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Renewal Application for Optional Liquor 2AM <br />License Type: 2AM -YR <br />Expires On: December 4, 2007 ID Number: 21942 <br />DBA <br />Karen M. Thao <br />Bangkok Ave <br />2900 Rice St/ #360 <br />Little Canada <br />MN 55113 <br />Business Phone: 6512220595 <br />If any of the above licensee information is not correct please make correCtione as necessary. <br />Licensee must report previous 12 month on sale alcoholic beverage gross receipts by checking one of the boxes below. <br />Next to the box you check is your 2 AM license fee. Make check payable to: Alcohol and Gambling Enforcement <br />Division (AGED). Mail this application and check to : AGED, 444 Cedar St., Suite 133, St. Paul, MN 55101 -5133. <br />$300 2 AM license fee <br />_ $750 2 AM license fee <br />$1000 2 AM license fee <br />$200 2 AM license fee <br />_ $200 2 AM license fee <br />Yes No Does the city <br />- Up to $100,000 in on sale gross receipts for alcoholic beverages. <br />- Over $100,000, but not over $500,000 in on sale gross receipts for alcoholic beverages <br />- Over $500,000 in on sale gross receipts for alcoholic beverages <br />- 32% On Sale Malt Liquor licensees or Set Up license holders <br />- Did not sell alcoholic beverages for a full 12 months prior to this application <br />or county that issues your liquor license allow the sale of alcoholic beverages until 2 AM? <br />City Clerk/County Auditor Signature Date <br />(I certify that the city or county of <br />2AM) <br />approves the sale of alcoholic beverages until <br />Licensee Signature QA/l ( 6-0 <br />(I certify that I have ans ered the above questions truthfully and correctly) <br />Licensee Minnesota Tax ID Number (Required): <br />672i/3 <br />Date <br />Licensee: Prior to submitting this application to the Alcohol & Gambling Enfocement <br />Division you must have this form signed by your local city or county licensing official <br />Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division (AGED) <br />444 Cedar Street, Suite 133, St. Paul, MN 55101 -5133 <br />Telephone 651 - 296 -6979 Fax 651-297-5259 TTY 651-282-6555 <br />www.dps.state.mn.us <br />2amRenewal2004 <br />