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Home My WebLink Aboutagenda.2019-04-18.packet.pdfCITY of CAPE GIRARDEAU Liquor License Review Board Thursday, April 18, 2019 City Hall - Council Chambers 401 Independence Street Cape Girardeau, MO 63701 5:00 p.m. AGENDA 1. Call to Order 2. Introduction and Opening Comments 3. Approval of Minutes of June 18, 2018, meeting. 4. Appeal Review: Suspension of Liquor License for Cape Broadway, LLC, d/b/a Hangout, located at 727 Broadway, Cape Girardeau, Missouri a. Applicant Comment b. City Staff Comment c. Board review, discussion, and possible action 5. Adjourn The Liquor License Review Board of the City of Cape Girardeau, Missouri, may hold a closed session to discuss legal actions, causes of legal action or litigation, or confidential or privileged communications with its attorneys. CITY or CAPE GIRARDEAU OFFICE OF THE CITY MANAGER LIQUOR LICENSE SUSPENSION NOTICE The City of Cape Girardeau liquor license held by Cape Broadway, LLC, d/b/a Hangout, located at 727 Broadway, License No. 11924, for Retail Liquor by the Drink and Sunday Sales is hereby SUSPENDED. GROUNDS FOR ACTION: 1. Licensee did permit on the premises, sell or distribute liquor to, persons under the age of twenty-one (2 1) on multiple occasions from October 2018 to March 2019. SUSPENSION EFFECTIVE DATE: April 12, 2019 LENGTH OF SUSPENSION: Ten (10) days The licensee may appeal this suspension by requesting a hearing before the liquor license review board. The written appeal request must be received within ten (10) days after this notice of suspension was received. The suspension notice is presumed received by the licensee three (3) days after it is mailed. The appeal must be in writing and addressed to: Gayle Conrad, Liquor License Review Board, City of Cape Girardeau, P.O. Box 617, 401 Independence, Cape Girardeau, MO 63702. Pursuant t. )-42 of the Cape Girardeau Code the SUSPENSION is hereby Ordered. Date City Manager I certify that on this day of ft to h , 2019, I mailed a copy of this NOTICE to Cape Broadway, LLC, by first class mail, postage paid, to the address provided the City by the licensee on the liquor license application: P.O. Box 735, Cape Girardeau, MO 63701. Gayle mad City C erk oM 401 Independence Cape Girardeau, MO 63703 573-339-6320 Tel 573-339-6302 Fax cityofcape.org/management 06/01/2019 MON 16:26 FAX 5736510507 6tatler Law Firm April 1, 2019 MS. GAYLE CONRAD LIQUOR LICENSE REVIEW BOARD CITY OF CAPE GIRARDEAU PO BOX 617 401 INDEPENDENCE CAPE GIRARDEAU, MO 63702 Sent via US MAIL andfacsimile to: 339-6308 RE: LIQUOR LICENSE FOR CAPE BROADWAY, LLC D/B/A HANGOUT Ms. Conrad: I represent Mr. Alam Zahed, owner of Cape Broadway, LLC; d/b/a Hangout located at 727 Broadway, License No.: 11924. We are in receipt of -the suspension and are asking for a hearing to appeal said suspension, Please let me know if I may he of further assistance in this matter. With kindest personal regards, I am... TLS: bmb CC: File Client Ve trulyyours, Travis L. Statler, Attorney and Counselor at Law STATLER LAWYERS 107 S. BROADVIEW • CAPE GIRARDEAU MISSOURI • 63703 PHONE; (573) 651-4855 • FAX: (573) 651-0507 STATLERLAWFIRM@SBCGLOBAL.NCT ®o01/001 INCIDENT DETAIL REPORT LIQUOR LAWS MISREPRESENTATION OF AGE Agency: CAPE GIRARDEAU POLICE DEPARTME Phone: (573) 336.6621 Address: 2530 MARIA LOUISE, CAPE GIRARDEAU MO 63701 Call For Service #: CAPE2018055267 Other # Disposition: CLEARED BYARREST UCR Disposltlon : CLEARED BY Officer: BeginDateMme: 10125/2018 22:54 End Date/Time: 10/25/2018 23:16 Date Reported: 10125/2018 UCR Disposition Date : 10125/2018 Incident #: 18006642 Occurence Date: Solvability Points: Total Damage; First Name: - 6"12A PrimaryViolation BLU I NCICCode: SR Code: UCR Code: 11 !LIQUOR LAWS MISREPRESENTATION OF AGE RYAN Hair Color: Home: (573) 460.0622 iPRIMARYpDDR99 I Location Type Inc Location Address: 727 BROADWAY �.. Name: THE HANGOUT Cape Girardeau MO 63701 "Place .. __._.__.....,...,__.._......... _.....,.�_.__.___.____.__.._.__.__.._.._.__._._..._._.__._.__.___..-_-_._____._....__._._..: Height: 6'9" A w,. Involvement: CITED Sex: M Last Name: GARD Birth Date: i I First Name: JACK Eye Color: BLU Primary: (573) 460.0622 MI: RYAN Hair Color: Home: (573) 460.0622 Suffix : Hair Length: Race: WHITE Height: 6'9" Ethnicity: NON HISPANIC Weight: 120 lbs Address : 920 SADDLEBROOKE ROG , Jackson, MO j.„._._....__...___._ 63755 ,. -__........,_.,........_......,.,_,._,..e,.._.._._.„,.. Involvement: CITED Sex: F Last Name: KELLER Birth Date: ago First Name: SYDNEY Eye Color: BRO Primary: (618)616.4203 MI: GABRIELLE Hair Color: Home: (618)616-4203 Suffix: Hair Length Race: WHITE Height: 5'6” Ethnicity: NON HISPANIC Weight: Address: 6 RACHAEL CT, TROY, IL 53379 Involvement: CITED Sex: M Last Name: STROLE Birth Date : [� First Name: ISAAC Eye Color: BRO Primary: (618)792.5168 MI: TODD HalrColor: Home: (618)7925168 Suffix: Hair Length Race: WHITE Height: 51" Ethnicity: NON HISPANIC Weight' 1351bs Address: 619 S OREGON ST, MARINE, IL 62081 ARRESTS FOR INCIDENT 18006642 GARD, JACK RYAN Printed: 03/25/2019 10:49;02 AM Incident Page 1 of 5 INCIDENT DETAIL REPORT LIQUOR LAWS MISREPRESENTATION OF AGE Agency: CAPE GIRARDEAU POLICE DEPARTME Incident#: 18006642 Phone; (673) 336-6621 Address: 2630 MARIA LOUISE, CAPE GIRARDEAU MO 63701 Arrest Date: 10/26/2018 00:00 Location;THE HANGOUT - ii 727 BROADWAY ........ ........^, ... .... Cape -Girardeau. MO 63701 'ARREST VIOLATIONS, 7 7,71, Violation Code: 5-1 2A - LIQUOR LAWS MISREPRESENTATION OF AGE rName: A.�.,: STEINER, ERIC Acton Date: 1012612018 -6 Aaki 4 T1 7-; KELLER, SYDNEY GABRIELLE Arrest Date: 10/26/2018 00:00 Locatlon:THE HANGOUT 727 BROADWAY _,,,gqpe 0.91701 BARRESTHOLATIONS j Violation Code: 5-12A LIQUOR LAWS MISREPRESENTATION OF AGE �ARREST EMPL !rqqS Name: STEINER, ERIC Action Date: 1012612018 1_ ' &rrq!0flq__ - , _ - -.