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<br /> <br />Minnesota Department of Public Safety <br /> <br />Alcohol and Gambling Enforcement <br />444 Cedar Street, Suite 133 <br />St. Paul, MN 55101-5133 <br />651-296-6979. TTY 651-282-6555. Fax 651-297-5259 <br /> <br /> <br />RENEWAL OF LIQUOR, WINE, OR CLUB LICENSE <br /> <br />No license will beapprovedorreleased untiL the $20 Retailer ID Card fee is received by MN Liquor Control <br /> <br />Licensee: Please verify your license information contained below. Make corrections if necessary and sign. City <br />Clerk/County Auditor should submit this signed renewal with completed license and licensee liquor liability for the new <br />license period. City Clerk/County Auditor are also required by M.S. 340A.404 S. 3 to report any license <br />cancellation. <br /> <br />License Code CMBS <br /> <br />City/County where license approved <br /> <br />License Period Ending <br />Centerville <br /> <br />12/31/2000 ID# <br /> <br />1958 <br /> <br />Licensee Name <br /> <br />Mountain Enterprises Inc. <br /> <br />RECEIVED <br />NOV 0 2 2000 <br /> <br />Trade Name <br /> <br />TJ~io Inn <br /> <br />Licensed Location address <br /> <br />7082 Centerville Rd <br /> <br />CENTENNIAL LAKES POLICE DEPT. <br /> <br />City, State, Zip Code <br /> <br />Hugo, MN 55038 <br /> <br />Business Phone (S51) 425 - 295S <br /> <br />LICENSE FEES: Off Sale$ <br /> <br />100.00 <br /> <br />On Sale $ 2,500.00 <br /> <br />Sunday $ <br /> <br />200.00 <br /> <br />By signing this renewal application, applicant certifies that there has been no change in ownership on the above named <br />lieens.ee. For changes in ownership, the licensee named above, or for new licensees, full applications should be used. <br />See back of this application for further information needed to complete this renewal. <br /> <br />AllPlicant's signature on this renewal confirms the followin~: Failure to report any of the following will result in fines. <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 had a liquor license rejected by any city/township/county in the state of <br />Minnesota. If ever rejected, please give details 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 />5. 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. Licensee confirms 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/county <br />where license is issued. $100 000 in cash or securities or $100,000 surety bond may be submitted in lieu of liquor <br />liability. <br /> <br /> <br /> <br />g ,2tbJ <br /> <br />Licensee Signature Date <br />(Signature certifies all above information to be correct and license has been approved by city/county.) <br /> <br />City Clerk/County Auditor Signature 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 />County Attorney Signature <br /> <br />County Board issued licenses ~SiQ:nature ce~i!i~s lice~s~. e ~7)ble for license). <br /> <br />Police/Sheriff Signature 1,a;?- L--? ' ft- <br /> <br />(Signature certifies licensee or associates have not been 'it d during.thepast-.. .f:i: <br />(criminal/civil). Report violations on back, then sign he . See p~ <br />----.,) <br /> <br />Date <br /> <br />Date <br />e years for any state/localliquor law violations <br /> <br /> <br />PS 9093-98 <br />