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Minnesota Department of Public Safety ..:. <br /> Alcohol and Gambling Enforcement € <br /> Cedar Street Suite 133 <br /> St Paul MN 55101-5133x . <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 pprvved or released unfi!the MO 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 ,, ONSS License Period 12/31/2002 7361 <br /> Ending.�_____,_.,�...._..,........__�...M..�..�._ .,�..�,.,.�........�._..ti�........__..,_. ____ _. ���.�. <br /> City/County where license approved.R o 5 e v i 11 e <br /> Licensee Name Outback Midwest II Ltd Ptsp. <br /> Trade Name Outback Steakhouse <br /> Licensed Location address *2181 N Snelling Aire <br /> City, State, Zip Code Roseville,, MN 5 5 1 1 3 <br /> Business Phone 651/697-1224 <br /> . <br /> LICENSE FEES: Off Sale $ On Sale$ 7 0 0 0 . 0 0 Sunday $ 2 0 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 /> Annlicant's sienature on this renewal confirms the following: Failure to report any of the following 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 below <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 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 =Aa <br /> (Signature certifies all above information to be correct and licen 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 -- Q z <br /> (Signature certifies licensee or a societe's o-'%hye not been cited during the past five years for any state/local liquor law violations <br /> (criminal/civil) Report violations on back, then sign here <br /> PS 9093-98 <br />