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~ Minnesota Department of Public Safety Alcohol and Gambling Enforcement 444 Cedar Street, Suite 133 St. Paul, MN 55101-5133 651-201-7507 -m 651-282-6555 - Fax 651-297-5259 RENEW AL OF LIQUOR, WINE, CLUB OR 3.2% LICENSES Licensee: Please verify your license information contained below. Make corrections if necessary and sign. City Clerk/County Auditor should submit this signed renewal with completed license and licensee liquor liability for the new license period. City Clerk/County Auditor are also required by M.S. 340A.404 S. 3 to report any license cancellation. License Code CMBS City/County where license approved. License Period Ending C e n t e t' viI 1 e 12/31/200fD# 1958 Licensee Name Trade Name Mountain Enterprises Inc. r - SC"Q':,::'t Tt'io Inn Licensed Location address 7082 Centerville Rd (". ,~ he, it:;: ZU06 City, State, Zip Code Business Phone Hugo, MN 550.3f.3 551/425-2955 LICENSE FEES: Off Sale $ On Sale $ Sunday $ B . . h' I I' 1.00.. 0171 'fi h h h b asplli'L l7I0 , h' h ti21210. l7Il7Jd Y slgmng t IS renewa app Icafion, ..ppTlcant certl es t at t ere as een 110 ~1iail.ge m owners Ip on t e auo'Ve nalbe- licensee. For changes in ownership, the licensee named above, or for new licensees, full applications should be used. See back of this application for further information needed to complete this renewal Applicant's signature on this renewal confirms the followinl:: Failure to report any of the followinl: will result in fines. 1. Licensee confirms it has no interest whatsoever, directly or indirectly in any other liquor establishments in Minnesota. If so, give details on back of this application. 2. Licensee confirms that it has never had a liquor license rejected by any cityltownship/county in the state of Minnesota. If ever rejected, please give details on the back of this renewal, then sign below. 3. Licensee confirms that for the past five years it has not had a liquor license revoked for any liquor law violation (state or local). If a revocation has occurred, please give details on the back of this renewal, then sign below. 4. Licensee confirms that during the past five years it or its employees have not been cited for any civil or criminal liquor law violations. If violations have occurred, please give details on back of this renewal, then sign below. 5. Licensee confirms that during the past license year, a summons has not been issued under the Liquor Liability Law (Dram Shop) MS 340A.802. If yes, attach a copy of the sununons, then sign below. 6. Licensee confirms that Workers Compensation insurance is in effect for the full license period. Licensee has attached a liquor liability insurance certificate that corresponds with the license period in city/county where license is issued. $1 in cash or securities or $100,000 surety bond may be submitted in lieu of liquor liabil- ity. (3.2% liquor licens '. $25,000 at on sale, or $50,000 at olJsale). (Signature certifies all above information to be correct and license has been approved by city/county.) City Clerk/County Auditor Signature Date (Signature certifies that renewal of a liquor, wine or club license has been approved by the city/county as stated above.) COlmty Attorney Sienatnre County Board issued lice Date (Signature certifies licensee or associates have not been cited during the past five years for any statelIocal hqu (criminal/civil). Report violations on back, then sign here. :&~. " . I~.:~. . . =.i1' ~ .'7 cense ). PS 9093-05 /;)