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<br />ST MN ALe GAMS ENF
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<br />6512975259
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<br />01 /04 '02 '15: 45 NO.5 97 Q1 /01
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<br />MIJw_ Oepo.rtme," ,;/ Public Sofucy
<br />Alrotzol and GlUublinll Enfo.rcolllent
<br />. 444 Ced... St=4$llilo 133
<br />St. P.ul. MN 55101-5133
<br />(,51.296-$79 '1Tr 6.51.282-6555, ~'X 651.297-52;9
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<br />RENEWAL OF LIQUOR, WINE. OR CLUB LICENSE
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<br />lil?W"""'''' '.ilI O. '.""',., or "'I~~~~I "" 52<111.1lI11" lD ':'!d too;, .....,...1 b)' iI\N Li..o,<:.';":.;\l,X;'~'
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<br />Lkeml~; P!ett.'l~ .,..,rif)' yQvr licens~ intbrl:naliOl1 COJ)~td beiQw. Make,: c.om:ction.~ If nece..'iisar"j aDd. siga, City
<br />O"l'itlCounty Audito, sOOuJd submit this sign.d tellCwal with CllJnl'leted licen.e and lie.,.,_ Hquar liability for tne lIew
<br />licen,e period. City Clo.l'!llCa.m.ly '~Ilditor .... akJo ""Iulred by M.S. 34OA.4Otl S. 3 to report <'Jny Iicm..
<br />C.n<<ln.ti"".
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<br />Licen'" Code
<br />Cit)'fCoutj(y where licen~ approved
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<br />Li_," Period Eodlng
<br />Cant Ql"Y i 1111
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<br />~.ID#.
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<br />Licefl,3eU Name
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<br />rellde Name
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<br />LICal'J.sed L.;x:arj,Q,Q. w.d.~s~
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<br />CIly. Staw, ,ZJp Code
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<br />Busine,. Phon<
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<br />LICFNSE {I!E.~: on Sole.~
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<br />Oi~Sale. S
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<br />Su:m!a;r S
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<br />By ~1/l;DlnlJ llils ....n.....1 'pplj,;atl"'D. apPUcDnl aitlfi.. lbal lb.... bas l>een lI<> change in <TOVIlI!nhjp an the .m,..
<br />iJettled lic.~. FoOl' dlange,. .w owncJ:"Ship~ th~ ll~en~ named above, or fur new Ucenstes, f'uf1 app.liadou ~JJ()uJd
<br />he 11Wd. See b.e1<. "r Ihi. appUcadOll for Alrtber intonnatf<)lI "..ded 10 l"",plet. this rea""al.
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<br />.1pj)Hrnn;'tsftmsn.u~ '1m lhk reo1!wel em:rUl"m.'iI tbll! fo.!lo'Wm2!: F'ilillIrP.to ~.murt!;lm' qftn~ {bl1owjn~ will n!ltuli in flr'f~
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<br />L Lkttt1see -conv.rms I[ h..'W no interest wfla~Wt~"r'er. dit"ef;dy or Indirea.l)' l.n .any o~ IJquc.>r. ~tabLiahrnenI.S LI'J.
<br />Minnosota. If"o, give dot.ill OIl bock oflh;s .ppUoatlon. .
<br />2. Ucentjcc eonfum~ that it ha., neV~M had i1 Hy:uor ficemlt!: rejected by ;my citj/to,vnshfplcounty In. tb.e:,~'b!~ of
<br />.'.1innes.'l,a, If "".r rejected, pI""". g,ve detllll. on the b.ck ',f tills ",.ewoJ.. Ih"" .i.1i!1 below,
<br />3, Li~e"~ contlt'li:1S th~t for tru:. 9ilSt flve yetJrs it h3SlI~l)l b:s.d a Uquor lice.mc revo~ for any liquOt law viol.atiOD
<br />(;\U1It'1 (Jf l:x:.<ll). If it reVOCl,;ltj()1l hm; IJCCl.:I;"tl;l(.i. plaaae ,give detaib on T,he back: of thi'\ reneww, thelt ~ign belew.
<br />4. UC('''Dsee. ,,;onftrm,l; t~u~l durin&; the pai!lt nv,," ~el1~ it or 1m employees l1u'V<t Mt been dtl:(] f('Jr t.lny civil or. c.riI:l1lnal
<br />liqU(.'f la.w .....io~tiOM. IT v.iIJJation.s bave \)Ccurred., pleaGe give: detailii on back of tbl~ rentwcl, then .liign below,
<br />S. Liccmee confjnns U:'1~ttdurL'lg t.h~ Pilslljcenee year, 4 summons.ha."1 not 'OOen i88U~ under the: LiquQr Linbilhy
<br />Low (Dram Shop) MS 340A.8OZ. If yes. acracl1 a cop:' "fthe ,ummOllJ>, then sign below.
<br />6. J....i.~1l!We coafn:m:; that Workers C.,;.mpe.n~ati~11'1 lnsumnee is in et'f~t for ::he flllt Ucense ped,Od.
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<br />LiCIIll8O" h06 atllt.hod .li.qllo" Uability n-rnll.. ",ntfl""totllot ocrresp<>nd!! ,..ltlllh.licen,. period III dty/coonty
<br />wb....lk...... i, iSliued. $100,000 IIIl.ash Ol""l'llrii:le.; or $100,000 ,uret,y bOlld may b<> ,ubrrritlod In lI.u 01' Iiqtlor
<br />liability.
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<br />Lic.:on:Jee Sigmlture . Date
<br />(SI3Jlnturo ccrwi<s ilJl'b~';;;;:;;'n (J be coiroct and ii';;''\e bas \,.;;n :lppt\1V~d by oityl.""nry.)
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<br />City ClerldCoun!~ .'udltor 5i"",",~ _ _.. _ . D'!.~._-r"
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<br />(Si~l1at.lJrc ceJ't!fj~ that t":m.....wal Or a liqU01\ wirw or l:l~lb lIc..."'t1~C has ~cn apptrJvect by the city/county aos stafud abave.
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<br />County AL10rney SifJIlaluJ'O __ ~"DUI'
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<br />County Beard lsaued li~Sign4tu~-'-;fii,::; nCl!llsC:I;.~ll.gibI~ f. . .
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<br />Pol~ISbeti.ff Sionat . (, Q". ,
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<br />(Sjgniltut'e ~ertifies He ..ae~~r I:!.~;;o;~ri;je not bet':ti cit~d dUrb&ie3t fi\ll~ ~tatel!ccat l!'quor la.,y\rjQl~on.<;
<br />(criminalJcivlJ). R<opl:'rt "/lQ . m:! 00 back, th~'U ~ig", \1~re--:- I
<br />I'S 9093-98
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