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Minnesota Department of Public Safety <br /> Alcohol and Gambling Enforcement <br /> ,. 444 Cedar Street. Suite 133 <br /> ` St Paul, MN55101-5133 <br /> • <br /> 651-296-6979. TTY 651-282-6555. Fax 651-297-5259 <br /> RENEWAL OF LIQUOR, WINE, OR CLUB LICENSE <br /> No license will be approved or released until the$20 Retailer ID Card fee is mceived by MN Liquor Ccmtml <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 <br /> license period. City Clerk/County Auditor are also required by M.S.3 A AW S. 3 to report any license <br /> cancellation. <br /> License Codd, MWNOrNSLe P e r i o d E n d i n g 12/31/2002 IDS 8554 <br /> City/County where license approved.Ro s e v i l l e <br /> Licensee Name Love From Minnesota Inc. <br /> Trade Name Love From Minnesota <br /> Licensed Location address 2 4 6 5 Fa i r~V i e W R v e N <br /> City, Slate.Zip Code R o s e v i l l e , M N 5 5 1 1 3 <br /> Business Phone 651/639-1413 <br /> LICENSE FEES: Off Sale $0' 0 0 On Sale S 0 . 0 0 Sunday $ 0 . 0 0 <br /> By signing this renewal application,applicant certifies that there has been no change in ownership on the above <br /> named licensee.For changes in ownership,the licensee named above,or for new licensees,full applications should <br /> be used.See back of this application for further information needed to complete this renewal. <br /> Applicant's signature on this renewal confirms the following: Failure to-rewrt any of the following will result in fines. <br /> I 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 hack of this renewal, then sign below. <br /> J. 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 /> Licensee has attached a liquor liability insurance certificate that corresponds with the license period in city/county <br /> where license is issued. $100,000 in cash or securities or$100,000 surety bond may be submitted in lieu of liquor <br /> liability. <br /> Licensee Signature Date <br /> (Signature certifies all above information to be correct and license has been approved by city/county.) <br /> City Clerk/County Auditor Signature Date <br /> (Signature certifies that renewal of a liquor, wine or club license has been approved by the city/county as stated above.) <br /> County Attorney Signature Date <br /> County Board issued licenses only (Signature certifies licensee is eligible for license). <br /> Police/Sheriff Signature Date [ --l —o <br /> (Signature certifies licensee or assn ates have> of been cited during the past live years for any state/local liquor law violations <br /> (criminal/civil). Report violations on back, then sign here. <br /> PS 9093-98 <br />