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2003-11-12 CC Packet
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2003-11-12 CC Packet
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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 />RENEWAL OF LIQUOR, WINE, OR CLUB.LlCENSE <br /> <br /> <br />;~~r~~;~~.'.?:~':. <br /> <br /> <br />Licensee: Please verify your license information contained below. Make corrections if necessary and sign. City <br />Oerk/County Auditor should submit this signed renewal with completed license and licensee liquor liability for the new <br />license period. City Clerk/County Auditor are also required by M.S. 340A.404 S. 3 to report any license " ~. '0_, \' <br />cancellation. . <br /> <br />License Code OFSL License Period Ending 12/31/2003ID# <br />City/County where license approved.Cent er\ol i 11 e <br /> <br />2439 <br /> <br />Licensee Name <br /> <br />SaHawk Inc. <br /> <br />Trade Name <br /> <br />Sager's Liquor <br /> <br />Licensed Location address <br /> <br />7093 20th Ave S <br /> <br />City, State, Zip Code <br /> <br />Centerville, MN 55038 <br /> <br />Business Phone <br /> <br />651/426-6674 <br /> <br />LICENSE FEES: Off Sale $1 00. 00 <br /> <br />On Sale $ <br /> <br />0.00 <br /> <br />Sunday $ <br /> <br />0.00 <br /> <br />By signing this renewal applicatio~ 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 />A,pplicant's sienature on this renewal contirms the fonowing: FaUure to report any of the following will result in fines. <br /> <br />1. 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 cityltownship/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 occUl'I'ed. 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 340A802. 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 Uquor liability insurance certificate that corresponds with the license period in city/county <br />where Ucense is issued. $100,000 in cash 0 securities or $100,000 surety bond may be submitted in lieu of Uquor <br />Uability. <br /> <br /> <br />Date <br />be correct and license has been approved by city/county.) <br /> <br /> <br />Licensee Signature <br />(Signature certifies all <br /> <br />City Oerk/County Auditor Signature Date <br /> <br />(Signature certifies that renewal of a liquor, wine or club license has been approved by the city/county as stated above.) <br /> <br />County Attorney Signature Date <br /> <br />County Board issued licenses only (Signature certifies licensee is eligible for license). <br /> <br />Police/Sheriff Signature Date <br /> <br />(Signature certifies licensee or associates have not been cited during the past five years for any statellocalliquor law violations <br />(criminal/civil). Report violations on back, then sign here. <br /> <br />PS 9093-98 <br />
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