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<br /> <br />Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement <br />444 Cedar Street, Suite 133 <br />St Paul, MN 55101-5133 <br />651-296-6979. TrY 651-282-6555 · Fax 651-297-5259 <br /> <br />RENEWAL OF LIQUOR, WINE, OR CLUB LICENSE <br /> <br />,c/.~:~.~~~~?~~~~~~:~~~~~~:'" <br /> <br /> <br /> <br />Licensee:. Please verify your license information contained below. Make corrections if necessary and sign. City <br />Clerk/County Auditor should submit this signed renewal with completed license and licensee liquor liability for the new <br />license period. City OerklCounty Auditor are also required by M.S. 340A.404 S. 3 to report any license <br />cancellation. <br /> <br />License Code CMBS License Period Ending 12/31 12003ID# <br />City/County where license approved.Cent erv i 11 e <br /> <br />1958 <br /> <br />Licensee Name <br /> <br />Mountain Enterprises Inc. <br /> <br />Trade Name <br /> <br />Trio Inn <br /> <br />Licensed Location address <br /> <br />7082 Centervil1e Rd <br /> <br />City, State, Zip Code <br /> <br />Hugo, MN 55038 <br /> <br />Business Phone <br /> <br />651/426-2956 <br /> <br />UCENSE FRR~: Off Sale $100. 00 <br /> <br />On Sale $ <br /> <br />2500.00 <br /> <br />Sunday $ <br /> <br />200.00 <br /> <br />By signing this renewal application, applicant certifies that there has been no change in ownership on the above <br />named licensee. For changes in ownership, the licensee named above, or for ,new licensees, full applications should <br />be used. See back of this application for further information needed to complete this renewal. <br /> <br />Applicant's signature on this renewal confirms the following: Failure to report any of the following will result in fines. <br /> <br />I. Licensee confirms it has no interest whatsoever, directly or indirectly in any other liquor establishments in <br />Minnesota. If so, give details on back of this application. <br />2. Licensee confirms that it has never had a liquor license rejected by any city/township/county in the state of , <br />Minnesota. If ever rejected, please give details on the back of this renewal, then sign below. <br />3. Licensee confirms that for the past five years it has not had a liquor license revoked for any liquor law violation <br />(state or local). If a revocation has occurred, please give details on the back of this renewal, then sign below. <br />4. Licensee confirms that during the past five years it or its employees have not been cited for any civil or criminal <br />liquor law violations. If violations have occurred, please give details on back of this renewal, then sign below. <br />5. Licensee confirms that during the past license year, a summons has not been issued under the Liquor Liability <br />Law (Dram Shop) MS 340A.802. If yes, attach a copy of the summons, then sign below. <br />6. Licensee confirms that Workers Compensation insurance is in effect for the full license period. <br /> <br />Licensee has attached a liquor liability insurance certificate that corresponds with the license period in city/county <br />where license is issued. $100, in cash or securities or $100,000 surety bond may be submitted in lieu of liquor <br />liability. <br /> <br />Licensee SignatUre Date A <br />(Signature certifies all above info 'on to be correct and license has been approved by city/county.) <br /> <br />City Clerk/County Auditor Signature Date <br />(Signature certifies that renewal of a liquor, wine or club license has been approved by the city/county as stated above.) <br /> <br /> <br /> <br />County Attorney Signature <br />County Board issued li <br /> <br />Police/Sheriff Signature ~ <br />(Signature certifies licensee or associates have not been ci <br />.~ (criminalIcivil). Report violations on back, then sign here. <br /> <br /> <br />Date <br /> <br /> <br />Date <br />the past five years for any state!localliquor law violations <br /> <br />PS 9093-98 <br />