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AldLeRenewal Application for Optional Liquor 2AM License Alcohol&Gambling Enforcement License Type: 2AM-100K-5001 Expires On: November 1,2015 IDNumber: 33600 DBA S &B Center Corp. Kelly's Korner 7098 Centerville Rd Centerville MN 55038 Business Phone: 6516537791 If any of the above licensee information is not correct,please make corrections as necessary. Licensee must report previous 12 month on sale alcoholic beverage gross receipts by checking one of the boxes below. Next to the box you check is your 2 AM license fee. Make check payable to: Alcohol and Gambling Enforcement Division (AGED). Mail this application and check to:AGED,445 Minnesota St.,Suite 222,St.Paul,MN 55101-5133. _$300 2 AM license fee - Up to$100,000 in on sale gross receipts for alcoholic beverages )($750 2AM license fee - Over$100,000,but not over$500,000 in on sale gross receipts for alcoholic beverages _$1000 2AM license fee - Over$500,000 in on sale gross receipts for alcoholic beverages _$200 2AM license fee - 3.2%On Sale Malt Liquor licensees or Set Up license holders $200 2 AM license fee - Did not sell alcoholic beverages for a full 12 months prior to this application Yes _No Does the city or county that issues your liquor license allow the sale of alcoholic beverages until 2 AM? .y Clerk/County Auditor Signature Date (I certify that the city or county of approves the sale of alcoholic beverages until 2AM) l I Licensee SignatureDate (I certify that I have answered the above questions /hfully and correctly) Licensee Minnesota Tax ID Number(Required): Licensee: Prior to submitting this application to the Alcohol&Gambling Enforcement Division you must have this form signed by your local city or county licensing official Minnesota Department of Public Safety Alcohol and Gambling Enforcement Division (AGED) 445 MinnesotaStreet,Suite 222,St. Paul,MN 55101-5133 Telephone 651-201-7500 Fax 651-297-5259 TTY 651-282-6555 dps.mn.gov 55