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��►� Minnesota Department of Public Safety <br /> 3. <br /> AY' <br /> Alcohol and Gambling Enforcement ' _ . <br /> Cedar Street. Suite 133 <br /> St.Paul,MN 55101-5133 r�, , <br /> 65 1-296-6979.TTY 651-282-6555. Fax 65 1-297-5259 <br /> RENEWAL OF LIQUOR, WINE, OR CLUB LICENSE <br /> No license will be ;plrvved or rcleasM until the$20 Retailer ID Card fee is received by MN Liquor Control <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.340A.404 S.3 to report any license <br /> cancellation. <br /> License Code MW [3N9B License Period Endini,.•_,•J�Z..3 1 / 2002. IN 5614 <br /> v r .�...�...„ � a•rrnv .-..-.....��. ,-,J..--- •up.riN.w�•�+_•�.o <br /> City/County where license approved.R o s e v i l l e <br /> Licensee Name T a n, F r a n k l i n . <br /> Trade Name Willow Gate Rest . II <br /> Licensed Location address 1885 W Perimeter Dr <br /> City, State,Zip Code R o s e v i l l e , M N 5 5 1 1 3 <br /> Business Phone 651/628-0990 <br /> LICENSE FEES: Off Sale $0. 00 On Sale S 1500 .00 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 /> Ayniicant's signature on this renewal confirms the followine: Failure to report anv of the followine will result in fines. <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 ht to%k. <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 310A.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 /> 1Z Z <br /> (Signature certifies 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 -- 1 a— Z_• <br /> r. ■U i k brti• 4+ L 1 { X14 t.1 LA 1 <L }ti„r+i 1\�a 1.11!1 �tc4l\.-11L7�.i4i 1ILiu i �LLS4 }aiiaLIMI.) <br /> J <br /> (crirninallcivil). Report violations on back, then sign here. <br /> PS 9093-98 <br />