Laserfiche WebLink
[�f Yes ❑ No Dai;s any person otherthan #he appiican�ts. have arry righ� title ar irrterest ir� the fumiture fixtur�es ar equipmecyt In the <br />iicensed prem+ses7 if yes, ginre names and details, <br />❑ Yes � No Ha�e the a}�plicar�ts any ir�#erests, directly ar indiredly, in any ot�her liquor establi�hme�'s irr Minnesata7 If yes. 9ive <br />nanne and mddress of establishmer�t. <br />I CERTEFY 7HAT 1 HAVE R�AD 7'F{E ABOVE QU�STI�NS AfVD THAt i'HE AN5VY�RS AR� TRUE ANR CORt�ECT ip TFlE gEgT pF MY <br />KNOWL�DG@. <br />��.�, <br />Signature of�App tail nt `�"'—" <br />?he lice�tsee must have one �f the folfawing: <br />Da ���% �`�1 <br />�, Liquar !"�abitiry insur�nce EDram Shop1$SO,Ut3t? per�ersan; $ t IX3.OpU more than one p�rson; � 1 Q.QDO PrapertY' destnuction; <br />$50.000 ar�d S'� 00,000 €or ioss of ineans of suppart. Attach "CER'ilF�CATE OF INSURANCE" to this fc�rm. <br />i A surety bond from a su�ty corrtp�ny with minitnum r,.average as spetified �bave in. <br />�., A certifirate frorri �he s�#ate treasurer that tfie licensee has de�asited wil� the srate. trusfi funds i�aving a market value ai $100,W0 or <br />$ a Qi?.00Q in cash ar securities. <br />Yes j� Mo i cercify tiiat ta the besc oPF my <br />are �ig�t�re to be Ikensed, tf no, state reasan. <br />5ignarure �ovaty At�.omey County Date <br />to <br />_ , ,_ . ------ ---_ _.._ __�,.,..,.�"., .,�,,.�..� � �����, � have not r�n convscn� wirn�n tne pas# flve y�ars <br />af lavvs of the Stat� of tt�t�nnesdta, Municipat or Caunty ordinances r�lating to i rrto�ci�a#ing liquar, except as fo�laws: <br />Signaxure <br />De{�atttttent and Title Date <br />IMP4RTANT' N�T[CE <br />ALL RETAtL LIQUOft UCfiV$EES MUST REGIS'CER WiTF� 7NE ALCOhf�L, TCiBACCO TAX ANi� i'�iADE BUREAU. <br />FQRINFORMATI�P1 CALLS13-68429790R 1-$OQ-937-88fi�{ <br />A 530� servtr� charge wtil be �ddEd ta atl dishonared checks Yau Ktray alsa qe subjected r.o � cfvil penalty of <br />9104.W ar 140 96 of tFfe v81ue af the checic, tni#�idsever is greater, pfus i�terest and ai;qmep fees. <br />Page 2 Gf 2 <br />