2002_0325_packet - Laserfiche WebLink

Home

8. Are the premises now occupied or to be occupied by the applicant entirely separate and exclusive from any other business establishment? Nyes o No 9 State whether applicant has or will be granted, an On We Liquor License in conjunction with this Off Sale Liquor Limse and for the same premises. J&Yes J No Will be granted 10. State whether applicant has or will be granted a Sunday On Sale Liquor License M conjunction with the regular Chu Sate Liquor License. 0 Yes 0 No "ill be granted 11 If this application is for a County Board Off Sale License, state the distance in mikes to the nearest municipality. 1. Slate whether applicant or any of the associates in this application, ha wer had an application for a liquor license rejected by any municipality or state authority; if so, give dates and details. 0 2 Has the applicant or any of the associates in this application. during the five years immediately preceding this application ever had a license r the Minnesota Liquor Control Act revoked for any violation of such laws or local ordinances; if so, give dates and details. ...._...,w..�...... ow M., 3 Has applicant, partners, officers,oK employees ever had any liquor law violations in Minnesota or elsewhere. including State Liquor Control penalties? [1 Yes XNo If yes,give dates,charges and final outcome. I 4. Dung the past license year, has a summons been issued under the Liquor Civil Liability Law(Dram Shop) MS. 340A 02. 11 Yes KNO If yes, attach a copy of the summons. This licensee must have one of the following: (ATTACH CERTIFICATE OF INSURANCE To THIS FORM.) Chick one kA. Liquor Liability Insurance (Dram Shop) . $50,000 per person, $100,000 more than one person; $10,000 property destruction; $50,000 and $100.000 for loss of means of support. or D B. A surety bond from a surety company with minimum coverage as specified in A. or 0 C. A certificate from the State Treasurer that the licensee has deposited with the state. trust funds having market ague of $ 100,000 or S 100,000 in cash or securities. i I certify that I have read the above questions and that the answers are true and correct of my own knowle ftc Print name of applicant & title Si tore of Ap 'cant Date �C' ckl, V ic's REPORT BY POUCEWHE IS DtPARTMEN T This is to certify that the applicant and the associates named herein have not been convicted within the past fire years for any violation of laws of the State of Minnesota or municipal ordinances relating to intoxicating li except as follows: I'oticelShe s Department Title _i -iu-re PS 9 136-94 County Attorney's Signature IMPORTANT NOTICE All retail liquor licensees must have a current Federal Special Occupational Stamp. This stamp is issued by the Bureau of Alcohol. Tobacco, and Firearms. For information call (612)290-3496.