Loading...
HomeMy WebLinkAboutA042 - List of 10% Exemptions SMOKING ORDINANCE "LESS THAN 10%" EXEMPTIONS Establishment Address Authorized Agent Date Filed American Legion Post#37 225 Main Street David Rehbein 07/13/01 Break, The 115 Main Street Louis Lex 02/15/02 Corner Pocket 125 Main Street Scott Griffen 06/29/01 Dean's List 2522 Chamberlain Street Charles Hill 06/21/01 Deano's 119 Main Street Kathy Perkovich 07/16/01 Fox I Lounge 111 S. 5" Street Kathryn Kempen 07/26/01 Hilton Coliseum Iowa State Center Mark North 07/31/01 Hunky Dory's 300 South 17`" Street David Wheelock 07/18/01 Lumpy's 2428 Lincoln Way Tom Zmolek 08/01/01 Meeting House (The) 823 Wheeler St., Ste. 4 Daniel Sondrol 07/27/01 Mickey's Irish Pub 109 Welch Avenue Jason Stewart 07/31/01 Paddy's Irish Pub 124 Welch (middle level) Andrew White 07/17/01 People's Bar& Grill 2430 Lincoln Way Tom Zmolek 08/21/02 Snooker's 118 Hayward, Ste. 2 Leandro DePaula 8/29/02 Sportsman's Lounge 123 Main Street Margaret Jacobson 09/10/01 Stephen's Auditorium Iowa State Center Mark North 07/31/01 Thumbs 2816 West Street Tom Zmolek 08/01/01 Tip Top Lounge 201 E. Lincoln Way Andrew White 07/17/01 Welch Avenue Station 207 Welch Avenue Thomas Northrop 07/20/01 **Cyclone Truck Stop has filed a separate Truck Stop Exemption certifying that they have sales of diesel fuel that on average, over a calendar year, amount to more than twelve thousand gallons per month.** Updated on 8/29/02 s:smkgwaiv AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned, Qa yi c} K, Renbi n, being first duly sworn, does hereby depose and state that: 1. The undersigned is the authorized agent and representative for Awr Fn i` art f7rner7l'car7 2. That ,Pos Y" 3 is both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food at aa•5_ /Va)o are in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds at aaS Mce i►7 . SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State of Iowa,by the affiant , aat i d b2.in to me personally known,on the day of J li ,2001 otary Public in and for Story County, Iowa F85 - Smoking Ordinance Affidavit-052901 AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY Lo v ts Le--;k The undersigned, being first duly sworn, does hereby depose and state that: 1. The undersigned is the authorized agent and representative for 7HE7 ic'�aeANL. 2. That THc 09rAyc is both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food at t 15 rimAw ST- are in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds at TI-I c FR&W4- SUBSCRIBED AND SWORN to before me,a Notary Public in and for the State of Iowa,by the affiant Lbws Lem ,to me personally known,on the 5 ^ day of -e6ar 20 02-. btg'a_m���� Notary Public in and for Story County,Iowa �pP�Af KAREN C. THOMPSON ° COMMISSION# 177422 MY COM ISSIO EXPIRES owl, - Smoking Ordinance Affidavit-052901 o7�3 AFFIDAVIT I I 1�7 �— SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned,ba,�qa , being first duly sworn, does hereby depose and state that: l. The undersigned is the authorized agent and representative for 2. That OcfpVlc--cde, is both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food at � are in a olla amount that is less than ten percent of the dollar amount of sales of all kinds at R U ALM- 1,�AUAJL� S,VBSCRIBED AND SWORN to before me,a Notary Public in and for the State of Iowa,by the affiant 00i yLa ttC to me personally known,on the a(-h day of S�&, ,20 b L. N DIANE R.VOSSCOMMISSION#134019MY MMISSION EXPIRES Notary Public in and for Story County,Iowa -G -�C F85 -Smoking Ordinance Affidavit-052901 15 rVicu AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned, Sevr( ' being first duly sworn, does hereby depose and state that: l. The undersigned is the authorized agent and representative for 2. That rry his both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food at Cis►^ "� Gxl are in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds at i�.'aAlA r1� SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State of Iowa,by the affiant Cott"Grp ,to me personally known, on the aq day of 5iU , 20 0 . '$u►r DIANE R.VOSS Notary Public in and for Story County, Iowa COMMISSION#134019 MY COMMISSION EXPIRES lowx —O —© F85 - Smoking Ordinance Affidavit-052901 AFFIDAVIT SMOKING ORDINANCE TRUCK STOP EXEMPTION '�" ? 