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<br />lVLinnesot<l Department of Public Safety
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<br />Al.conoi and Gambiing EnfuIT~ment
<br />444 Cedar Street, Suite 133
<br />St. Paul, MN 55101-5133
<br />65\-296-6979' TTY 651-282-6555 > Fax 651-297-5259
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<br />RENEWAL OlF UQUOR, WINE, OR CLUB LICENSE
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<br />-N?}i(;~~~e..willbe.ai;pro~ddor:re19j~e4,uritiiJ~e' $20..R~tailer;ID.-~ar~fee-i~~~~~\I:~~:}j)i;:_M~,,~iq'u6p;C,9riii:bi':
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<br />Ucensel2: Pleabe verify your license information contained below. Make corrections if necessary and sign. City
<br />ClerklCOlmtyAuditor shQuld submit this signed renewal with completed license and licensee liquor liability for the new
<br />license peliod, City ClerfrtiCounty Auditor are ansa required by lVtS. 340AA04 S, 3 to report any licfose
<br />cancellatioll1,
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<br />License Code OF SL
<br />City/County where license approved
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<br />License Period Encling 12/31../2001 ID#
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<br />2439
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<br />C2ntf'::,~,.) i 21 e
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<br />Licensee Name S,:iHaiN[-( I lie,
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<br />Trade Name Saget" ',; LlqUQ
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<br />Licen'sed Location address
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<br />7093 20th
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<br />HV,?
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<br />City, State, Zip Code
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<br />C2nt2r'vi 112? jVIN 5:5()3,~.
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<br />Business Phone (1;51) 425-6E.,7L~
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<br />LICENSE FEES: Olf SaLeS
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<br />100,00
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<br />On Sale $
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<br />Sunday $
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<br />By signing this rell<ewa~ appHcat]QU], applurnnt 'i:'l:j)'t:ifi;es that U.I1eln.~ has beif:n i]O 1:hau.ge in. oWII1lership on. the above
<br />J]amerl~j.c~n:see. lP'{H' change.:; jn 'Jlwne,rs},I]!p1 lhrc HC1;H.,seil': named ab~ve. m- fm' JJ.ew iicelfisi;CS, fun 3.ppikatimllS should
<br />he used. See back ,1]1' thjs applic.~.ritlon fDil Xl!.IIrdl;er informatnon needed to c~;mp~ete this renewnl.
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<br />A,piOlk"-l:ililt's s~Qnatl!!.fefO!11 Uds reJrn{.'w,<lj ,i~lmfirm8 Ij;Jlle fnU!1'>WRll,!: 1F'aHulrlCtJ, f,enm-t ~nv of th~ fn~lo'Wh]l't wm iifSlllt in fines.
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<br />1. Licensee confirms it has no interest whatsoever, direcIly or indirectly in any other liquor establishments in
<br />Minnesota. If ~O, give details on back of ihis application.
<br />2. Licensee confilms that it bas never bad a liquor License rejected by any city/township/county in the stilte of
<br />Minnesota. If ever rejected, please give details 011 the back of this renewal, tllen sign below.
<br />3. Liccl1$ee .:,:onfirms thLlt tor the past tlve ye~l[.'). it has not l1au a liquor license revoked for any Equor law violation
<br />(state or loed). If a revoc:.ltion bas oecuned, please give details on the back of this renewal, then sign below.
<br />4. Licen:,;ee -';vufiri:ils H1~lt duting the P;):"t five ye~u's it or its employees have not been cited for any civil or criminal
<br />liquor LaVi/ violation.s. If violations bave occulTcd, please give details on back ot tbis renewal., th..::n 3ign belo',V
<br />S. LLcensee confirms that dLlring the past liCEnse yeur, :} sumITIons h:J.S not been issued under the Liquor Liability
<br />Law (Drum Shop) MS 340A.302. If yes, .uttach a copy of the summons, then sign below.
<br />6. Ucensee confirms that 'Workers CompeJ1s~Hion insurance is in effect for the fnillitense period.
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<br />U<c~n5,;e :w.s aUachcd .a l]quo.r ~j.:..lbni;[y 2nSU,fllua:l: i:~rHnlC~Jite that {:nli"rc~ponds with the Ric'~nse pcdndlliL dty/county
<br />wh~re ~k~1!se is issued. :B1D010UO in. cash i[lI!" setlJ.rit.ies ~~r :SlHO~aOO suret)' b'0ud may he submitted 1n Hen of liquor
<br />liability. / ,1
<br />A /I.V'
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<br />Licensee 19O11ture l/.: ,;1.";;/". ~/;__;':'/;~I
<br />(Signature certifies <.\11 ~b;ve in~rmatiO-n'1{Q be cnrr~st ;mrl license has been approved by city/county.)
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<br />Date
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<br />/'.1
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<br />City Clerk/County Auditor Signature
<br />(Signature certifies that renewal Ol a [iqunr, wine
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<br />Date
<br />Dr ciub iic~nse Iw.s been approved by the (..:itY!cQunly ~'lS :.;[nted above.
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<br />County Attorney Signature Date
<br />County Beard issued tl(~~eT;---;:)nly (S~1I;lkce:'tiHe'::;[\CZ:'1See~"eiig-ible cor li~l'rssJ~/ j
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<br />t:Joi;ce/Sl1eliif s;gn~t"~::~){~"2- /0,ae;,/f{- C,:-,:~.~,t:;i.I;i:'Z. ,;.Z::) ,,~-::~?t;/:L-_--".---'-Qate / -=..../<1 "':"i.--/lrj',/
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<br />(Signatme cenifi'.':s \t~nsc"C or a~isGdales have not been cited during d~iZ/i1ast t1ve vears for ,Jny--:~Eltejlocall{qul)r J~lW violations
<br />(criminailci.yil), RC9ort'~~ToTi:'ltlo;;s on back, then sign aere. '--/-
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<br />PS 9093-91\
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