResidence Address Phone 2. Full Name Position IResidence Address Phone I3. Full Name Position Residence Address Phone 1 4 . Full Name Position Residence Address Phone 1 -4- . . . 17 . Names and addresses of your employers and partners , if any, for the preceeding ten years . (Begin with present on last one first I and work back. ) Names:Employers or partners 'Addresses:City and State Dates l(ti1 �h�r M S (COM i Pao ( P/'si/1� ?- 2c'- 7 y 7 ,2Lfr, I 1 18 . Names and addresses of our spouse 's employers ' Y p ployers and partners, • if any, for the preceeding ten years . (Begin with present or last one first and work back. ) I Names:Employers or partners Addr_esses:City and State Dates � I CY-- V∎{ .--t1'lby w511 PI-112, Miwtec p,%il 4-tne-k - g1Zi r • r 1 19 . Have you, your spouse, or a parent, brother , sister or child I of either of you, ever been convicted of any felony, gross or petty misdemeanor, or violation of any ordinance, other than traffic? Yes v No. I If yes, give information as to the time, place and offense for which convictions were had. 20 . Have you, your spouse, or a parent, brother, sister or child of either of you, ever been engaged as an employee or in operating a saloon, hotel, restaurant, cafe, tavern or other business of a similar nature? Yes No. _ If yes, give information as to the time, place and length of time. ' 1 -3- • 21 . Have you been in military service? Yes No. If yes , was discharge (s) ever other than honorable? IYes No. (Upon request, you may be required to exhibit all. discharges . ) I22 . Names, residence address, business address, and telephone numbers of each person who is engaged in Minnesota in the business of I selling, manufacturing or distributing intoxicating liquor and who is nearer of kin to you or your spouse than second cousin, whether of the whole or half blood, computed by the rules of civil law, or who is a Ibrother-in-law or sister-in-law of you or your spouse. 1. Full Name Relationship IResidence Address_ Phone Business Address . Phone I2 . Full Name Relationship I • Residence Address _ Phone Business Address Phone I3 . Full Name Relationship Residence Address Phone IBusiness Address Phone I23 . Are you a manufacturer or wholesaler of intoxicating liquor or interested directly or indirectly in the ownership or operation of any such business? _Yes `/No. I24 . Are you directly or indirectly interested in other establish- ments in the City of Chanhassen to which a license of the same kind has I been issued? / Yes v No. I • 25 . Are you the spouse of a person who would be ineligible for a license? (Refer to Ordinance Nov--2 , Section 4 for persons ineligible for license. ) Yes ✓ No I26 . What is the amount of investment that you will have in the business , building, premises , fixtures, furniture, stock in trade, I etc . , and what was the source of such money? (You must he prepared to furnish proof of the source of such money . ) I - -4- I I . 4 l '', 277 Have you had any interest in any previous intoxicating liquo ' license that was revoked, suspended or not renewed? Yes No. "If yes, explain in detail . 28 . Have you ever individually, or with others, made applica- tion for an intoxicating liquor license and had such application denied? Yes intoxicating,,liquor If yes , explain in detail. I II 1 0 Pi* STATE OF ) I If( n , ) ss . COUNTY OF ) 4(i k1 ' ►v y61-) , being first duly sworn upon his/her I oath, deposes and says that he/she is the person who has executed the above Personal Information form• and that the statements made therein are true of his/her own knowledge and belief. I Signed: 14 ?A-- V I wor • Subscribed and sworn to before me • thi rok day of �0-jy,,. , 19 d I �1 " HAROLD E. NESS,JR. MoTM Y/USW-MINNESOTA I Notary Public, (��l�t, County, Minn. �1,0,..- 1 HENNEPIN COUNTY wr Omam NON Expires Au..WIN • My Commission Expires A-Y ', ( (e r`t a • II I • II II ;_ il I il • -5- 6 The City Council wishes to have from all applicants - individual , partnership or corporation, and including also persons required to complete the individual personal information forms -` a notarized declaration of all direct or indirect contributions made to or in behalf of a candidate for Chanhassen City Councilman or Mayor, I including but not limited to Candidates ' Committees, Volunteer Committees, etc . , for all City elections from and including 1961 to date . _ IThis additional information is being requested at this time to _ - establish a precedent for future license consideration to protect I any license holder from being solicited for political contributions under the burden of knowing that any candidate could conceivably be making a determination of a license renewal. I1 . Have you made any contributions as described in the first paragraph above? / I . Yes ✓ No. I2 . If Yes , state year, to whom made, and amount. I ISignature Date i Subscribed and sworn to before me '• . this day of , 19 INotary Public, County, Minn. My Commission Expires I • 4 1 . . t Z