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8. Are the premises now occu ied orto be occupied by the applicant entirely separate and exclusi�e from any other business <br />establishment? �Y�s �No <br />9. State whether applicant has or will be granted, an On safe Liquor License in conjunction with this Off Sale Liquor License and for the <br />same premises. �3Yes {} f�o (�Will be Granted <br />10. State whether applicant has or will be granted a Sunday On Sale Liquor License in conjunction with the regular On 5ale Liquor License. <br />[� Yes (,� Na (� Will be Granted <br />11. Iftfiis application is for a County Board OfFSale License, state the distance in miles to the nearest municipality. <br />12. 5tate Nur�rtber of Emp[oyees <br />13. Ifthis license is being issued by a County Board, has a public hearing been held as per MN Statute 340A.�405 sub2(d)? <br />14. Ifthis license is being issued by a County Baard, is it located in an organized township? If so, attach township approval. � <br />1. State whether applicant or any of the associates in this application, ha�e e�er had an application for a liquor iicense rejected by any <br />municipality or state authority; if so, gi�e dates and details. <br />2. Has the applicant or any of the associates in this application, during the five years immediatefy preceding this application ever had a <br />license under the Minnesota Liquor Control Act re�oked far any violation of such laws ar Iocal ordinances; if so, gi�e dates and details. <br />3. Has applicant, partners, ofFicers, or employees ever had any liquor law �iolations ar felony convictions in Minnesata or elsewhere, <br />including State Liquor penalties? �Yes [� No If yes, give dates, charges and final autcome. <br />4. During the past license year, has a summons been iss�ed underthe Liquor Civil Liability l.aw (Dram 5hop) M.S. �40A.802. <br />[} Yes �j No If yes, attach a copy af the summons. <br />This licensee must �a�e one of the following: (ATTACH CERTIFICATE QF INSURANCE TO THIS FORM.} <br />Checkone <br />Liquor l.iability Insurance (Dram Shop) -$50,004 per person, $100,000 more than one person; $10,000 property destruction; $50,000 <br />� and $100,000 for loss of inean5 of support. <br />�A surety bond from a surety company with miniurt� coverage as specified in A. <br />A certificate from the 5tate Treasurer that the licensee has deposited with the state, trust funds having market �alue of $1 QO,ODO ar <br />� $1d0,000 in cash or 5eturities. <br />I certify that I harre reacf the above questions and that the answers ar�ue,�nd c,prrkr�of my own knowledge. <br />Print name <br />James Gilbertson CFO/SEC <br />re <br />REPOitT BY POLICE1SFi�RIFF'S <br />�� <br />This is to certify that the applicant and the associates named herein ave not been convicted within the past f�e years for any �ialatian <br />af laws of the State of Minnesota or municipal ordinances relating t intoxlcating liquor ex�ept as follows: <br />Caunty Attorney's 5ignature <br />IMPQRTANT NOTICE <br />All retail liquor licensees must ha�e a current Federal Special Occupational Stamp. This stamp is issued by the Bureau of Alcohol, Tobacco, <br />and Firearms. For information call (651 } 726-0220 <br />