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<br />@ <br /> <br />Minnesota Depanment of Public Safely <br /> <br />Alcohol and Gambliog Enforcement <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 /> <br />'f,-~: <br /> <br />-""----" <br /> <br />...~~~...nf,e~~~,#; <br /> <br /> <br />.;2.:',~~~~C:.C: <br /> <br /> <br />i'~~;;j~~~~:~;~~i~"'~~~t <br /> <br />LiceJlllft: Please verify your license information contained below. Make corrections if necessary and sign. City <br />ClerklCounty Auditor should submit this signed renewal with completed liceuse and licensee liquor liability for the new license <br />period. City Clerk/County Auditor are also required by M.S. 340A.404 S. 3 to repwt 01 license <br />cam:eOation. <br /> <br />License Code ONSS <br />CitylCollDty where license approved. <br /> <br />License Period Ending <br />Cent er'v i 11 e <br /> <br />12/31/200b <br /> <br />(;273 <br /> <br />Licensee Name <br /> <br />Trade Name <br /> <br />Wiseguys Pizza Inc. <br /> <br />Wiseguys Pizza <br />Licensed Location address <br /> <br />7095 20th Ave S <br /> <br />City, State. Zip Code <br /> <br />Centerville, MN 55038 <br /> <br />Business Phone <br /> <br />651/653-1077 <br />LICENSE FEES: Off Sale S On Sale $ Sunday $ <br /> <br />B . . 6"'~ at -. 0.. 00ppti t .......... "'-t the .._ ....~5001ia~ . _h;" the ~0. 0~.. <br />y sagmug UUlO renew app~ a can <:e.......,.. >WI re ...... --. DO C m owne........ on auun; oaDl.,.. <br />licensee. For changes in ownership, the Jiceosee named above, or for new licensees, run applications should be IIlled. See <br />back of this appDeatioD for farther information needed to complete this renewal. <br /> <br />Aopliamt's ..tare on this renewal confirms the foUo~: Failure to reoon any of tile roUowine will result in fiDes. <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 bad a liquor license rejected by any cityltownsbip/county in the state of <br />Minnesota. If ever rejected, please give details on the baclt of this renewal, then sign below. <br />3. Licensee confirms that for !be pa..... five years it taa... not bad a liquur Iicen...erevoked 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 bave occum:.d. please give details on back of this renewal, then sign below. <br />S. Licensee confirms that during the past license year, a summons bas not been issued under the Liquor Liability <br />Law (Dram Shop) MS 340A.802.If yes. attach a copy of the smnmons. then sign below. <br />6. Licensee confums that Workers Compensation insurance is in effect for the fulllicensc period. <br /> <br />Licensee has attaehed a liquor &ability insurance certilkate that corresponds with the license period in tity/county <br />where I1eense Is issued. $100,000 lD cash or secorlties or $100,000 surety bond lDay be submitted in lieu of Uq1lOl" Babil. <br />ity. (3.2% liquor IiceIllll!8 are elD ihales are less tIwl 2S 000 at on sale, or $50,000 at othale). <br /> <br /> <br /> <br />rcJ '::2S.-ofo <br /> <br />(Signature certifies all above information to be correct and license bas been approved by city/cmmty.) <br /> <br />City C1erkICOImt:y Aumtn1" SigJ18.tmc Date <br /> <br />(Signature certifies that renewal of a liquor. wine or club license has been approved by the city/comty as stated above.) <br /> <br />County Anomq SigJlAture Date <br />County Board issued liceoses only (Signature certifies licensee is eligible for license). <br /> <br />PolicPJSheriff SigJ1Amte narc <br />(Signature certifies licensee or associates have not been cited during the past five years for any statellocalliquor law violations <br />(criminal/civil). Report violations on back, then sign here. {~o,f!. PS 9093-05 <br /> <br />II ~~b <br /> <br /> <br />~5 <br />