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#; Minnesota Department of public Safety j Alcohol and Gambling Enforcement Cedar Street. Suite 133 ` °~ St_ Paul} MN 55101 -5133 651- 296 -6979 - TTY 65 l -2 82-6555 -a Fax 651. -297 -5 259 RENEWAL OF LI UOR9 WINE9 OR CLUB LICENSE No license will be approved of released until the $20 Retailer III Card fee is received by MN Liquor Control Licensee: please verify your license information contained below. flake 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. 340A.404 S. 3 to report any license cancellation. License Cade ONS S _ License Period Ending City /County where license appro ved.R o s e v i 1 1 e Licensee Name R a v 1 i c k Holding C o. Trade Name 01 Mexico Licensed Location address 1754 N Lexington Ave City. State. Zip Code Roseville, M 55113 Business Phone 651/487-2847 LICENSE F 5; Off Salc $ 12/31/20031D# 3406 On Sale $ 7000.00 Sunda y $ 200.00 By sighing 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 sigagture on this renewal confirms the following: Failure to report any gf the following will result in flues., 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. ?. Licensee confirms that it has nearer had a liquor license rejected by any cityltownship /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 gears 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 blow. 4_ Licensee confirms that during the past five ire 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 hack 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 p liquor babil lnsuranC4 certificate that corresponds with the license period in city /county where license is issu Xoo19*1"h or or $ ;p surety bond may be submitted in lieu or liquor liability. f. {J Licensee Signature ,. g Date U/1/03 r (Signature certifies all above information to be correct and license has been approved by city /county.) City Clerk/County Auditor Signature Date (Signature certifies that r.%ne Fal 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 ecrtifies licensee is eligible for license). Police /Sheriff Signature late (Signature certifies licensee or associates have not been cited during the past five gears for any state/local liquor law violations ( criminalkivi2). Report violations on back, then sign here. PS 9093 -98