- _ . . ... .. ... ...... ARRESTS ROLE, ISAAOTOD Arrest Date: 10125/2018 00:00 Location: THE HANGOUT II 727 BROADWAY Cape Girardeau, MO 63701 qNS j LI -violation Code .5,42A.-., LIQUOR, LAWS MISREPRESENTATION OF AGE ARRST,EMPirOYEES,; Name: STEINER, ERIC Action Date! 1 0/2512 01 8 flqht: Arresting_ _..Agency_.. CITATIONS FOP INCIDENT 18006642 .......... ... ,CYTATION, DIESCRIPTIO I i Citation#: 151122808 Officer: STEINER, ERIC Citation TvDe: Criminal Municipal Assist Officer: Citation Date, 101`25/2018 23:02 Location: 727 BROADWAY L_ ... MO CITATION1 VlolafionCode : 6-12A -FALSIFY AGEIOBTAIN LIQ NneAmount: $0.00 - ---------...... ...... iTATxo Court Date 11/27/2018 9:00:OOAM Court Type : Court Name: MUNICIPAL COURT Jury Trial : No . ......... Comment: CITATION DESCRIPTION STROLE, ISAAC T Citation #: 161122809 Officer: STEINER, ERIC Citation Tvoe: Criminal Municipal Assist Officer: Citation Date: 1012512018 23:06 Location: 727 BROADWAY MO IT4TIQN VIOLATIONS Violation Code: 6-1 2A -FALSIFY AGE/OBTAIN LIQ Fine Amount: $0.00 Printed: 03/25/2019 10:49:02 AM Incident Page 2 of 5 INCIDENT DETAIL REPORT LIQUOR LAWS MISREPRESENTATION OF AGE Agency; CAPE GIRARDEAU POLICE DEPARTME Incident #: 18006642 Phone : (573) 336-6621 Address: 2530 MARIA LOUISE, CAPE GIRARDEAU MO 63701 Printed: 03/25/2019 10:49:02 AM Incident Page 3 Df 5 Court Date: 1112712018 9:00:OOAM CourtType: Court Name: MUNICIPAL COURT Jury Trial :No —j CITATION TAT'9'N DESCkl 0 IN • - _PTI, Citation #: 161122810 Officer: STEINER, ERIC Citation TvK)a: Criminal Municipal Assist Officer: Citation Date: 10/2612018 23:07 Location 727 BROADWAY . .......... �6%. 11-1 ;TATkON VIOLATIONS" Violation Code: 6.12A-FALSI FYAGEIDBTAIN LIQ FineAmount: $0.00 .. 'qU4TXPN COURT APPEARANCES: ....... . . ..... .. Court Date: 11127/2018 9:00:' OOAM Court Type: Court Name: MUNICIPAL COURT Jury Trial :No Comment: Printed: 03/25/2019 10:49:02 AM Incident Page 3 Df 5 INCIDENT DETAIL REPORT LIQUOR LAWS MISREPRESENTATION OF AGE Agency: CAPE GIRARDEAU POLICE DEPARTME Incident # : 16006642 Phone :(573) 3356621 Address: 2530 MARIA LOUISE, CAPE GIRARDEAU MO 63701 I aD.9- TTNARRATIyF.„.._ On Thursday, October 25th, 2018, at approximately 2254 hours, I, Patrolman Steiner, DSN 303, was j eastbound on Broadway from Sprigg Street when I observed a vehicle stop in the roadway in front of 727 Broadway at The Hangout (Bar). I observed four people exit the vehicle and walk into The Hangout. The last individual, a white male wearing a vest, to exit the vehicle appeared to have an open beer bottle in j his hand and he placed it under his shirt as he was walking into The Hangout, in violation of the open container ordinance. I parked my patrol vehicle and opened the front door of The Hangout and asked the individual to speak with me outside. The male followed me outside at which point I asked him what he did with the beer bottle and he stated he threw it in the trash can just inside the door of the business. verified there was a trash can inside the front door and there were numerous beer bottles Inside. I then asked the male to provide me with his identification and I also asked him how old he was. The male did i not answer my question but provided me with a Missouri operator's license. CITED Gard, Jack Ryan W/M DOB SSN: Unknown 920 Saddlebrooke Ridge, Jackson MO (573) 450-0622 POE: Student at SEMO As Gard handed me his identification, I noticed what appeared to be another identification card from another state also in his wallet. I asked Gard to hand me that identification and he did so. The second identification card was from the state of Mississippi and had all the correct pedigree information except the year of birth was 1995, indicating he was over the age of twenty-one (21) making him eligible to drink alcohol. I then opened the door of the business where two of the individuals Gard had exited the car with were standina.Memals was n tie r0 ocess Of heina"carded' `v`the daor man and afe liad I'alrea ' instructed the door -man to get the male's attention. The male and female then exited the business, The door -man handed me the identification the female had provided which was a Missouri operator's license which did not appear to be authentic due to poor printing quality. I asked the unidentified male to provide me with his fake ID as well as his real identification. CITED Keller, Sydney Gabrielle W/F DOB SSN: Unknown 6 Rachael Court, Troy IL (618)616-4203 POE: Student at SEMO I CITED igloo=' W/M DOB i Printed: 03/25/2019 10;49;02 AM Narrative Page 1 of 2 Incident Page 4 of 5 INCIDENT DETAIL REPORT LIQUOR LAWS MISREPRESENTATION OF AGE Agency: CAPE GIRARDEAU POLICE DEPARTME Incident # : 18006642 Phone: (673)336.6621 Address: 2630 MARIA LOUISE, CAPE GIRARDEAU MO 63701 SSN: Unknown 619 S, Oregon St, Marine IL (618)792-5158 POE: Student at SEMO Keller's fake Missouri operator's license provided all the correct pedigree information except for the year of birth which is listed as 1995, indicating she was over the age of twenty-one (21) making her eligible to drink alcohol, Keller stated she did not have her real identification card because it was in her vehicle which was at a separate location. The above subjects were issued the following municipal citations and released from the scene. CITATION 151122808 (GARD) Misrepresentation of Age 5-12 Court Date: 11-27-2018 Court Time: 0900 hours r 151122809 (STROLE) Misrepresentation of Age 5-12 Court Date: 11-27-2018 Court Time: 0900 hours 151122810(KELLER) Misrepresentation of Age 5-12 Court Date: 11-27-2018 Court Time: 0900 hours The fake identification cards were seized and placed into evidence. i This case is cleared by arrest. Printed: 03/25/2019 10:49:02 AM Narrative Page 2 of 2 Incident Page 5 of 5 INCIDENT DETAIL REPORT LIQUOR LAWS MISREPRESENTATION OF AGE Agency: CAPE GIRARDEAU POLICE DEPARTME Phone: (573) 335-6621 Address: 2630 MARIA LOUISE, CAPE GIRARDEAU MO 63701 Call For Service #: CAPE201180566511 Other #: Disposition: CLEARED BYARREST UCR Disposition: CLEARED BY Primary Officer : ERIC STEINER Begin Date/Time: 11102/2018 23:29 End Date/Time : 11/03/2018 00:09 Date Reported: 1110212018 UCR Disposition Date: 1110312018 Incident #: 18006842 Occurence Date: Solvablity Points: Total Damage: . . . ......... 