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Minnesota Department of Public Safety O tt' Alcohol and Gambling Enforcement �� . 444 Cedar Street, Suite 133 � St-Paul, MN 55101 -5133 651-201-7507 • TTY 651 - 282-6555 • Fax 651- 297 -5259 RENEWAL OF LIQUOR, WINE, CLUB OR 3.2% LICENSES No license will be approved or relaxed until the $20 Retailer ID Card fee is received by MN Liquor Control • (3.2% licenses exempt) Licensee: Please verify your license information contained below. Make corrections if necessary and sign. City Clerk/Camty Auditor should submit this signed 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 ONSS License Period Ending 12/31 /20)716# • 20065 City/County where license approved. Cent et. v 11e Licensee Name Sahawk of Minnesota Inc. Trade Name Re22y's Licensed Location address 7098 Centerville Rd City, State, Zip Code Cent erville, MN 55038 Business Phone 651/653 -7791 .ICEN,CF, PEES: Off Sale $ Sunday $ p On Sale $ Aap0It-� AA By signing this renewal a plica dn bee§ ;dctla; ' in ownership i I Lie� p , ptlrant certifies that there has m ownershi on the a 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 Applicant's signature on this renewal confirms the following; Failure to report any of the following will result in lines, 1, Licensee confirms it has no interest whatsoever, directly or indirectly in any other liquor establishments in Minnesota. 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 sate 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 not had a liquor license revoked for any liquor law violation (state or local). If a revocation has occurred, please give details on the back of this renewal, then sign below. 4. Licensee confirms that during the past five years it or its employees have not been convicted of any criminal violations or imposed with any civil penalties. If so, please report on back of this application. 5. Licensee confirms that during the past license year, a summons has not been issued under the Liquor Liability Law (Dram Shop) MS 340A.802. If yes, attach a copy of the summons, then sign below. 6. Licensee confirms 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 where license is issued. $100,000 in cash or securities or $100,000 surety bond may be submitted in lieu of liquor liabil- ity. (3.2% liquor lice ns s are a mp 'f sales are less than $25,000 at on sae, or $50,000 at off sale). tears -asp ran tune nnn ) •30 csa - na. /f7' /f - OQ (Signature certifies abov info tion to be correct a license has been approved b city county. City C9erk/C nnnty Date ■/ /do (Signature certifies that renewal of a liquor, wine or club license has been approved by the city /county as stated above.) County Attorney Signature Date County Board issued licenses only (Signature certifies licensee is eligible for license). tk,lire/Sheriff Signatnrc nee (Signature certifies licensee or associatetEv'e.no&.$eencitM (hiring the past five y S r any state/local liquor law violations (criminal/civil). Report violations on back, then sign here. 1 ?' ,�,� t � z y,!E�41 i�R reAv " 7i PS 9093 -05