3 2001 CIT �IK 6 STATE OF IOWA CITY OF ANTES,IOWA SS: STORY COUNTY The undersigned, Robert James, being first duly sworn, does hereby depose and state that: 1. The undersigned is the authorized agent and representative for James Enterprises,Inc. 2. That James Enterprises, Inc., is in possession and control of the food service establishment known as The Cyclone Truck Stop. 3. That the establishment called The Cyclone Truck Stop has, in addition to its food sales,sales of diesel fuel that on average,over a calendar year,amount to more than twelve thousand gallons per month,as shown by records made in the regular course of that establishment's business, said records being now on file with the Ames City Clerk. Robert Jknes SUBSCRIBED and sworn to before me, a Notary Public in and?uly the State of Iowa,by the affiant Robert James, to me personally known, on this� day of , 2001. Cyclone Truck Stop Affidavit-071301 /V.D AFFIDAVIT t JuN, Z I J 1t SMOKING ORDINANCE - LESS THAN 10% EXEMPTION CI1 Y C'60 CITY OF ARES,IOWA STATE OF IOWA ss: STORY COUNTY The undersigned, being first duly sworn, does hereby depose and state that: / 1. The undersigned is the authorized agent and representative for 2. That V4 .�.�� is both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food at � '"�'s-F are in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds at SUBS BED AND SWORN to before me, a Notary Public in and for the State of Iowa,by the affiant Cha,rpe Hid,to me personally known,on the c-7/ f day of ()Wlel 20joL. I� tarp, Public in and for Sic unty,Iowa - MMD!E] wp=�' EX7 F85 - Smoking Ordinance Affidavit-052901 j � q Main AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned, 2r V C , being first duly sworn, does hereby depose and state that: I. The undersigned is the authorized agent and representative for DeanO'S I Ic( CY1aln u-C . 2. That I)edn0,5 I I Main is both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food atT-'PL OAS I Iq Win are in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds at DPrtnd:s 119 Min . SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State of Iowa,by the affiant Kl koVtC_ to me personally known,on the I b_ day of 2001 S.AJ� Notary Public in and for Story County, Iowa E SUSAN R. DeMOSS COMMISSION#197808 MY COMMISSION RES wx _ _0 F85 - Smoking Ordinance Affidavit-052901 III �. ��' � • AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned, cAr e M , being first duly sworn, does hereby depose and state that: 1. The undersigned is the authorized agent and representative for O - L4`U N'611e' 2. That Fy X is both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act.3. That sales of non-alcoholic food at Frrrt 17 Loc'O e in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds at ro' A :T: LoLCK)GC- 1 U/. SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State of Iowa,by the affiant +hrgn ke�ry a y► ,to me personally known, on the 44' day of _, 20 Q J Notary Public in and for Story County, Iowa ZAPOAL SUSAN R. DeMOSS COMMISSION#197808 * MY COMMISSION EXPIRES /OWA F85 - Smoking Ordinance Affidavit- 052901 AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned, Mark North , being first duly sworn, does hereby depose and state that: l. The undersigned is the authorized agent and representative foiHilton Co7iseun 2. That Hilton Col.iseun is both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food at Hilton Coliseum are in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds at Hilton Coliseum . Sul BED AND SWORN to before me,a Notary Public in and for the State of Iowa,by the affiant Ma^ ,to me personally known,on the 3/ day of ,20D1 CN tary Public in and for St County. Iowa ��~LINDA R.W'lLCOX j Notary Public, lii,S140 of Iowa 1 Commission Expires Sept.12 '__� F85 -Smoking Ordinance Affidavit-052901 AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned, 'h"'(a U)Lee being first duly sworn, does hereby depose and state that: }� 1. The undersigned is the authorized agent and representative for bor 's —1—nC.. D8 k kAunky 2. That Inc. is