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0 Rertiplis ,ml[ApplicatiliDnfloc OptionalliLl,iiiuor2l!ILNI License <br /> A11iialholl&Gaiiabblaill T <br /> Licenscype:: 2AN4 IOO1K.-5001 EIDNurnber., 336Q0xpires On: November 1, 2018 <br /> ............. <br /> DBA <br /> S &B Center Cono. <br /> Kelly's Korner <br /> 7098 Centerville Rd <br /> Centerville MN 55038 <br /> Business Phc:)ne: 6514936626 <br /> If arty of the above licensee information is not correct;please make corrections as necessary. <br /> Licensee must report previous 12 month on sale alcoholic beverage gross receipts by checking one of the boxes below. Next <br /> to the box you check is your 2 AM license fee. Make check payable to: Alcohol and Gambling Enforcement Division <br /> (AGED). Mail this application and check to:AGED,445 Minnesota St,Suite 222, St. Paul,MN 55101-5131 <br /> ----$300 2 AM license fee Up to$100,000 in on sale gross receipts for alcoholic beverages <br /> )($750 2 AM license fee Over$100,000,but not over$500,000 in on sale gross receipts for alcoholic beverages <br /> $1.000 2 AM license fee Over$500,000 in on sale gross receipts for alcoholic beverages <br /> $200 2 AM license fee 3.2%On Sale Malt Liquor licensees or Set Up license holders <br /> $200 2 AM license fee Did not sell alcoholic beverages for a full 12 months prior to this application <br /> X "et" Nc, Does ffie city or county that issues your liquor license allow the sale of alcoholic beverages until 2 AM? <br /> City(tic ric/County ALu or Sigriafine- I <br /> (I ceitify thal,the city orl c(.)unty alf............... ......................... 'approves tile <br /> 94[JIN1151015 Sigriaturlu "Jill r/1.1...'.l. 6!pvt- — —------- <br /> A t� <br /> tte <br /> (I l thill I havie mswericrl the ablcvt,,,quit.,,slica,ttl� thfililly,anid oDrrVX1Jy)l <br /> qpl <br /> ...................... .................................. <br /> Licc.,�rusee ID T tan'ber ........1 2 .. <br /> Liicenseei: Prior to submitting this application to the Alcohol &Gambling Enforcement Division you must have this form <br /> signed by your local.city or county licensing,official. <br /> W nii Department of IP ublic Safely <br /> Ali and Gaii Enforcement IDiviiWon (AGEID) <br /> 445 MilinnesotaStii Sufte 22Z St. IP auil,I155101-5133 <br /> Telephone 651-201-7500 Fax 651-297-5259 'TTY 651-282-6555 <br /> dps.imii <br /> 25 <br />