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<br />/ <br /> <br /> <br />Minnesota Department of Public Safety <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 />RENEWAL OF LIQUOR, WINE, CLUB OR 3.2% LICENSES <br /> <br /> <br />/ <br /> <br />i <br /> <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 license <br />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 Ctt1BS <br />City/County where license approved. <br /> <br />License Period Ending <br />Cent et~V i 11 e <br /> <br />1 ;:.' / ~ 1 / PilllZl$D# <br /> <br />19~a <br /> <br />Licensee Name <br />Trade Name <br /> <br />Mountain Enterpt~ises Inc. <br /> <br />Tt~iQ Inn <br />Licensed Location address <br /> <br />City, State, Zip Code <br /> <br />7082 Centerville Rd <br /> <br />Business Phone <br /> <br />Hugo, MN 55038 <br /> <br />651/426-2956 . <br />H€ENSE-FEES:-0ff-Sa1e-$ ---en-Sale-$ Sunday$ <br /> <br />By signing this renewal applicJ&W;a~Siicant certifies that there has b&tti~~e in ownership on the a~rJ.l\~Hld <br />licensee. For changes in ownership, the licensee named above, or for new licensees, rull applications should be used. See <br />back of this application for rurther information needed to complete this renewal. <br /> <br />Applicant's sil!llature on this renewal confirms the followinl!: Failure to report any of the followinl! 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. $100,0 . cas r securities or $100,000 surety bond may be submitted in lieu of liquor liabil- <br />ity. (3.2 % liquor licenses ar. exe pt' sese less tha 25,000 at on sale, or $50,000 at off sale). <br /> <br />L' e D <br /> <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 /> <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 Date <br />County Board issued licenses only (Signature certifies licensee is eligible for license). <br /> <br /> <br /> <br />Police/Sheriff Signature Date <br /> <br />(Signature certifies licensee or associates have not been cited during the past five years for any state/localliquor law violations <br />(criminal/civil). Report violations on back, then sign here. <br /> <br />PS 9093-98 <br /> <br />9~ <br />