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<br />~ <br /> <br />Minnesota Department of Public Safety <br /> <br />Ak:obeI and {'..ambling Enfon:emeot <br />444 Cedar Street, Suite 133 <br />St. Paul, MN 55101-5133 <br />651-201-7507. TrY 651-282-6555. Fax 651-297-5259 <br /> <br />RENEWAL OF LIQUOR, WINE, CLUB OR 3.2% LICENSES <br /> <br />8 <br /> <br /> <br />Licensee: Please verify your license information contained below. Make comctions if necessary and sign. City <br />ClerkICOWlty Auditor should submit Ibis signed renewal wiIh completed license and licensee liquor liability for the new license <br />period. City ClerklCouoty Auditol" are also required by M.S. 340A.404 S. 3 to "port any HceDlle <br />cancellation. <br /> <br />Li~C~ ONSS <br />City/CoWlty when: license approved. <br /> <br />License Period Ending <br />Centet'ville <br /> <br />12/31/200&># <br /> <br />20065 <br /> <br />Licensee Name <br />Trade Name <br /> <br />Sahawk of Minnesota Inc. <br /> <br />Sager's Bar & Grill <br />Licensed Location address <br /> <br />7098 Centerville Rd <br /> <br />Cily, Stale, Zip Code <br /> <br />Centerville, MN 55038 <br /> <br />Business Phone <br /> <br />651/653-7791 <br />LICENSE Fli:R~: Off Sale S On Sale $ Sunday $ <br /> <br />By sigDillg tIlis reneW'al applk:a,&li'pplkant certifies tbat there bas tJB~~ in ownersbip 011 the a~0~~ <br />licensee. For changes in ownenhip, the liceDSee named above, or (or neW' Ucensee!i, I'uIl applications should be used. See <br />back of this application for further information needed to complete tIlis renewaL <br /> <br />Applicant's si2Dature on this renewal confirms the foUowinr: Failure to reDOrt allY of the foUowine will result in fiDes. <br /> <br />1. Licensee confirms it has RO intereSt whatsoever. directly or indirectly in any other liquor establishments in <br />Minnesota. If so. give detJIi1s on back of this application. <br />2. Licensee confinns that it has never had a liquor license rejected by any cityltownshiplco1lllty in Ihe state of <br />Minnesota. If ever rejected, please give details on the back. of Ibis reoewaI. then sign below. <br />3. Licensee confinns 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 confinns that during the past five years it or its employees have not been cited for any civil or criminal <br />liquor law violatioDS. If violations have occurred, please give details on back of this renewal, !hen sign below. <br />5. Licensee confinns that during the past license year. a summons has not been issued under the Liquor Liability <br />Law (Drdm Shop) MS 340A.802. If yes, auach a copy of the swnmons, then sign below. <br />6. Licensee confinns that Workers Compensation insurance is in effect for the full license period. <br /> <br />Licensee has attached a liquor liability insurance certificate that corresponds with the license period in city/c:oonty <br />where licease is issned. $100,000 in cash or securities or $100,000 llUAty bond lIUly be submitted iD tie. of Iiq..-Iiabil- <br />ity. (3.2~ liquor IiceolIes are exem if are less than $25,000 at 011 sale, ... $50,000 at 011' sale). <br /> <br /> <br /> <br />be conect and license has been approved by city/county.) <br /> <br />City Clerk/ConI\ty Anditor SigJ'atllre 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 />COlmty Att~ S~gI1AhIre <br />County Board issued <br /> <br />Dille <br /> <br />""_...!':'- ., ...":t~': I_I' &...~ I..... ~"I "'...~. I J; "tt ~'" <br /> <br />\ . - -, - <br /> <br />). <br /> <br /> <br />(Signature certifies licensee oc associates have not been cired during the past five years foc any 8tateJlocaJ <br />(crimina1Icivil). Report violations on back, then sign here. <br /> <br />PS 9093-05 <br /> <br />J1 <br />