7-1 7 , F, f qffpp.SEq "Ir7r 6-12A Primary Violation NCIC Code: LIQUOR LAWS MISREPRESENTATION OF AGE 6.128 NCIC Code: LIQUOR LAWS POSSESSION OF INTOXICANTS �LOCATIVINk.:_ i. .- jPPUMAR—AjI . bortesS ,: I J Location Type : Inc Location Place Name: THE HANGOUT PERSONS Involvement: CITED Last Name: HARRIS First Name : TANNER MI: BRYCE Suffix: Race: WHITE Ethnlclty : NON HISPANIC Address: 11537 OLD SAINT CHARLES i IBR Cade : UCR Code: 11 Address: 727 BROADWAY Cape Girardeau MID 63701 Sex: M Birth Date: 111NEW Eye Color : Heir Color: Heir Length : Height; Weight: Primary (314) 458-9506 Home (314) 466-9605 Printed: 03/25/2019 10:54:33 AM Incident Page 1 of 3 INCIDENT DETAIL REPORT LIQUOR LAWS MISREPRESENTATION OF AGE Agency: CAPE GIRARDEAU POLICE DEPARTME Incident # : 18006842 Phone: (673) 336-6621 Address: 2630 MARIA LOUISE, CAPE GIRARDEAU MO 63701 Citation#: 151122814 Officer: STEINER, ERIC Citation Tvoe : Traffic Municipal Assist Officer: Citation Date : 1110212018 23:36 Location: 727 BROADWAY CITATION VIOLATIONS � Violation Code: 6-12A -FALSIFY AGEIOBTAIN LIQ iCITATIIOON COURT,/[PPEARAN�ES Court Date: 12/412018 9:00:OOAM Court Type Court Name : MUNICIPAL COURT Jury Trial : No .._....-.._......Judge ........... .... .. _,..._...,___...., .._...,.wComment....,-......_.., ...._,....,.. CITATION OCSCRIPT1 N: - Citation #: 161122816 Officer: STEINER, ERIC Citation Two Traffic Municipal Assist Officer: Citation Date; 11102/2018 23:36 Location: 727 BROADWA L_._..... _ ....... ._ .._.,.. ............ _Md_. ........... ;CITATYON VIOLAMNS . i:,'- ... , • .' :' Violation Code : 6-12B -LIQUOR LAWS POSSESSION OF INTOXICANTS rCITATIQN COURT APPEARANCES, I Court Date : 121412018 9:00:00AM Court Type Court Name: MUNICIPAL COURT Jury Trial :No f' Judge. ......... ... .. .. Comment .....,......_.. . Printed: 03/25/2019 10:54:33 AM Incident Page 2 of 3 INCIDENT DETAIL REPORT LIQUOR LAWS MISREPRESENTATION OF AGE Agency: CAPE GIRARDEAU POLICE DEPARTME Incident # : 18006842 Phone: (573) 335.6621 Address: 2530 MARIA LOUISE, CAPE GIRARDEAU MO 63701 NOTNTNAROTIVE ._.: p.:- s.. ..... On Friday, November 2nd, 2018, at approximately 2329 hours, I, Patrolman Steiner, DSN 303, conducted a walk-through of 727 Broadway (The Hangout) due to multiple anonymous citizen complainTs recently regarding underage drinking on the premises. While conducting the walk-through I observed a white male who appeared to be purposely trying to avoid me by noticeably walking in the opposite direction of myself and other officers. I made contact with the individual who was identified as Tanner Harris. CITED Harris, Tanner Bryce W/M DOB SSN: 11537 Old St. Charles Rd, Bridgeton MO 63044 (314)456-9505 It should be noted should be noted that Harris was extremelv cooperative durino this incident. ID appears to be of lower printing quality than an The suspected alcohol will be submitted to the MSHP crime lab for further analysis. Harris was released from the scene with two municipal citations. CITATION 151122814 Misrepresentation of Age 5-12(a) Court Date: 12-04-2018 Court Time: 0900 hours 151122815 Possession of Alcohol by Minor 5-12(b) Court Date: 12-04-2018 Court Time: 0900 hours Nothing further. Printed: 03/25/2019 10:54:33 AM Narrative Page 1 of t Inddent Page 3 of 3 INCIDENT DETAIL REPORT LIQUOR LAWS POSSESSION OF INTOXICANTS Agency: CAPE GIRARDEAU POLICE DIEPARTME Phone : (673) 3366621 Address: 2630 MARIA LOUISE, CAPE GIRARDEAU MO 63701 ORIGINAL Incident # :18001602 Printed: 03/22/2019 9:33:41 AM Incident Page 1 at 2 Call For Service #: CAPF2019012690 Begin Date/Time : 03/2112019 23:29 Occurence Data ; Other#: EndDatelTlme: 0312212019 00:18 Solvability Points: Disposition : CLEARED BY ARREST Date Reported; 113/1 Total Damage UCR Disposition : NOWUCR UCR Disposition Date: 0312212019 __ REPORTABLE,_,,,_ Primary Officer: RICHARD COUCH COUCH RICHARD Rolo,�Rsporting DateAsaianed:0312112019 LVa se: COUCH RICHARD Roly �;R Ourtin DateAss(gned 0 �� ,Nae SMITH BRADLEY a � algnsd:031a1I2D19 ,ry w Role,Re,Porting __ DateAsmming 4d28 ,. Primary Aclation NCIC Code: I SR Code: UCR Code : 22 LIQUOR LAWS POSSESSION OF INTOXICANTS Location Type : Inc Location Address 727 BROADWAY Place Name: THE HANGOUT Capt Girardeau MO 63701 -.7 Involvement: ARREST Sex; F Leel Name: BRIM13ERRY Birth Date: First Name: EMILY Eye Color: Primary: (314) 6862696 MI: ELIZABETH Hair Color: BLD Suffix: Hair Length : Coll: (314) 686.2696 Race: WHITE Height: Ethnicity: NON HISPANIC Weight: Address: 9816 GENEL DR, ST. LOUIS, MO 63126 GAG ,5 Printed: 03/22/2019 9:33:41 AM Incident Page 1 at 2 INCIDENT DETAIL REPORT LIQUOR LAWS POSSESSION OF INTOXICANTS Agency: CAPE GIRARDEAU POLICE DEPARTME Incident # 1 19001692 Phone 11673) 336.6621 Address; 263D MARIA LOUISE, CAPE GIRARDEAU MO 63701 � soo169z On Thursday, 03.21-19 at approximately 2310 hours I, Corporal Couch and Lt Smith along with agents of the Missouri Division of Alcohol and Tobacco conducted an alcohol compliance check at the Hangout Bar located at 727 Broadway In Cape Girardeau, Missouri, This operation was conducted by the agents entering Into the bar and we uniformed officers entered a short time after. Upon entering the bar at appro>dmately 2315 hours I was approached by Agent