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<br /> <br />(i) <br /> <br />Atcoltal Ii GmllDg Eafon:.mem <br /> <br />Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division (AGED) <br />444 Cedar Street, Suite 133, St. Paul, MN 55101-5133 <br />Telephone 651-296-6979 Fax 651-297-5259 TIY 651-282-6555 <br />www.dps.state.mn.us <br /> <br />License type code: <br /> <br />ADDleation for ODtionall AM Liauor License <br /> <br /> <br />.,-,'") <br /> <br />2AM License Expiration Date r(~/, fl ~L::~ wZiJj~ ID# <br />/ ':'~ ("'or Utllce Use Unly) <br /> <br />/~ <br /> <br />Licensee Name: ~SAHjfW( JJ~ n~.t~lSo1"4. ~rflI', <br />Trade Name: __C;A~R~ ~-Al- 6/lItL · <br />Licensed Location Address: 70 '11 Ct~(lA"(U (. It I), <br />City, State, Zip Code: CrAJftAtllulJ IIII;V, SJo.j1 <br />Business Phone: 6~/- 6~1 "'" 7791 <br />If the above named licensee is a corporation, partnership, or LLC, complete the following for each partner/officer: <br />16ePAlv,i 'J/tp1tJ $AbGR IJ-J() ~'6Y ~~S is) 1'JJ s".J'1.I. <br />Parbler/OfficerName' (First Middle Last) DOB ,^",ICII a.ANUIUJ rr Home Address <br /> <br />Partner/Officer Name <br /> <br />(First Middle Last) <br /> <br />DOB <br /> <br />Social Security # <br /> <br />Home Address <br /> <br />Partner/Officer Name <br /> <br />(First Middle Last) <br /> <br />DOB <br /> <br />Social Security # <br /> <br />Home Address <br /> <br />Licensee must report previous 12 month on sale alcoholic beverage gross receipts by checking one of the boxes <br />below. Next to the box you check is your 2 AM license fee. Make check payable to: Alcohol aDd <br />Gamblina Enforcement Division (AGED). Mail this application and check to : AGED, 444 Cedar St., Suite <br />133, St. Paul, MN 55101-5133. <br /> <br />o $300 2 AM license fee - Up to $100,000 in on sale gross receipts for alcoholic beverages <br />D $750. 2 AM license fee - Over $100,000, but not over $500,000 in on sale gross receipts for alcoholic beverages <br />o $1,0002 AM license fee - Over $500,000 in on sale gross receipts for alcoholic beverages <br />D $200 2 AM license fee - ~.2% On Sale Malt Liquor licensees or Set Up license holders <br />l( $200 2 AM license fee - Did not sell alcoholic beverages for a full 12 months prior to this application <br /> <br />~ Yes 0 No Does your city or comty licensing official allow the sale of alcoholic beverages mtil 2 AM? <br /> <br />Licensee Signature <br />(I certify that I have answered th <br /> <br /> <br />Date <br /> <br />City Clerk/County Auditor Signature <br />(I certify that the city or county of <br />Licensee Minnesota Tax ID Number (Required) <br /> <br />Date )-ll.rd6 <br /> <br />Licensee: Prior to submitting this appDeation to the Alcohol and Gambling Enforcement Division, it must be <br />signed by your loeal city or eounty Deensing official. <br /> <br />(2AM-l1/0S) <br /> <br />J3 <br />