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<br /> <br />8. . <br /> <br />Arc tho pmniaco now occupied or to be oceupied by tho appli.....t entj...ly separate ond IlltCllI8ive from any other businoss <br />...,.ilbmcnl'I Wos uNo <br />SII~ whcIbcr 1JlP'b~!,"" or win be pmt.od, an On ....e Liquor Liocnoc in conjunolian with thi. otrSlle Liquor License and for <br />the 88DIll pmui.... P.r" uNo U WiD be poled <br />~..uelher .pplicant bu or will be pmt.od . Sunday On Sale Liquor License in oooj_lion with tlae ,...w- On S.... Liquor <br />Liccuoc.).(ye. uNo UWlIl be gnnted <br />IfthisapplicatiOll i. Cor a County Boanl OlfSaIe License. _ tlae dJ_ in miles ID tho nc=stl!lllDiclpality. <br />S_ NumberofBmpl"Y"'" <br />If lIP license is bcill(! i..uod by a County Board, ha.. publio IIoariIl(! been held II per MN Sllllulo 340A.40S IUIl2(d)1 <br />Iftbi.li_ i. bcill(! i.oucd by a County Board, i. it looatod In an orpnized townahip? If so, altKh _lIIIIlp ......v>>oL <br /> <br />9. <br />10. <br /> <br />11. <br />12. <br />13. <br />14. <br /> <br />~ wbotber applicant or any orlbo aaoociBi in lbia appliealiDllf, have ever bad an appli..tion far a liquor li_ rej~ by any <br />muaioipalily or _ authority; iho, sivo dIln and delllill. .A ~ <br /> <br />Baa tho .pplieant or any of1be ..lOCialn in tbia appli..tion. during 1110 liVe years immediately p.-dill(! tbit oppIicatiOll over Iwl a <br />li_ under tho Minftooola Liquor Control Act rovo/i:ed far any violation or a""" II... or 'ocal mdi_ if BO, sive daIcI oDd <br />dotaiI.. t.JO <br /> <br />Hoe .ppl.cant" parlncto, olli..... or ompl~ ever bid any II,!"!,, law V101abono or folOlly aan.,olioDlIO lIti_ or <br />.I..whom, induding Stale Liquor Con1roI pcoaItios? J Ve. )llNo ICyco, give daD, charpo and linal oub:omc. <br /> <br />Duriolllbo pullicenao year, bao. oummona lJoenisoued und<rtlJoLiquorCivil LillhilityLsw(Drom Shop) M.S. 340A.l102. <br />J V... ~o ICyco, allleh 0 oopy or1be 1WDDlODI. <br /> <br />Thioli_ must bow ooe of the follo";lI8: <br /> <br />(AlTAaJ CERTIFICATE OJ'INStIJlANCB TOTWS JORM.) <br /> <br />0..._ <br />U A. <br /> <br />Liquor Liobility J.nsuromce (Dram Shop). $50,000 per perIOD, 5100,000 IIKlre than one penon; $10,000 property <br />....lnleIion; $50,000 llIId 5loo.oooforlOOl ofmoans or.apport. <br /> <br />A IIUIOly bond Ii'om ollUrely colDpOD1 with minimum coverage u apocilicd in A. <br /> <br />A cortifioale 1i'om Ihc Stale TRDsurCr thal1bo IiIlCllSOC bao cIepoon.d with the sID, truat1'undo bavins rnatkct ..100 or <br />5100,000 or 5100,000 in cash or ocouriti... <br />. veua <br /> <br />.. <br />LJ B. <br /> <br />'" <br /> <br />U <br /> <br />c. <br /> <br /> <br />0'( <br /> <br />Tbia i. to cortify that the applioont and tho aaaociala IllIDICCI herein have DOl boco c:onvi*<l within the put live yearo for any violllion of <br />Iowa oC Ibc S~ orMi~oIa e< mllJlicipal onn- """liDs to iJ1loXlcatiog liquor oxcept ull>lIOWl: <br /> <br />~-i~A'~ ~l:~ <br />PoIigclSbori1f. o.plIolldonl <br /> <br />fl'i <br /> <br />_. L':'''''/ L.,Ju.. I'~ <br /> <br />Ie. isnahne <br /> <br />PS 9136-(2006) <br /> <br />County AttoI'llCY" Signalunl <br /> <br />IMPORTANT NOTICB <br /> <br />A1J retailli..-li......-. moat bave . turmIl Fc<ImI Special 0cc:upmi00aI Slimp. Tbi. olllmp i. iuuod by tho Bumu of AIoaImI, Tobaoco, <br />and Fireonno. Fe< Information oaJl (651)726-0220 <br /> <br />-49- <br />