Tate who Informed me he located a female consuming alcohol under the age of 21. Agent Weaver later located a female consuming alcohol under the age of 21, Agent Henderlokson also had a female detained who was consuming alcohol under the age of 21. The three females were escorted out of the building by the agents, Once outalde, I was provided identifying Information for the females by the agents and began to complete citations, CITED -/ RELEASED: BRIMBERRY, Emily Elizabeth DOB:_ Brimberrywas Issued the following Municipal Court Mellon: CITATION INFORMATION: Citation #160368298 Charge: Minor in Possession ofAUcohol Ordinance A 5.12 B Court date/time: 04-23-19 10900 hours And released to a sober person. See reports 19001693 and 19001694 for additional citations issued at this location. The alcohol evidence was seized, packaged, photographed and entered Into evidence per procedure. The body worn camera footage of this Incident was downloaded. Corporal Richard k Couch #243 I'Mited: 93/22/2019 9;33:41 AH Narrative Page 1 of 1 Incident Page 2 of 2 INCIDENT DETAIL REPORT ORIGINAL LIQUOR LAWS POSSESSION OF INTOXICANTS Agency: CAPE GIRARDEAU POLICE DEPARTME Incident #: 10001693 Phone: (673) 3366021 Address: 2630 MARIA LOUISE, CAPE GIRARDEAU MO 63701 C'iall For Ser%4ce#: CAPE2019012693 Begin DateMme: 03/21/2019 23:41 Occurence Date: Other#: End Date/Time; 0341/2019 23,41 SDlvabilltyPoints: Disposition :CLEARED BY ARREST Date Reported : 0312112019 Total Damage! UCR Disposition: NON•UCR UCR Dlspoan on Date: 03/21/2019 Offlcer : NCIC Code; IBR Code: UCR Code: 22 LIQUOR LAWS POSSESSION OF INTOXICANTS Locatlon Type; Inc Location Address; 727 BROADWAY Cape Girardeau MO 63701 Involvement; ARREST Last Name; QUIST First Name: ALLISON MI: K Suffix: Race: Ethnicity; Address; 2666 HICKORY MANOR DR, BALLWIN, MO Sex: F Birth Data: woo Eye Color; Hair Color: Hair Length: Height: Weight: Primary: (636)6764463 Home: (636) 676.4463 Printed; 03122/2019 10:06,31 AN Inddant Pago 1 of 2 INCIDENT DETAIL REPORT LIQUOR LAWS POSSESSION OF INTOXICANTS Agency : CAPE GIRARDEAU POLICE DEPARTME Incident rf : 19001693 phone: (673) 336.0621 rtYYf O`J-J . GVJY W -MIA LV V13K, cArr GIRARDEAU MO 63701 19001693 On Thursday, 03-21.19 at approximately 2310 hours], Corporal Couch and Lt. Smith along with agents a the Missouri Division of Alcohol and Tobacco conducted an alcohol compliance check at the Hangout Bar located at 727 Broadway In Cape Girardeau, Missouri. This operation was conducted by the agents entering Into the bar and we uniformed officers entered a short time after, Upon entering the bar at approximately 2315 hours I was approached by Agent Tate who Informed me he located a female consuming alcohol under the age of 21. Agent Weaver later located a female consuming alcohol under the age of 21, Agent Henderickson also had a female detained who was consuming alcohol under the age of 21. The three females were escorted out of the building by the agents, Once outside, I was provided Identifying information for the females by the agents and began to complete citations. CITED f RELEASED, QUIST, Allison Kate DOB;` Quist was found Inside the bar consuming Sprite and Vodka byAgent Weaver, Quist was issued the following Municipal Court citation: CITATION INFORMATION Citation #160388296 �u Charge: Minor in Possession of Alcohol Ordinance #: 5.12 B Court dateltime: 04.23.1910900 hours And released to a saber person. See reports 19001692 and 19001694 for additional citations issued at this location. The alcohol evidence was selzed, packaged, photographed and entered into evidence per procedure. The body worn camera footage of this incident was downloaded Corporal Richard K. Couch 0243 imncnn: ua/ZZIZU19 10;06:31 AM Wrrotive Page 1 or 1 Inddent Page 2 of 2 INCIDENT DETAIL REPORT LIQUOR LAWS MISREPRESENTATION OF AGE Agency: CAPE GIRARDEAU POLICE DEPARTME Phone: (573) 3380621 Address: 2530 MARIA LOUISE, CAPE GIRARDEAU MO 63701 ORIGINAL IncidentC 18001604 r.E .o'i .. p, �x iJ::•'x .r�M1 rgWl� rl(il�+�E�d �t�'fh.Y '��'� }^�F'+tlY �ivM'k,�r L -'f r � y 5. YCh{4y.e - xY,� F.f - A ` 1- i4f'r�.S. Jyl':�]i Call For 1 0Begin•: 03121/2019 61 _ _ Other 1 •. a 0312112019 .I SolvabilityPoints Disposition ; CLEARED BY ARREST Data Reported: 0312112019 Total Damage REPORTABLE IA,ARIL'likk9t4"��Jl.��v •��i'A1 �`LYv'.. ,¢... �'�'��'.r:S�1 �� 4 'Y.: .1�i4'P"e3'fl�fi. (��y ,Y ".i%:F �d�'h�e Nt�''�'`T,.{t5.. Primary Officer: ..Y�fl"�h�}��%i��`A Tf2'e��'�R�13. �. Lil � r •�}.ILS} f'r IU%.n �. AY JkS� fiU�Jeteyy t Q�vif9%wir�'Yv 4S,V�v��Y.'IM .$U.�i ;,��Sf A'�.. �"Su}Ifii�. Printed: 03/22/2019 10:0242 AM Incident Page 1 or 2 INCIDENT DETAIL REPORT LIQUOR LAWS MISREPRESENTATION OF ACE Agency: CAPE GIRARDEAUPOLICEDEPARTME Incident#:19001694 Phone: (573) 338.8621 "V(Vp U; caaar IviAKIA wUaSC, 6AF'E UIRARDEAU MO 63701 19001694 - On Thursday, 03.2119 at approximately 2310 hours I, Corporal Couch and It. Smith along with agents of the Missouri Division of Alcohol and Tobacco conducted an alcohol compliance check at the Hangout Bar located at 727 Broadway in Cape Girardeau, Missouri. This operation was conducted by the agents entering into the bar and we uniformed offlcars entered a short time after, Upon entering the bar at approximately 2315 hours I was approached by Agent Tate who Informed me he located a female consuming alcohol under the age of 21, Agent Weaver later located a female consuming alcohol under the age of 21. Agent Henderlckson also had a female detained who was consuming alcohol under the age of 21. The three females were escorted out of the building by the agents. Once outside, I was provided Identifying Information for the females by the agents and began to complete citations. CITED I RELEASED: PRINCE, Morgan Denee DOB: Prince was found Inside the bar