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<br />I) <br /> <br />Minnesota Dep~ent of Public Safety <br /> <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 />~ <br />\S <br /> <br /> <br />RENEWAL OF LIQUOR, WINE, CLUB OR 3.2% LICENSES <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 CMBS <br />City/County where license approved. <br /> <br />License Period Ending <br />Centet"'ville <br /> <br />1? / ~ 1 /21lt1Zt!D# <br /> <br />19~A <br /> <br />Licensee Name <br />Trade Name <br /> <br />Mountain Enterprises Inc. <br /> <br />Tt"'io Inn <br />Licensed Location address <br /> <br />City, State, Zip Code <br /> <br />7082 Centerville Rd <br /> <br />Business Phone <br /> <br />H'Jgo, MN 55038 <br /> <br />651/426-2956 . <br />LICENSE FEES: Off Sale $ On Sale $ Sunday $ <br /> <br />By signing this renewal applicd&W;a~lSbcant certifies that there has b&:iM11qe in ownership on the a~nMd <br />licensee. For changes in ownership, the licensee named above, or for new licensees, full applications should be used. See <br />back of this application for further information needed to complete this renewal <br /> <br />Applicant's si2l1ature on this renewal confirms the lollomn!!: Failure to report any of the followine 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 Iiabllity insurance certificate that corresponds with the license period in city/county <br />where license is issued. $100, · 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 /> <br /> <br /> <br />(SignatUre certifies all above information to be correct and license has been approved by City/county.) <br /> <br />City Clerk/County Auditor Si&nature Date <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 Si~ature <br />County Board issued licenses a <br /> <br /> <br />Date <br /> <br />(Signature cenifies licensee or associates have not been cited during the past five years for any state/loc <br />(criminaVcivil). Report violations on back, then Sign here. <br /> <br /> <br />PS 9093-98 <br /> <br />(}~ <br />