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y Minnesota Department of fubhc Safety ,Ts,� Alcohol and Gambling Enforcement4. 415 Niinnesnta Sucet, Suite 222 S1. Paul. TvIN 55101 6 5 1 - 2 0 1 - 7 5 0 7 • TTY 651-282-6555 • Fax 6 5 1 - 2 9 7 - 5 2 5 9 RENEWAL OF LIQUOR, WINE, CLUB OR 3.2 % LICENSES NI he ens, •.a rrl be anpiuved or re.lensed until the .$20 Retarlei ID Caid fee n ,ccened by NtN Liquor C•onhol • (3 2% Licenses e\empt) Licensee: Please verify your license information contained below. Make corrections if necessary and sign. City Clerk/County Auditor should subrni! this signed renewal with completed liCenSC and licensee liquor liability for the new license period. City Cleric/County Auditor are also required by M.S. 340A.404 S. 3 to report any license cancellation. License. Code License Period Ending City/County where license approved. License^ Name Trade Manic Ail L- .-', l+. f_ (7 i_1 1 -I � �_. l) ! t t ` :a Licensed Lncafion address is 1 City, >!atc. 7:(_t Cu�1e Ill Business Phone L1CIst\SE r sES: Off Sale $ On Sale $ Sunday ]ZIII t'hII%14:5„ ;'ll' hey„ I'Ifa By 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 hack of this application for further information needed to complete this renewal. Aliplicont's signature nn this renewal eonin'ms : Eaiiure t0 report any of the folluwin Ina, result in civil penalties. 1. Licensee confirms it has no interest whalsoeve-r, directly or indirectly in any other liquor establishments in Minnesota. Tr so, give details oil back of this application. ? Licenseeconfirms 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 not had a liquor license revoked for any liquor late violation (state or total). if a revocation has occurred, please give details on the back of this renewal, then sign below. 4, Licenses confirms that donna Iho past five years it or its employees have not becn cited for any civil or criminal liquor law violations. Tf violations have occurred, please give details on hack of this renewal, then sign below. 5. Licenses con(i rim, Ili;][ during the past license year, a summons has not been issued under the Liquor Liability Lavr (Or<un :Shop) VIS 340A.802. If yes. attach a copy of the summons, then sign below. 6. T"iccnsee con firms that Workers Compensation insurance will be kept in effect during the 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 es Rre exir Mr if, sales are less than $25,000 at on sale, or $50,0001 at off sale,). ` 1 �nn.cup Cionnnro/i�'Y"� •Yt IXiR �y CCI! LI� J ��`�' it:i. i I } �� (Signature certifies all above information to be correct and license has been approved by city/county.) City.Clerk/C ountkfluditoL ipill llrn.1 _ Dale (Signature certifies that renewal of a liquor: wine or club license has been approved by the city/county as stated above.) CU.Luuy_Altornt:y 5rr_tn+l re Dnte Count; Board issued licenses only (Signalurc cer(ifres licensee is eligible for license). L'tah"Islieutt -signawre. Dale (Signature certifies licensee or associates have not been cited during the past five years for any state/local liquor law violations. (crirninaJcivil). Report violations on back, then sign here. PS 9093-10