consuming Mikes' Hard Lemonde by Agent Hendrickson. Prince was issued the following Municipal Court citation: CITATJ.QN INFORMATION: Citation 9160388297 Charge: Minor In Possession of Alcohol Ordinance M 5-12 B Court date/time: 04.23.1910900 hours And released to a sober person. See reports 19001692 and 19001693 for additional citations issued at this location. The alcohol evidence was seized, packaged, photographed and entered Into evidance per procedure. The body worn camera footage of this incident was downloaded. Corporaf Richard K. Couch #243 PHn[ed: 03/22/2019 10:02:42 AM Narrative Page 1 or 1 Inddelt Page 2 or 2 INCIDENT DETAIL REPORT ASSAULT Agency: CAPE GIRARDEAU POLICE DEPARTME Incident # : 19001884 Phone: (573) 336-6621 Address: 2630 MARIA LOUISE, CAPE GIRARDEAU MO 63701 Call For Service 9: CAPE2019014088 Begin Date/Time: 03/3012019 01:20 OocurenceDate: Other k : End Date/Time : 03/30/2019 01:38 Solvability Points: Disposition: EXCEPTIONALLY CLEARED Date Reported : 03130/2019 Total Damage UCR Disposition: NON-UCR UCR Disposition Date : 03/30/2019 PrimaryOfficer : ETHAN GARNETT NCIC Code: ASSAULT IBR Code UCR Code: D4E Location Type : Inc Location Address: 727BROADWAY __ Place Name : THE HANGOUT M Cap a Girardeau MO 63701 r_ _._. ,..�.. _......„_..u. .. .. ,._.. ..._ `1" ..,,,._. ,..,. ..� Involvement: OTHER Sex: M Last Name: FORD Birth Date : M� First Name: JEFFREY Eye Color: BRO Primary: (573)576.4469 ML JEWEL Hair Color: BLK Home: (673)335.7938 Suffix : Hair Length : Sht Cell: (573) 576-4469 Race: BLACK Height: 67' Ethnicity: NON HISPANIC Weight: 235 lbs Address: 542 S SPRING ST APT 1 , Cape Girardeau, .....__..... _.._,.MO 63701,..._......_.._,......_,.._..._........,..._..._._.____»._....._........._._...,..__�__.....�......._.�...-.._.__..._.____ .............„.__._....,._............_,.,.....e......_ Involvement: OTHER Sex: M Last Name: SARHAGE Birth Date: First Name: MATTHEW Eye Color: Primary: (618)830-3634 MI: D l Color: Home: (618)830.3634 Suffix: Hair Length : Race: WHITE Height: Ethnicity: NON HISPANIC Weight: '. Address : 1000 TOWERS CIR H 9101, Cape ______ Girardeau, MO fi3701 ._..._.___.,�...__.__._..__,.__..__..____......._.._..Sex: __ Involvement: VICTIM M Last Name; OUILLIN Birth Date : 9� First Name: CHRISTOPHER Eye Color: Primary: (573)576.6671 MI: LANE Halr Color. 8RO Home: (573)576.6671 Suffix : Hair Length: Race: WHITE Height: Ethnicity: NON HISPANIC Weight: Address: 6 VILLAGE DRAFT 6, Cape Girardeau, MO 63701 Printed; 04/03/2019 B:04:08 AM Incident Page 1 of 3 INCIDENT DETAIL REPORT ASSAULT Agency: CAPE GIRARDEAU POLICE DEPARTME Incident # : 19001884 Phone: (573) 336.6621 Address: 2530 MARIA LOUISE, CAPE GIRARDEAU MO 63701 On March 30, 2019 at 0120 hours, I Officer Garnett DSN 354, was dispatched to a fight in progress at The Hangout Bar, which is located at 727 Broadway St, Cape Girardeau, MO 63701. Upon arrival, there was no active fight in progress, however it appeared a disturbance had occurred prior to my arrival, based upon the crowd of bystanders present outside the Hangout Bar. I spoke to the victim on scene, who is Identified as: VICTIM Quillin, Christopher Lane W/M (573)576-6571 6 Village Dr, Apartment 6 Cape Girardau, MO 63701 Quillin stated on March 29, 2019 at 1255 hours, he traveled to the Hangout Bar to pick up a friend. Quillin only identified his friend as "Keegan Brown". Quillin also stated Brown was under the age of 21 years old, and should not have been inside the Hangout Bar. While inside the Hangout Bar, Quillin stated a fight had started. Quillin was unsure why the fight had started, but intervened in an attempt to stop the fight. During the fight, Quillin stated he was approached by an intoxicated female. Quillin was not able to identify the female. Quillin stated he advised the female to get back. After she did not step away, Quillin informed me he pushed the female away. After pushing the female away, Quillin stated four to five men approached him and began to attack him. Quillin informed me he was struck several times in the face, and complained of an injured jaw. I did not observe any apparent injuries on Quillin's face. Quillin refused medical assistance while on scene. While being attacked by the four to five men, Quillin stated a bouncer approached the fight, grabbed him by the neck, and escorted Quillin outside of the bar. Once outside of the bar, Quillin stated he contacted 911. Quillin did not wish to file charges, but was upset Brown was able to enter the Hangout Bar while being under the age of 21 years old. Quillin also informed me he would not be able to identify the males that attacked him, if given the opportunity, Quillin completed a voluntary statement on scene in reference to this incident. I did not speak to the bouncer on duty while on scene. Please refer to Patrolman Hellmann, DSN 304, supplement for more information. My department issued body worn camera was activated while on scene. cleared. On 03-30-2019 at about 0120 hours, I Cpl Hellmann DSN 304, responded to The Hangout located at 727 Broadway for a reported fight in progress. Upon arrival, there was no physical disturbance observed; however, Patrolman Garnett DSN 354 made contact with an individual who advised he was Printed; 04/03/2019 8:04:08 AM Narrative Page I of 2 Incident Page 2 of 3 INCIDENT DETAIL REPORT ASSAULT Agency: CAPE GIRARDEAU POLICE DEPARTME Incident #: 19001884 Phone: (573) 3356629 Address: 2530 MARIA LOUISE, CAPE GIRARDEAU MO 63701 assaulted inside The Hangout. While Patrolman Garnett obtained a written statement from this Individual, I made contact with the two following door men working at The Hangout during the time of the incident: OTHER Jeffrey J Ford B/M DOB: 542 S Spring Apt I Cape Girardeau, MO 63701 573-576-4459 POE: The Hangout