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<br />" <br /> <br />>> <br /> <br />, f <br /> <br />, <br /> <br />',~' <br />.''1 <br /> <br /> <br />Minnesota Department of Public Safety <br /> <br />Alcohol and GambUng 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 /> <br /> <br />LJl"aI_: 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 Oerk/County Auditor are also required by M.S. 340A.404 S. 3 to report any Jiceuse <br />canceDation. <br /> <br />License Code n~j::lI License Period Ending 1 :=> I ~ 1 1:=>flJf1I!iD# <br />City/County where license approved. Cent eY'v i 11 e <br /> <br />1!=iflJAq <br /> <br />Licensee Name <br /> <br />GNAW Inc. <br /> <br />1i'ade Name <br /> <br />CenteY'vil1e LiauoY's <br /> <br />Licensed Location address *712193 2121th Ave S <br /> <br />City, State, Zip Code <br /> <br />CenteY'yil1e. MN 5512138 <br /> <br />Business Phone <br /> <br />651/426-6674 <br /> <br />LICENSE 1i'ilR~: Off Sale $ 10.121.121121 On Sale $ 121.121121 Sunday $ 121.121121 <br /> <br />By sigDJng this renewal application, al'l'Hcant certifies that there has been no change in ownership on the above <br />named Heensee.For changes In ownersbip, the Hcensee named above, or for new Hc:ensees, foB 81'l'Hcations should <br />be used. See back of this appHcation for further information needed to complete this renewal. <br /> <br />AppHeant's ~pflltn~ on this renewal mnflnnR the following: FaDure to re.port any of the following will reso1t in fhu>JL <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 cityltownshiplcounty 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 sip below. <br />S. 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 insmance is in effect for the full license period. <br /> <br />Licensee has attached a Dquor HabDity bisurance certificate that corresponds with the Hcense period In city/county <br />where license is issued. $100,000 in cash or securities or $100,000 surety bond may be submitted in Heu ofliquor <br />DabDity. <br /> <br />Licensee Signature "71/1..-";-I>.I;r W~ . Date /0 -U-D.'I <br />(Signature certifies all :oo"Z ~~n '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 />County Attorney Signatll1'e Date <br />County Board issued licenses on! <br /> <br />Police/Sheriff Signature <br />(Signature certifies lice or associates have not been cited during the past five years for any state/l <br />(crimina1Icivil). Report violations on back, then sign here. <br /> <br /> <br /> <br />PS 9093-98 <br />