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Minnesota 'Department of Public Safety <br /> IJA <br /> Alcohol and Gambling Enforcement _ <br /> W ,, <br /> 1.'.. <br /> Cedar Street. Suite 133 <br /> St.Paul.MN 55101-5133 �• � <br /> 65 1-296-6979. TTY 65 [-28?-6555 o Fan 6.5 I-297-515`) <br /> RENEWAL OF LIQUOR,WINE, OR CLUB LICENSE <br /> No ticense will be wrovGd or released until the S20 Retailer ID Card fee is rmeived 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 NI.S. 340A.404 S. 3 to report any license <br /> cancellation. <br /> License Code License Period Ending 1 P/ 00P ID#- 504.7 <br /> City/County where license approved.R❑ 5 e y i. 1 e <br /> Licensee Name Big Bucks Inc. <br /> Trade Name Panino's Restaurant <br /> Licensed Location address 2441 R i c e St <br /> City,State.Zip Code Roseville, M N 55113 <br /> Business Phone 651/481-7009 <br /> LICENSE FEES: Off Sale $0. 00 On Sale 750.00 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 /> Ap licant's signature on this renewal confirms the follwine: 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 /> J. 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 /> Police/Sheriff Signature Date <br /> (Signature certifies licensee or ass iatcs 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 />