OTHER Matthew D Sarhage W/M DOB: 1000 Towers Circle (Building H #101) Cape Girardeau, MO 63701 618-830-3634 POE: The Hangout Jeffrey appeared to be too busy to assist with my investigation; however, I spoke to Matthew who advised he was standing near the front door of the business when he was alerted to a fight which had broken out in the middle of the business. Matthew said he approached the fight and began escorting individuals out of the bar. I advised Matthew to respond to CGPD Headquarters at his earliest convenience to complete a voluntary statement. Nothing further. Plnted: 04/03/2019 8:04:08 AM Narrative Page 2 of 2 Incident Page 3 or 3 0 LIQUOR LICENSE APPLICATIONDate Submitted: _ CITY Of CAPE GIRARDEAU Desired Sales Start Date: CUSTOMER SERVICE OFFICE, 401 INDEPENDENCE ST, CAPE GIRARDEAU, MO 83703,573-339-8322 All questions (6;pages) on this application must be answered completely before the application will be considered. Answers must be typed or legibly printed. Where netessory, respond on a`separate document. A background check must accompany this application. Application For (check all that 5% Liquor by the Drink Wholesalers of Malt Liquor Not in Excess of 5% Sunday Sales Retail Liquor by the Drink Wholesalers of Intoxicating Liquor -Under 22% Wine Tasting Original Package Liquor Wholesalers of Intoxicating Liquor -All Kinds Consumption of Liquor Manufacturers of Beer Distillers/Manufacturers of Liquor Applicant's Full Name (First, Middle, last) Business Name CAPE BROADWAY, LLC HANGOUT Address Physical Address PO BOX 735 �,"�- ROADWAY City, State, 2Ip City, State, Tip GAPE GIRARDEAU, MO 63701 CAPE GIRARDEAU, MO 63701 BmailAddress Number of Stories Number of Rooms ALAM7-AHEDQaGMAIL.COM - 1 1 Business Phone Additlonal, detailed description of premises - all areas listed are subject to 573.587-6017 Inspection TWO STORY BUILDING LOCATED ON BROADWAY. THE BAR WILL, Type of Ownership (nate special sections by type below) ONLY BE ON THE FIRST STORY r ---I-7 Corporation I i Partnership -p I Proprietorship, Sole Owner 11 Are you in present possession of the premises described above? YES t°".'t NO f Are any alterations to the building or premises currently underway or planned In the immediate future? Has there been a liquor license Issued within the past six months which was similar or less restrictive? YES I""^+p NO e IF N0: EACH APPLICANT WILL BE GIVEN A SIGN TO BE POSTED FOR AT LEASTTEN DAYS PRIOR TO COUNCIL ACTION. THE SIGN WILL CONTAIN THE NOTICE OF APPLICATION AND T'HE TIME WHEN AND PLACEWHERE THE COUNCIL SHALL CONSIDER THE APPLICATION THE APPLICANT SHALL BE RESPONSIBLE FOR POSTING THE SIGN. WHEN GIVEN THE SIGN TO POST, A WOODEN STAKE(S) WILL ALSO BE GIVEN, W WHICH THE APPLICANT MUST RETURN IN ORDER TO RECEIVE THEIR LIQUOR LICENSE. (SEC. 5-34) the licensed premises, or the of a school or church? YES IF YES: NO LICENSE SHALL BEG RANTED FOR THE SALE OF INTOXICATING LIQUOR WITHIN TWO HUNDRED FEET OF ANY SCHOOL, CHURCH, OR OTHER BU I LDING, REGULARLY USED ASA PLACE OF RELIGIOUS WORSHIP. (SEC, 5-6) TO BE COMPLETED BY CORPORATIONS ONLY exact corporate name of applicant I State the date and place of incorporation State the address of the principal office of the corporation State the names and residence addresses of all officers of the corporation and the office held by each. State names of all stockholders and the number of shares owned by each (If not a closely held corporation, list those who own at least t0°%of issued stock) TO BE COMPLETED BY PARTNERSHIPS ONLY State the name the partnership State date partnership was formed _CAPE BROADWAY, LLC 04/02/2015 State the name of all partners Full Name (w/ma/den) DOB Driver's License No. SHAH REEZA ALAM ZAHED I� ALL REMAINING QUESTIONS MUST BE COMPLETED BY ALL APPLICANTS PROVIDE THE FOLLOWING INFORMATION PERTAINING TO THE MANAGING OFFICER OF THE CORPORATION, EACH PARTNER OF A PARTNERSHIP OF THE OWNER OF A SOLE PROPRIETORSHIP Managing Officer Full Name (with Malden if Applicable) Date of Birth Place of Birth SHAH REEZA US Citizen? YES•'.: NO n DHAKA, BANGLADESH Current Residential Address Driver's Number /State5ociartyNumber 1749 DELAWARE PLACE City, State Zip All Former Driver's Licenses (List number and state) CAPE GIRARDEAU, MO 63701 N/A List all former names and corresponding dates List last 15 years of former addresses and corresponding dates Name From To Address From To N/A 1749 DELAWARE CAPE GIRARDEAU 2000 2015 2717 THEMIS CAPE GIRARDEAU _ 1990 2000 1. 'type of business: BAR _ 2. Describe all related activities which you Intend to conduct on the premise for which you seek a license: LIQUOR SALES 3, Is the owner, managing officer, corporation, any stockholder owning 10% or more of issued stock, or any partner, or any member of family interested directly or ind redly in any other license issued by the Supervisor of Liquor Control or the City of Cape Girardeau which Is now in force? CiYES NO If so, give details: LIQUOR LICENSE ISSUED TO CAPELAND, LLC AND SOUTHEAST GROUP, LLC 4. Has the owner, managing officer, corporation, any stockholder owning 10% or more of issued stock, or any partner, or any member of owner's, managing officer's, or any partner's household or Immediate family at any time In the past, held a license from the Supervisor of Liquor Control or the City of Cape Girardeau which was denied? OYES 0 NO If so, give details: 5. Has the owner, managing officer, corporation, any stockholder owning 10"%or more of issued stock, or any partner, or any member of owner's, managing officer's, or any partner's household or immediate family ever had any license issued by the Supervisor of Liquor Control of the State of Missouri or by the licensing authority of any other state or by any city, suspended or revoked? OYES G) NO if so, give details: 6, Has the owner, managing officer, corporation, any stockholder owning 10% or more of issued stock, or any partner, or any member of owner's, managing officer's, or any partner's household or Immediate family ever had any license issued by the Supervisor of Liquor Control of the State of Missouri or by the licensing authority of any other state or by any city, suspended or revoked? 