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200 1 RSMo Oorug Store Oconfectionery SIGNATURE OF OWNER MANAGING OFFICER OR PARTNER SIGNATURE OF PARTNER IF THERE ARE MORE THAN ONE 0Cigar and Tobacco Store 0General Merchandise Store 0Grocery Store 0Delicatessen DATE Page 1. MISSOURI DEPARTMENT OF PUBLIC SAFETY DIVISION OF ALCOHOL AND TOBACCO CONTROL APPLICATION FOR A PRIMARY RETAIL LIQUOR LICENSE BUSINESS STRUCTURE D MO 829-A0008 Rev. 03/07/2017 SOLE OWNER PARTNERSHIP ALL Partners must sign in ALL spaces. CORPORATION Only the Managing Officer can sign application. LIMITED LIABILITY COMPANY LEGAL NAME OF ENTITY DOING BUSINESS AS PHYSICAL LOCATION ADDRESS STREET ADDRESS CITY STATE ZIP CODE MAILING ADDRESS IF DIFFERENT FROM ABOVE BUSINESS TELEPHONE NUMBER I MISSOURI RETAIL SALES TAX NUMBER IF AP PLYING AS CORPORATION LLC OR PARTNERSHIP PLEASE STATE MISSOURI SECRETARY OF STATE FILE NUMBER DATE OF INCORPORATION OR ORGANIZATION P LACE OF INCORPORATION OR ORGANIZATION CITY/STATE IF YES PROVIDE IRS TAX EXEMPT NUMBER WILL TOBACCO PRODUCTS BE SOLD AT THE BUSINESS DYES rs CD N OD N PROFIT ONO OPTIONAL APPLICATION FOR PERMISSION TO EMPLOY MINORS MUST MEET QUALIFICATIONS Does applicant hereby make application for permission to employ minors between the ages of eighteen 18 and twenty-one 21 years old as provided in Section 311. 300 RSMo. and Regulation 11 CSR 70-2. 140 7 8 Rules Regulations of the Supervisor of Alcohol and Tobacco Control If yes indicate the following appropriate qualification and applicant managing officer or - if applying as a partnership - all partners must sign. OR A If qualifying as a restaurant I certify that at least fifty percent 50 of the gross sales of the business for which this license application is made consists of food. CORPORATION Only the Managing Officer can sign application. LIMITED LIABILITY COMPANY LEGAL NAME OF ENTITY DOING BUSINESS AS PHYSICAL LOCATION ADDRESS STREET ADDRESS CITY STATE ZIP CODE MAILING ADDRESS IF DIFFERENT FROM ABOVE BUSINESS TELEPHONE NUMBER I MISSOURI RETAIL SALES TAX NUMBER IF AP PLYING AS CORPORATION LLC OR PARTNERSHIP PLEASE STATE MISSOURI SECRETARY OF STATE FILE NUMBER DATE OF INCORPORATION OR ORGANIZATION P LACE OF INCORPORATION OR ORGANIZATION CITY/STATE IF YES PROVIDE IRS TAX EXEMPT NUMBER WILL TOBACCO PRODUCTS BE SOLD AT THE BUSINESS DYES rs CD N OD N PROFIT ONO OPTIONAL APPLICATION FOR PERMISSION TO EMPLOY MINORS MUST MEET QUALIFICATIONS Does applicant hereby make application for permission to employ minors between the ages of eighteen 18 and twenty-one 21 years old as provided in Section 311. 300 RSMo. and Regulation 11 CSR 70-2. 140 7 8 Rules Regulations of the Supervisor of Alcohol and Tobacco Control If yes indicate the following appropriate qualification and applicant managing officer or - if applying as a partnership - all partners must sign. OR A If qualifying as a restaurant I certify that at least fifty percent 50 of the gross sales of the business for which this license application is made consists of food. business for which this license application is made consists of non-alcoholic sales. twenty-one 21 years of age or older on the licensed premises during all hours of operation as provided by Regulation 11 CSR 70-2. 00 exclusive of fixtures and intoxicating liquors at all times while said license including any renewal thereafter is in effect that an itemized inventory of said stock of goods is hereto attached that all of said goods are saleable and that they are prominently exposed and offered to the public of sale in said store and will be exposed and offered for sale at all times as prominiently as liquor is exposed and offered for sale that as said merchandise is sold it will be replaced with other saleable merchandise and said stock of goods will at all times be maintained at a value of at least 1 000. 00 exclusive of intoxicating liquors and fixtures. Does applicant hereby agree to the above and make application for business to engage in one or more of the following business types as provided in Section 311. 300 RSMo. and Regulation 11 CSR 70-2. 140 7 8 Rules Regulations of the Supervisor of Alcohol and Tobacco Control If yes indicate the following appropriate qualification and applicant managing officer or - if applying as a partnership - all partners must sign. OR A If qualifying as a restaurant I certify that at least fifty percent 50 of the gross sales of the business for which this license application is made consists of food. business for which this license application is made consists of non-alcoholic sales. twenty-one 21 years of age or older on the licensed premises during all hours of operation as provided by Regulation 11 CSR 70-2. 140 8 6 Rules and Regulations of the Supervisor of Alcohol and Tobacco Control. Applicant is required to keep in said store if granted a license a stock of goods having a value according to invoice of at least 1 000.

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