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�+�~'h� _ Mi€�ttesa4a De�7arts�ic�t of Public Safaty <br />f .�� LIQUOR CONTROL DIVISION <br />, <br />�L y 4� 444 Cedar St., Suite ]00 L, St. Paul, N�N 55101-2156 <br />_. �a�. (612)297-5259 <br />(6!2)29b-G430 TTY(6E2}282-b555 <br />�,� x�• � <br />.�`� . <br />� <br />:�� �k� . <br />,� , �. <br />..�:_, , <br />CERTIFICATION OF AN ON SALE ANDI4R SUNDAY LIQUOR LICENSE <br />-- �— � �- . . .. _ _.. ._._ _ . . _. ... __.. . <br />No iiccnse rvi�i bc x�prured or relrs�se� until thr S20 Retailer II' Card fee is recci� e� b}' �'� Liquor Cc»itvl <br />Workers Compensation ��.rance: Company � �.�. Policy# �� � I <br />LICENSEE'S SFI.LES & USE TAX ID#_ ' '' To apply for saies taa� nizmber= ca11296-6181 or 1-500-657�-37 ,' ; <br />I ING fk�'F��BATF'�' ']I <br />C�'.�'Y �7i' �� � ��� � .C'� �C!�I':'}' i)J� lC �i'. �Y1 ���� � . + <br />Lzcensee �Iame (C�sp,�t'�k3;5�, �a�l�rsl�ip, Individual) I DOB �'radc Name or ��3A <br />�� I+:' �;t'� ��� �'}'�'�-� -i i L L �- '� � �S' � � r�_1 � � i� �� d �' � <br />Busm�ss f�,c��i; ��� � Ciiy � Zip Cc3de _ <br />{�� � � L�,�•'= ��� �? �i`�+� � �� ������� ._ � � ��� <br />�..� <br />�a�se Type (Check one or both) T�:.��i.�c �'�ir� {'�*�-rh,• <br />��.?� �a'.e ------- �unday ..__. J�147J; � _��'� 'fo � � -�7.� ,�='.��� <br />On Sale �,ic✓e�se Number � On Sale Fce —� ��'�i i} 1•tiL�r�� �y �Irii471� �51fi�i5ti• 17.,a T�n ?,��� :'�i��.,t <br />If a partnership, state the naine and address of each partner; If a <br />Yartner/O�c.�r Name (�'ixsi, middle and Iasi) pDT3 � Title <br />a <br />�' �_� C� ��� ��r,� � � ��-,�'�� y <br />Par[n�r/OCficer Nnme (f'irst, middle and last) <br />DOB � � Title <br />� state the name and add�e4s of each offier. <br />Address <br />Address <br />" .I <br />� � � <br />; <br />Partr�er/(}fficez� Name (First, middle and last) DOf3 � Title Address � <br />f <br />�,�.�.��_ . � .— �—�. � <br />The �.z�usee n�us� have one of SI��U st7 �?,s,� iti��. - <br />(ATTACH CERTIFICATE OF INSURANCE TO THIS FORM.) � <br />Cltaatc m e <br />s�- Liquor Liability Insurance (L�ra�a� Shop) �$50,000 per person; $100,000 naore than one person; $10,000 Property �sttl�ctao <br />$50,004 and $100,000 for loss of ineans of support. <br />or <br />��- A bond of a s��rety company with a�ine.ro.�m coverage as specified above in A <br />or <br />d C. A certificate from the Stale Treasurer that the licensec has dcposite,tl with ihc State, '1'€�s�i Funds having a mar�Cet value of <br />� 100,000 in cash or securities. <br />f] �r��� i� �T� During the past license year bas a sun�mons been issued under the Liquor Civil Liability Law (Dra_ui ��•.��.��� <br />11� ���:, �d?=!I a �.}r}� �F �I:;: _�I�rr.i�or_ . _ . <br />f: h�k rl�,�x ir��r�7s t ���� -- �---�--- — - - — <br />Tr�ir�7:�litim TYOC :1 �CN <br />", F�e4���ke� L"aii�l <br />[:uult unt <br />tirt�s�x[!id:9�[.�r�kt�C`in:.r� <br />From _To <br />���T��:15;� �7J� U+ktiLrxT7i�r �rck:0 �_`��n_a � r��l A,'J��.•ssi . <br />{ <br />�� �i'�- ���=��� i ��� - t �{�°� ��1-€'�_�� �?�• �t•5r"-��tr{�' f����'' �5�+� - - <br />I o3�tify that this license was approved in an of�cza.1. meeting by the ��'-��i;n� �y of e city or county. <br />{�i 4 �'1�1 �'s 5i�ua��rc Date <br />' �� � � - -5Yt- ..- __ ___' _ _ '_ _ __ <br />IMPORTANT NO'T�CE <br />All �taiF liquor licensees must have a current Federal Special Occupational Stamp. This stamp is issued by thc Bureau of <br />Alcohol, Tobacco and Firearms. For infnrmativn call (612)290-3496 1'S 40I 1-94 <br />� <br />_� <br />