0 YES ®' NO If so, give details: 7. Is there now employed, or do you expect to employ, In the business sought to be licensed hereunder any person who has at any time had a license from the Supervisor of Liquor Control revoked or suspended? OYES 0 NO If so, give details: 8, Has the owner, managing officer, corporation, any stockholder owning 10°% or more of Issued stock, or any partner ever been employed by any person partnership, or corporation that had a license suspended or revoked by the Supervisor of Liquor Control of the State of Missouri? YES E' NO If so, give details: 9, Has any license heretofore Issued by the Supervisor of Liquor Control for the premises for which you seek a license ever been suspended or revoked by the supervisor of Liquor Control of the State of Missouri? 0YES I@ NO If so, who was the licensee? 7.0, Has the owner, managing officer, or any banger ever been arrested or indicted for the violation of any Federal Law, law of the State of Mlssourl, or any other state: OYES ' NO If so, give details: 11, Has the owner, managing officer, or any partner ever been convicted of any crime 1n any Missouri Court, any Court of any other State, any Federal Court or any Court of any other Country? ® YES) NO If so, give details: 12. Has the owner, managing officer, or any partner ever been convicted of the violation of any ordinance of any city relating to intoxicating liquor gambling, immorality, fighting, or peace disturbance? ® YES(j) NO If so, give details: 13, Has the owner, managing officer or any partner or any member of owner's, managing officer's or partner's household or immediate famlly ever been convicted of any Federal Law or law of any state concerning intoxicating liquor? OYES 6e) NO If so, give details as to each conviction, giving name of person convicted, date and nature of offense, court where sentence was entered, and sentence imposed orfine imposed. 14, Is there now employed or do you expect to employ, in the business hereunder any person who has been convicted of any crime? YES 0 NO C') If so, give details: 15. Do you own or rentthe premises for which you 16. Who is your landlord? N/A _ 17. What Interest, if any, does your landlord have, directly or indirectly, In the business which you intend to engage in if the license is granted? NIA 18. Does your landlord now hold, or has he ever held, a license of any kind issued by the Supervisor of Liquor Control? YESONO 19. Did you pay the former owner the total purchase price in cash? YES 0 NO.D If not, store in detail manner of payment? BANK OF MISSOURI MORTGAGE LOAN PAYED FOR THE BUILDING 20. Does the former owner of the business have any Interest either directly or indirectly in the business for which you seek a license? 'YES 0 NO (D If so, give details: 21. Give the name of any person, firm, or corporation holding any mortgage or encumbrances of any kind against the business for which you seek a license. BANK OF MISSOURI 22. State names of persons, firm, or corporations that have advanced, or that will advance any money to you to purchase or operate the business for which you seek a license. BANK OF MISSOURI 23. Does the owner, managing officer, corporation, any stockholder, or any partner have any Interest directly or Indirectly In any brewery, winery, distillery, rectifyin or blending plant or wholesale liquor concern either as part owner, stockholders, agent or employee or otherwise? YES NO 0 If so, give details: 24. State the name and address of any distillery, wholesaler, winemaker, brewer, or any employee, officer or agent thereof that has, or will have any financial interest directly or indirectly, In the business for which you seek a license. N/A 25. State the name of any distiller, wholesaler, winemaker, brewer, or any employee, officer, or agentthereof who has loaned or who will directly or Indirectly, loan, give away, or furnish equipment, money, credit or property of any kind to you except ordinary commercial creditfor liquors sold to you and except such articles and services, if any, as are permitted by the regulations of the Supervisor of Liquor Control. N/A 26. State the name and residence of any person, firm or corporation, if any, who is interested, or who will become interested, directly or indirectly, otherthan hereinabove set out, In the business for which you seek a license and the nature of such Interest. NIA 2.7. Has any bonding company ever cancelled any bond signed by it for the owner, managing officer, corporation, any.stockholder owning 3.0% or more of issued stock, or any partner In connection with any license Issued to you by the Supervisor of Liquor Control? YES NO 0 !f so, give details: 28. Has any bonding company ever refused to sign any such bond for the owner, managing officer, corporation, any stockholder owning 10% or moreof issued stock, or any partner? YES 0 NO (" If so, give details: 29. Is this application a subterfuge to permit any person other than yourself or the corporation to secure a license from the City of Cape Girardeau, in your name, for his/her benefit? YES 0 NO G) If so, give detoils: 30. Name, address and phone number of partners or officers, and ownership percentage: (Attach a separatesheet rf needed) Name I Address _ 1 Phone Percentage Held SHAH REEZA 1 1749 DELAWARE CAPE GIRARDEAU, MO 63701 I 573-225-0091 50% ALAM ZAHED 11363 EASNIEW RIDCF_ CARE GIRARDEAU, MO 63701 573-587-6017 50% 