both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food at Dory s , 1:M. are in a dollar amo t that is less than ten percent of the dollar amount of sales of all kinds at SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State of Iowa,by the affiant laoi ,tome personally known,on the day of 12001 . otary P lic in and for Story County,Iowa F85 -Smoking Ordinance Affidavit-052901 AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned, Tor' � L , being first duly sworn, does hereby depose and state that: 1. The undersigned is the authorized agent and representative for S 2. That L-0 M- 'S is both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food at L�MPy �S are in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds at LjtAL1 S _ SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State of Iowa, by the affiant _k4 ZMOL-Lk to me personally known, on the day of c 7,20_LL. Notary Public in and for Story dJunty, Iowa 'OIL'11%, JILL L. RIPPERGER T_ COMMISSION# 146549 MY COMMISSION EXPIRES F85 - Smoking Ordinance Affidavit-052901 AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned,T,)cjri,,r I _5a-Aro , being first duly sworn, does hereby depose and state that: 1. The undersigned is the authorized agent and representative for 2 i R Hoose. 2. That !' -cl ,'na LaLL is both a food establishment and licensed premises under the Iowa Alcoholic Beverage dontrol Act. 3. That sales of non-alcoholic food at ,n were in a dollar amount that is less than ten percent of the dollar amount of sales of all kin s at jz. SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State of Iowa,by the affiant Qwy tel 50ndro1 , to me personally known, on the Z-Tt" day of JLUQ 20 01 . Notary Public in and for Story ounty, Iowa !PAL� KAREN C.THOMPSON ~P COMMISSION#177422 * MY COM ISSI N EXPIRES IOWA fa . F85 - Smoking Ordinance Affidavit-052901 AFFIDAVIT A SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned, �� o�,c,h S�c n�� , being first duly sworn, does hereby depose and state that: 1. The undersigned is the authorized agent and representative for,/�/6/1,4 S Ll"'h h 2. Thatl/c both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food at"Le Key 5 LA/ /_)/2zl4Lre in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State of Iowa,by the affiant _j p/f 271-,WR�7 , to me personally known, on the 3I:1 day of , 20 0% . -- X. -L Notary Public in and for Story ounty,Iowa JILL L. RIPP R COMMISSION#146549 MY COMMISSION EXP/RES OWA i-7 D F85 - Smoking Ordinance Affidavit-052901 Pack�_I's I risl--\ PSI b AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned,Atj4t � , being first duly sworn, does hereby depose and state that: 1. The undersigned is the authorized agent and representative for BLOT�s/fi f o a 2. That PA DN �ko,� ?0 G is both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food at 604S 1,fY,sN ?d3 are in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds at PAnI24-s !L. tjs P�fi r� '/Z SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State of Iowa,by the affiant Ayyty,e, ,_) LAN, E,, tome personally known, on the_ ilt"- day of 2001 Notary Public in and for Story County,Iowa �Pp1At KAREN C. THOMPSON COMMISSION# 177422 ' ''101 MY COMM/ SION EXPIRES F85 - Smoking Ordinance Affidavit- 052901 owe Pew P i , I' AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned, ���`'` 1-` �r`ocK , being first duly sworn, does hereby depose and state that: 1. The undersigned is the authorized agent and representative for EDKL S Q GRl t-L. 2. That A�Uk S %k��C-kkLL is both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food at S �� � dare in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds at 2_430 L', W off, SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State of Iowa,by the affiant `Tj?ry -Zmc k--k.. to me personally known,on the Z Lsf day of A-u�, 20 02- . Notary Public in and for Story County,Iowa Z�p?.AL KAREN C. THOMPSON Aik COMMISSION# 177422 MY COMM SSION EXPIRES ,oWA �a3 F85 - Smoking Ordinance Affidavit-052901 T Memo Legal Department Caring People Quality Programs Exceptional Service TO: Diane Voss, City Clerk FROM: John R. Klaus, City Attorney DATE: August 29, 2002 