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Minnesota Department of Public Safety <br /> Alcohol and G= ling Enforcement <br /> 444 Cedar Street, Suite 133 <br /> St Paul, MN 55101-5133 <br /> 4 <br /> 651-296-6979 M 651-282-6555 . Fax 651-297-5259 <br /> RENEWAL OF LIQUOR, WINE, OR CLUB LICENSE <br /> No liCCnse will be 4mved or released until tt $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 perm.City Clerk/County Auditor are also required by MS.340A.404 S.3 to report any license <br /> cancellation. <br /> License Code 760a&ONSA License Period Ending 12/31 /20D2_1D# <br /> City/County where license approve .Ro s e w i 11 e <br /> Licensee Name D & D of Minnesota Inc. <br /> Trade Name Famous Dave's BBQ Shack <br /> Licensed Location address *2131 N Snelling Ave <br /> City, State, Zip Code R o s e v i l l e , M N 5 5 1 1 3 <br /> Business Phone 612/294-1300 <br /> LICENSE FEES: Off Sale $0• 00 On Sale$ 1500 . 00 Sunday $ 0 . 00 <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 report anv of the following will result in tines. <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 Si nature v < Dat e /0-- <br /> �-Y ()� <br /> (Signature certifies all above in Lion to be correct and license has been approved by city/county►.} <br /> City Clerkl+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 i 1 —0 Z, <br /> (Signature certifies licensee or assn sates 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 />