Laserfiche WebLink
Minnesota Department of Public Safety �. <br /> Alcohol and Gambling Enforcement <br /> 444 Cedar Street. Suite I33 <br /> 4 <br /> St.Paul.MN 55101-513 c. :. <br /> 65 1-296-6979.TTY 65 I-282-6555.Fxx 65 I-297-5259 <br /> RENEWAL OF LIQUOR, WINE, OR CLUB LICENSE <br /> No license wilt be gppr+oved or n~leascd until the S20 Retailer ID Card fee is rmcivcd 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 MS.340A.404 S.3 to report any license <br /> cancellation. <br /> License Code OFSL License Period Ending.1.,2!31/2,002 [ ]# , uW 1 1 8 3 <br /> City/County where license approved.R o 5 e v i 1 l e <br /> Licensee Name Roseville Liquor Inc. <br /> Trade Name Roseville Liquor <br /> Licensed Location address 700 W Co Rd B <br /> City, State,Zip Code R o s e v 111 e, M N 55113 <br /> Business Phone 651/488-1070 <br /> LICENSE FEES: Off Sale $200. 00 On Sale $ 0 . 0 0 Sunday S 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 renew'al. <br /> Awficant'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 <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 /> L <br /> Police/Sheriff Signature r�, D ate R -1 Z-0- <br /> (Signature certifies licensee or a nciates have 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 />