SUBJECT: Smoking Ordinance, "People's"Affidavit An affidavit was filed August 23 by Tom Zmolek with respect to "People's Bar & Grill" per Section 21A.201 Ames Code. You ask if it is a proper and effective affidavit under §21A.201 Ames Code. The pertinent words are: "if non-alcoholic food sales at such establishment are less than ten percent of the dollar amount of sales of all kinds at that establishment ..." There is a food service license issued for"People's Bar&Grill"at 2430 Lincoln Way;a food service license for"Lumpy's at 2428 Lincoln Way;and a single liquor license has been issued to encompass both"People's Bar&Grill"and"Lumpy's Underwhere?". The exemption affidavit is made for"People's Bar&Grill"at 2430 Lincoln Way. The affidavit does not pertain to "Lumpy's". Therefore sales at "Lumpy's" are not included in the 10% computation. The affidavit is effective to allow smoking at"People's Bar&Grill". The police department asked you how"People's"could allow minors on the "People's"premises if more than half the business is alcoholic beverage sales,given the 50%rule of Section 17.16(1)Ames Code. The answer is that minors can be on the premises pursuant to Section 17.16(2)(e)if,as that subsection provides: "(e) The underage person is on the premises during specified posted hours that the licensee does its business primarily in food sales,in accordance with a plan approved in advance by the Chief of Police. To receive plan approval, a licensee shall be required to demonstrate that there is a clearly definable pattern of daytime hours during which more than 50%of the business' sales are food." That exemption to the liquor ordinance requires that"People's"demonstrate that there is a clearly definable pattern of daytime hours during which more than 50%of the business is food,even though over all the hours of operation food sales are less than 10%. JRK:gmw c: Loras Jaeger Michael Johns AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned, L EANDas Zc being first duly sworn, does hereby depose and state that: 1. The undersigned is the authorized agent and representative for J N o o 2. That .S N o 0 '�- c-(x_<z, is both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food at S N c,4 k 0.S are in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds at S 0 c),,� SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State of Iowa,by the affiant Le_andro V�Prru la ,to me personally known,on the 1'54', day of l 12002 . Notary Public in and for Story County,Iowa '!pAI KAREN C. THOMPSON COMMISSION#177422 `;a " MY COM ISS1pN EXPIRES F85-Smoking Ordinance Affidavit-052901 aW ���/0 3 AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned, �k"A 10-BYe a, being first duly sworn, does hereby depose and state that: 1. The undersigned is the authorized agent and representative for aajstA�S � 2. That 9 both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food at re in a dollar amount that is less than ten percent of the dollar amount of sales4oall kinds at iaa M4-rA[ 5'f- A�sTir �o27SlkA ds' �0 wng SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State of Iowa,by the affiant fY1LW g0.�eC J�-O time personally known, on the Idlti` day of Se pte,-Wer 20Q, Notary Public in and for Story County,Iowa �PS%AC KAREN C.THOMPSON COMMISSION#177422 MY COMMISSION EXPIRES F85 -Smoking Ordinance Affidavit-052901 IOWA �a S L->er�s — lewa S-k_te Cb� AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned, Marc North , being first duly sworn, does hereby depose and state that: 1. The undersigned is the authorized agent and representative for Stephens Aucht�iun 2. That'Stephens Auditorim is both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food atStenhenG Aud;tnr;,mare in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds at Stephens Auditcriun M t...