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Minnesota Department of Public Safety a <br />s r. +c LIQUOR CONTROL DIVISION <br />Ter ' 444 Cedar St., Suite 100 L, St. Paul, MN 55101 -2156 s` <br />i & f (612)296.6439 TTY(612)282 -6555 <br />«.6 mas <br />RENEWAL OF CONSUMPTION & DISPLAY PERMIT <br />Permit Fee $150 (Renewal Date: April 1) <br />7035 PUBLIC <br />Little Canada Hall Inc. <br />Little Canada Hall <br />433 E Little Canada Rd <br />Little Canada, MN 55117 <br />IF NAME AND ADDRESS <br />SHOWN ARE NOT CORRECT, <br />MAKE CHANGES BELOW <br />°®s <br />Workmens Comp Ins. Co. Policy No. Policy Period <br />City /County where permit approved_ , l/ i C,$, ✓4.c 1@ <br />/�,e, <br />Permit Name: 4 ' t1(ei C, N 4-014- /7 . - li/ .-2;ve . <br />Trade Name: /T..0 F lI •e C4.v4r -1.4 47,917 <br />Location address: Y 33 Ir. L •" %led C't ^' a cr <br />City, State, Zip Code: G-(' /We C4',1/4.1:: GLt ^> S 5-7 t 7 <br />Business Phone / 8" el" —3 C a-'C <br />By signing this renewal application, applicant certifies that there has been no change in ownership, corporate officers,bylaws, <br />membership, partners, home addresses, or telephone numbers. If changes have occurred during the past 12 months, please <br />give details on the hack of this renewal, then sign below. <br />Applicant's signature on this renewal confirms the following: Failure to report any of the following will result in <br />fines. <br />1. Applicant confirms that it has never had a liquor license rejected by any city /township /county in the state of Minnesota. <br />If ever rejected, please give details on the back of this renewal, then sign below. <br />2. Applicant confirms that for the past five years it has not had a liquor license revoked for any liquor law violation (state <br />or local). If a revocation has occurred, please give details on the back of this renewal, then sign below, <br />3. Applicant confirms that during the past five years it or its employees have not been cited for any civil or criminal liquor <br />law violations. If violations have occurred, please give details on back of this renewal, then sign below. <br />4. Applicant confirms that Workers Compensation insurance is in effect for the full license period. <br />5. Applicant confirms, no club on -sale intoxicating liquor license is held. <br />6. Applicant confirms business pre t 's are sepal- e from any other business establishment. <br />. <br />r <br />Applicant Signature t / - Date <br />(Signature certifies all above inf. r anon to he correct and permit has been approved by city /county. <br />CityClerk/County Auditor Signature Date <br />(Signature certifies that a consumption and display permit has been approved by the city /county as stated above). <br />PS09097(8/95) <br />Amount Received <br />Page 72 <br />