Application For Branch License
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Application For Branch License Form. This is a Minnesota form and can be use in Alcohol And Gambling Enforcement Division Statewide.
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Tags: Application For Branch License, PS 09055, Minnesota Statewide, Alcohol And Gambling Enforcement Division
Minnesota Department of Public Safety
ALCOHOL AND GAMBLING ENFORCEMENT DIVISION
444 Cedar Street/Suite 133
St. Paul, MN 55101-5133
(651) 201-7506 TDD (651) 282-6555
FAX (651) 297-5259
APPLICATION FOR BRANCH LICENSE
Wholesaler of:
Intoxicating Liquor $3,000
Malt Beverages $25
LICENSE EXPIRATION DATE: ____________ LICENSE # ________________________ DATE APPROVED ____________
FEDERAL TAX ID #
I, _________________________________________ as ____________________________________________
(Owner, Partner or Officer)
for and in behalf of __________________________________________________________________________
(Trade Name)
__________________________________________________________________________________________
(Home Office Address)
(City)
(Zip Code)
Phone No. (_____)_______________ , Fax No. (_____)_________________ hereby apply for a wholesale
branch license to sell alcoholic beverages containing more than 3.2% of alcohol by weight, as herein
designated, at:
__________________________________________________________________________________________
(Street Address)
(City)
(Zip Code)
The branch establishment shall be under the management of _________________________________________
_________________________________________________________________________________________.
_______________________________________________
(Name of Firm)
_______________________________________________
(Signature of Affiant)
MAKE CHECK PAYABLE TO: DIRECTOR ALCOHOL AND GAMBLING ENFORCEMENT
AMOUNT RECEIVED
PS 09055 (5/06)
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