>C �_ n SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State of Iowa,by the affiant / '�ar ✓t�o�/�! tome personally known,on the 3/ day of_�L<T,200. --ran of Public in and for Sto ounty, Iowa c Iowa 1 ' 1 F85 - Smoking Ordinance Affidavit-052901 - ------<�' AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned, To►--, Z1"OL-C—�, , being first duly sworn, does hereby depose and state that: 1. The undersigned is the authorized agent and representative for T)ejM6�S 2. That -MV( M 3,S is both a food establishment and licensed premises under the Iowa,Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food atyS are in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds at T�UM1�S SUBSCRIBED AND SWORN to before me, a Notary Public in a d for the State of Iowa,by the affiant to me personally known, on the�—day of `'� , 20,'�1 . Notary Public in and for Story ,, ounty, Iowa Z�POAA ill L JILL L. RIPPERGER COMMISSION#146549 MY COMMISSION EXPIRES F85 - Smoking Ordinance Affidavit-052901 lOWA „ " AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTION STATE OF IOWA ss: STORY COUNTY The undersigned, GrJ +�"� "fI , being first duly sworn, does hereby depose and state that: 1. The undersigned is the authorized agent and representative for T, ►o p Loy.. e _ 2. That is both a food establishment and licensed premises under the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food at LwA4-s are in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds at l o l�A 1-4o�e SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State of Iowa,by the affiant &Ak'tO.L0 In1f4f� to me personally known, on the 174t\ day of 20QL. ��'�.E,l L��z--C�YVL��o►-J Notary Public in and for Story County, Iowa J �e KAREN C.THOMPSON COMMISSION#17 4422 MY COMMISSIO EXPIRES owl F85 - Smoking Ordinance Affidavit- 052901 a07 w(-try, AFFIDAVIT SMOKING ORDINANCE LESS THAN 10% EXEMPTIONl .I 20 CIP LC STATE OF IOWA CITY OF ArVIES,UNA ss: STORY COUNTY The undersigned, i �% �.r " , being first duly sworn, does hereby depose and state that: 4/�DWAaQt�1�!/QdO�1N '(� 1. The undersigned is the authorized agent and representative for u'e14' A&+r* 2r V el���U� �both a food establishment and licensed premises under 2. That 6� the Iowa Alcoholic Beverage Control Act. 3. That sales of non-alcoholic food at 1/"d '`ITG��are in a dollar amount that is less than ten percent of the dollar amount of sales of all kinds at Off C& *?.S l y 22�ZCL z c 4 SUBSCRIBED AND SWORN to before me, a Notary Public in and for the State of Iowa,by the affiant QT ,to me personally known, on the a(c day of �tl4U ,20 L Notary Public in andMr/StorY County, lowa �aI L JILL L. RIPPERGER COMMISSION# 146549 * MY COMMISSION EXPIRES owe rg.. -,,per F85 - Smoking Ordinance Affidavit-052901 ' City Clerk's Office 515 Clark Avenue,P.0. Box 811 Caring People Ames,IA 50010 Quatily Programs Phone: 515-239-5105 Eurplinnal.tinvice Fax: 515-239-5142 July 16, 2001 Best Western Starlite Village 2601 E. 13th Street Ames, Iowa 50010 Attention Dan Ramthun RE: Smoking Ordinance Waiver Dear Mr. Ramthun: We have your Affidavit for exemption from the "Smoking Ordinance" for the Starlite Village Lounge. The Starlite Village Lounge is not a separately licensed place for food service and alcoholic beverages. The Lounge is currently licensed as part of the Starlite Village Motel. If the Lounge becomes a separately licensed place, you may file for an exemption. The Starlite Village Lounge cannot be treated as an establishment separate from the Motel unless the Lounge has separate food service and liquor licenses. Your affidavit is returned with this letter. If you have any questions, please contact me. Sincerely, John Klaus City Attorney JK/dry ill,1,1i01 WED 11:50 FAX 515 233 2440 Y.S.S. OFFICE AFFIDAVIT SrvlOKING ORDINANCE LF,SS TERN 100/-EXEIVII''it'IiON STATE OF IOWA ss: STORY COUNTY The undersigned, G being first duly-swom, does hereby depose artd state that: 1. The undersiped is the authorized agent and represcutative for—qu b , U , 141k l '�'��Low►�q e. 1 That is both a food establishment and li=nsed premises under the Iowa Alcoholic Beverage Control Act. ? That sales of Don-;alcoholic food at ' �F'1�a9 C L m a dollar amount that is less than ten percent of the dollar=.oun:of sales 0-1 all ldads at ZIOLii I 11n Lo koy Q— SUBSCRIBED AND SWORN to bofam me,a ota~y Pabulo m Ad for the State of Iowa,by the affiant A to ore personally koawn.off.the day of LAUFt ROH FIN 4Notafyve inand for Story Cauav,I a YY GO►1 F85-Sraokmg OrdiAaIIGO Affidavit-052901