2002-01-09 CC Packet - Laserfiche WebLink

Home Browse Search

@j"""" ;~r i;) r' ,\ \ ;' "'{' ,p.~.' ~'f~"J'f' Minne~ota Department of Public Safety Alcoboi:.and Gambling Enforcement 444 Cedar Street, Suite 133 St. P;'ul, MN 55101-5133 651-296-6979' TrY 651-282-6555' Fax 651-297-5259 _ "_;>_',:."'_.,', ,_ '.'''''',',::' '.':.',. >,'<: ,>::':" >:' -'-',::'.,--\:",";c ",.':-,<:--";\-::-:_:;i':'-"':";~:':-:"'" ,-: - ' ~:()>i=~~~_>~11"~:~l?~~~Y~~:?r_f~,~~_~~-~Jl~J~~;~tq:~itW:~)p~€~;l~f::~~W~,~i~?:~i!~::~9yifS:?~~t-'- RENEWAL OF LIQUOR, WINE, OR CLUB LICENSE Licensee: Please verify your license information contained below. Make corrections if necessary and sign. City Clerk/County Audjtor should submit thtssigned 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 12/31/2001 ID# Centerville 9144 Licensee Name Richard A. DeFoe Ent. Inc. Trade Name Waterworks Beach Club Licensed Location address 7281 Main St City, State, Zip Code Centeryille, MN 55038 Business Phone (651) 429-3033 LICENSE FEES: Off Sale$ 100.00 On SaId 4,000.00 Sunday $ 200.00 B:y signing this renewal application, applicant certifies that there has been no change in ownership on the above named 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. Ap9licant's shmature on this renewal confirms the foUowinf!: Failure to report any of the followio!! will result in tines. l. Licensee confirms it has no interest whatsoever, directly or indirectly in any other liquor establishments in. Minnes.ota. If so, give details on back of this application. 2. Licensee confirms that it has never had a liquor license rejected by any city/township/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 nol had a liquor licem,e revoked for :my liquor law violation (state or local). If a revocation has occun'ed, please give details on the back of this renewal, then sign below. 4. Licensee con.firms that dUling the past five years it or its employees have not been cited for any civil or criminal liquor law violations. If violations have occUlTed, please give details on back of this renewal, then sign below. 5. Ljl:ensc~ confinns that during the past license year, a summons has not been issued under the Liquor Liability Law tDram Shop) MS 340A.802. If yes, attach a copy of the summons, then sign below. 6. Licensee confinns 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 ~he,~ license is issued. $100'00y" h or securiti~e. 100,000 surety bond may be submitted in lieu of liquor lIabIlIty. i rr. " Licensee Signature.vk. . Date / tI J'" ! d (Signature certifies all above information to be con'ect and license has been approved by city/county.) City CkrklCounty Auditor Signature Date (Signature certifies that renewal of a liquor, wine or dub license has been approved by the city/county as. stated above. County Attomey Signature County Board issued licenses only (Signature certifies licensee is eligible for license). Police/Sheriff Signature Dare (Signature certifies licensee or associates have not been cited during the past five years for any state/local liquor law violations (criminal/civil). Repon violations on back. then sign here. Date PS 9093-98