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<br />il' <br />~ <br /> <br />t- .' <br /> <br />.. <br />lJ\, <br />, ". . <br /> <br />/" . <br /> <br /> <br />Minnesota Department of Public Safety . <br />Alcohol and GambUng Enforcement <br />444 Cedar Street, Suite 133 <br />St. Paul, MN 55101-5133 <br />651-296-6979. TIY 651-282-6555. Fax 651-297-5259 <br />RENEWAL OF LIQUOa, WINE, OR CLUB LiCENSE' <br /> <br /> <br /> <br />T .flWl~: Please verify yoW' license information contained below. Make corrections if necessary and sign. City <br />ClerklCounty 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 BceDSI! <br />cancellation. <br /> <br />License Code r.M'R~ License Period Ending 1 ;::./ A j /:=-OIl7tlID# <br />City/County where license approved. Cent erv i 11 e <br /> <br />1q!=iB <br /> <br />Licensee Name <br /> <br />Mountain Enterorises InCa <br /> <br />Trade Name <br /> <br />Trio Inn <br /> <br />Licensed Location address 7082 Cent e 1''' v i 11 e Rd <br /> <br />City, State. Zip Code <br /> <br />HuClo.. MN 55038 <br /> <br />Business Phone <br /> <br />651/426-2956 <br /> <br />LICENSE FEES: Off Sale $ 100a 00 On Sale $ 2500.00 Sunday $ 200... 00 <br /> <br />By sigoiDg tbis renewal appBcation, appHcant certifies that there bas been no change in ownersbip on the above <br />named Ii~ For clumgesin ownership, the Bcensee named above, or for new lieeusees, foB applications should <br />be used. See baek of tbis appHcation for further information needed to complete tbis renewaL <br /> <br />Apglieant's ldr~ on tbis ~ewal confirms the following: FaDnftlj to ~port any of the following will resuIt in fines. <br /> <br />1. Licensee confirms it has no interest whatsoever. directly or indirectly in any other liquor estabIishments 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 detaiIs 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 />S. 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. LiceDsee confirms that Workers Compensation insurance is in effect for the full license period. <br /> <br />Licensee bas attached a Hquor IiabDity Insurance certificate that corresponds with the Heense period in city/county <br />where Heense Is Issued. $100,000 in cash or seeur.lties or $100,000 surety bond may be snbmitted in Heu ofHquor <br /> <br />HabDity. ~ /) YJ1~ <br />Licensee Signature . k 1/ I ' t'j ~r Date / () ;;C; -t1 L/ <br />(Signabae c..:.me. aD aOO"- iDiODiiition to be c:a:rect and ~ """" bas beeo ~ by c:l1y/couDly.) / . <br /> <br />City Clerk/County Auditor Signature Date <br />(Signature certifies that ~ewal of a liquor, wine or club license has been approved by the city/county as stated above.) <br /> <br />County Attorlley Signature <br />County Board issued licenses only (Signature certifies licensee is eliglole for license). <br />Police/Sheriff Signature <br />(Signature 4'~"- -- --88E)~ba.e BG't ~ during <br />(criminallcivil) violations on then sign here: . <br />. . <br /> <br />Date <br /> <br /> <br />Date <br /> <br />liquor law violations . <br /> <br />PS 9093-98 <br />