31. Print this farm and execute the appropriate acknowledgement: I, the undersigned, hereby apply to the City Council of the City of Cape Girardeau, State of Missouri, for the license above described on the above described premises and for the purpose of Inducing the City Council to issue to me said license, I make the statements and answers hereinafter set out and understand and agree that if any statements of answers made herein are untrue and the license herein applied for is granted, such license may be revoked or suspended by said City Council and I further understand and agree that if I, or any of my employees, shall violate the provisions of any ordinances of the City of Cape Girardeau, Missouri, or knowingly allow any other person to do so upon the licensed premises, the City Council may suspend or revoke the license granted hereunder. Applicant further agrees that If the license Is granted, inspections may be made in accordance with the regulations as set forth in the Ordinances of the City. In addition, applicant understands that any false statement contained In this application may result In prosecutl n under the Cade of ordinances for the City of Cape Girardeau, Missouri, and/or state law. SIGN:' FOR PARTNERS OR SOLE PROPRIETORS: STATE OF SS. COUNTY OF l3h`Jh { &zVl Z ah -M of lawful age being first duly sworn upon oaths, depose and say that (he, she) have read this application and the instructions with reference thereto and that (he, she, they) fully understand the same; that (he, she) know the contents and the statements contained therein and that the same are true, Applicant has personal knowledge of the information contained the application and has read the provisions of Article XV of Chapter 15 of the Code of Ord tyances of the C' eGlrardeau, Missouri. Subscribed and sworn to me before this. day of, PAULA A.BESS NOTARY PUBLIC Notary Public—Notary Seal My Commission Expires: STATE OF MISSOURI Cape Girardeau County commission Number 14252529 9 l �' , y M commission ex Tres September 12,2915 Date Submitted: gr 1 RENEWAL OF LIQUOR LICENSE APPLICATION CITY Of CAPE GIRARDEAU Desired Sales Start Date: CUSTOMER SERVICE OFFICE, 401 INDEPENDENCE ST., CAPE GIRARDEAU, MO 63703, 573-338-6322 Application For (check all that aoolvl 5% Uquor by the Drink Wholesalers of Malt Liquor Not In Excess of 5% Sunday Sales r{� Retail Liquor by the Drink Wholesalers of Intoxicating Liquor — Under 22% Original Package Liquor Wholesalers of Intoxicating Liquor — All Kinds Wine Tasting Manufacturers of Beer Distillers/Manufacturers of Liquor Consumption of Liquor pplicant' Full Name (First, Middle, Last) a4 Business Name 4A (IV) 116U4 APP man 's Address Business'A dress Vv city, State, Zip 01 pDArar(lea-1D� `ty State, .p ` I pU sines'Phone Ho a/Other Phone Email rromge me touowmg mtormation pertaining to the managing officer of the corporation, each partner of a partner of a partnership, or the owner of a sole proprietorship FAI,Name(and rrAlden name, if applicable) - - DattLof Birth Place of Birth .� List all former names Full Name 4„ states r) 101 I Is the managing officer a U. S. Citizen? From I To Full Name - I From I To rai Name I From I To Has the owner, managing officer, corporation, any stockholder owning 10% or more of issued stock, or any partner, or any member of owner's managing officers, or any partner's household or Immediate family had any license Issued by the supervisor of liquor control of the state of Missouri or by the licensing authority of any other state or by any city, suspended or revoked within the last 12 months? YES ® NO W If so, give details: Is there now employed or do you expect to employ in the business hereunder any person who has been convicted Of crime? YES 0 NO 0 If so, give details: NNII cirya CAPE Name, address and phone number of partners or officers, and ownership percentage: (Attach aseparate sheet if needed) FOR PARTNERS OR SOLE PROPRIETORS: STATE OF L SSU t..e.-Y` 1 ) d ) Ss. COUNTY OF 9.( "" ) 'aq of [awful age being first duly sworn upon oaths, depose and say that (he, she) have read this application, and he Instructions with reference thereto and that (he, she, they) fully understand the same; that (he, she) know the contents and the statements contained therein and that the sameare true. Applicant has personal knowledge of the information contained the application and has read the provisio i XV of Chapter 15 of the Code of Ordinances of the City of Cape Girardeau,. Missouri. -tb-- ubscribed and sworn to me before this Lday of NOTARY PUBLIC BELINDAdQNES Notary Public - Notary Seal My Commission Expires: State pf Mlssoud r"k"' , cam alone for Cape Girardeau Goun My Cammilssion Nusion mbat:res:12341749 202 FOR MANAGING OFFICER OF CORPORATION/PARTNERSHIP: STATE OF ) SS. COUNTY OF of lawful age, being first duly sworn upon (his, her) oath, deposes and says that (he, she) is the managing officer of the corporation seeking a license hereunder, that (he, she) has been authorized by said corporation to make this application in its behalf, that (he, she) has read this application and the instructions with reference thereto, and that (he, she) fully understand the same and that (he, she) knows the contents thereof and the answers and statements contained therein and the same are true. Subscribed and sworn to before me this day of My Commission Expires: 'SA pata, NOTARY PUBLIC i Ago (a&-) 5.-1 to -t8 OFFICEUSEONLYBuilding Inspector Approve Disapprove Signature Date Zoning inspector Approve Disapprove Signature Date ,/ CG -1g-18 Health Inspector Approve Disapprove Signature Date Fire Inspector pprov Disapprove Sig ura Date 15 Firtonce.Diuisiven Approve Disapprove Signature Date rt�C7 5•I k 1 d 2 Taxes Utility edal Assess ant No Tax Due License # Setup Issue HMR Tax # Setup