Laserfiche WebLink
S. Are the premises now occupied or to be occupied by <br />establishment? ::;Yes trio <br />9. State whether applicant has or will be granted, an On <br />the sante premises. '';Yes ;1.4 -No a Will be granted <br />10. State whether applicant has or will be granted a Sunday <br />License. :Yes Mo ;.i Will be granted <br />11. If this application is fora County 13owrd Off Sale License, <br />12. State Number ofEmployees --S <br />the applicant entirely separate and exclusive from any <br />sale Liquor License in conjunction with this Off Sale <br />On Sale Liquor License in conjunction with the regular <br />state the distance in utiles to the nearest municipality <br />a public hearing been held as per MN Statute 340A.405 <br />it located in an organized township? If so, attach township <br />otter ousmess <br />Liquor license and for <br />On Sale Liquor <br />sub2(d)? <br />13. If this license is being issued by a County Board, has <br />H. If this license is being issued by a County Board, is <br />approval. <br />State whether applicant or any of the associates in this <br />municipality or state authority; if so, give dates and <br />application, have ever had an application for a liquor license rejected by any <br />details, Li <br />2. Has the applicant or any of the associates in this application, during the five years immediately preceding this application ever had a <br />license under the Minnesota Liquor Control Act revoked for any violation of such laws or local ordinances; if so, give dates and <br />details. 0 0 <br />3. Has applicant, partners, officers, or employees ever had any liquor law violations or felony convictions in Minnesota or <br />elsewhere, including State Liquor Control penalties? f:; Yes N&No If yes, give dates, charges and final outcome, <br />4, During the past license year, has a summons been issued under the Liquor Civil Liability Law (Dram Shop) M.S. 340A.802. <br />;_? Yes /214o If yes, attach a copy of the summons. <br />This licensee must have one of the following: (ATTACH CERTIFICATE OF INSURANCE To THIS FORM.) <br />Check 011c <br />A. Liquor Liability Insurance (Dram Shop) - $50,000 per person, $100,000 more than one person; $10,000 property <br />destruction; 850,000 and $100.000 for loss of means of support. <br />er <br />... B. A sooty bond from a surety company with minimum coverage as specified in A. <br />or <br />C. A certificate from the State Treasurer that the licensee has deposited with the state, trust funds having market value of <br />$100,000 or $100,000 in cash or securities. <br />1 cet Ws that I have read the above questions and that the Ans'tehe* re true and correct of my own knowledge. <br />Dale <br />/ - /l'./-4� <br />1 rin name ofapplicant&fide <br />.. <br />Signalui'epf piicant <br />,41.---1 -...'/fir \ <br />REPORT 13Y foucEf5IiOWE'S DEPARTMENT <br />This is to certify that the applicant and the associates named herein ha\ e not been convicted within the past five years for any violation of <br />laws of the State ol'Minnesota or municipal ordinances relating to intoxicating liquor except as follows: <br />Police/SheriffsDepariment Title Signature <br />PS 9136•(2006) <br />County Attorney's Signature <br />IMPORTANT NOTICE <br />All retail liquor licensees must have 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 />3 <br />