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It I Minnesota Department of Public Safety Alcohol and Gambling Enforcement f 444 Cedar Street Suite 133 St Paul MN 55101-5133 5x 65 1-296-6979 . TTY 65 I-282-6555 . Fax 65 1-297-5259 RENEWAL OF LIQUOR,WINE, OR CLUB LICENSE No ficenm will be 4pproved or released until the$20 Remoter ID Card fee is received by MN Liam Contmi LiCenW: Please verify your license information contained below Make corrections if necessary and sign City Clerk/County 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. 90A.404 S. 3 to report any license cancellation. License Code 0 N S S License Period Ending 12/31 1 2002 i p# . .,. 1502 City/County where license approved.Ro s e v 1 e Licensee Name Don Pablo's Operating Corp. Trade Name Don Pablo's Licensed Location address *2700 L i n c o l n D r i v e City, State, Zip Code R o s e v 111 e, MN 55113 Business Phone 6511639-3916 LICENSE FEES: OH Sale $0' 00 On Sale$ 7000.00 Sunda Y 200* 00 `� 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 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 jo-t1owinLi will result in fines. 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 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 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 cited for any civil or criminal liquor law violations If violations have occurred, please give details on back of this renewal then sign below 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 securities or$100,000 su ty pond may be submitted in lieu of liquor liability. Licensee Signature Date (Signature certifi I above in �5-Fewmoc�orrect and license has been approved by city/county.) City Cler aunty Auditor i ture Date (Sign ptlfre certifies tha newal 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) Police/Sheriff Signature Date � t— 1 L - 02, (Signature certifies licensee or ass Mites ha a not been cited during the past five years for any state/local liquor law violations (criminal/civil) Report violations on back, then sign here. PS 9093-98