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8. Are the premises now occupied or to be occupied by the applic ant enfi re ly separ to and a eIusivc from any other business <br />st bllshirient? MYes ❑loo <br />9, State whether applicant leas or will he gra nte d, an On sale Liquor License in conjunction with. th is 0 ff" S a I e Liquor License and for <br />the same premises. ElY Qs EIN I Will be granted <br />1 .i State whether applicant has or wi 11 be granted a Sunday On Sale L i qu or License in conjunct1on with the regular On Sale Li quor <br />License. [I Yes a No [:1 Will be granted <br />I L If this application i for a County Board Off Sale me se, state the distance in miles t the nearest iminicipa�li r, 1�► <br />:1 Z State Nurnb r of Emp loyees <br />13. If this license is being issued by a County Board, has puhli hearing been held per l I Statute ` v.._....... ...Y......,. <br />14. if this license is being issued by a County Board, is it located in are organized township? If so, attach township appr 0 Val. NtA <br />State whether applicant am any of the associates in this application, have ever had an application for a liquor licensr, rejected by any <br />municipality or state authority; if so, give dates and details. No <br />+�x�x+owwrnNw <br />2. s the applicant or any of the associates in this app IIcartio, , during the fir D years i m m c d i ately prece ding this application ever lead <br />license under the Minnesota Liquor Control Act revoked for any violation of such laves or local ordinances, if so, give dates and <br />details. a ... J.. Y..._ ..... �. 4.__.._.._..._,. ,.-- ry-- .. ry... w..- .ry..:.:.n.mri,,....- ..�... <br />3. flas app Teant, partners, 0 1 , or emp oyes :ver any r uor law at�o� or felon convict�c r s rr Minnesota I or <br />else here, including State Liquor Control penalties? BY rss If yes, give dates, charges and final outcoinc. <br />See, Attached <br />4: During the past license year, has a summons been issued under the Liqu oir Civil Liability Law (Dram Slop) KS. 3 40A. 802. <br />[J es EJNo If yes, attach a copy o.f the suniIIIons, lvqlp�w - 11 <br />This licensee must have one of'the following: (ATTACH CERTIFICATE OF INSURANCE TO T S FORM. <br />Check one <br />A, 1,iq or LiabiIity Insurance (Dram Shop) - $50,000 per person, $100,000 more than one person; 510,000 property <br />di struction- $50,000 and 100 , 00 for lass of means of support. <br />or <br />[3 B surety band from a surety company with minis uin coverage as specified in A. <br />or <br />C. A certificate frorn the Mate Treasurer that the licensee has deposited with the state, trust fu M s having m arket vaIne of <br />$104,000 or 1 00,00 in cash or securities. <br />per r � 1 i are err � kil WIN <br />t nae . app r tat :tit iput �t p Ica <br />rI m <br />t <br />Robert Tro e, Managing Member M1 7A 1 #7019, <br />This is to ce7rtif'y that the applicant and the associates named herein have not been convicted withi n the past five years for any violation of <br />I a vvs of the State 0fMiTIn csota or municipal ordi na nccs relating to i n tox lca tin g liquor except as fol lows: <br />OF <br />Police /Sheriff's Department 'Title Signature <br />PS 91 J-6-(2009) <br />a u nty Attorney's Signature <br />.TAT NOTICE <br />A II retail Iiquor licensees inust register with the Alcohol, Tobacco Tax and Trade bureau. <br />For in- fortuati on call ( 513) 694 -2979 or 1-800-937-8864 <br />