06/10/1996 Council Packet - Laserfiche WebLink

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LIQUOR CONTROL DIVISION 444 CEDAR ST -SUITE 100 L ST. PAWL M( 55101-2156 Safety ION 1N 55101 (612)296-6430 TTY(612)282-6555 RENEWAL OF LIQUOR, WINE, OR CLUB LICENSE e.not be approved er retetaed ................ ltd Card t* s C�o JJicensee: Please verify your license information contained below. Make corrections if necessary and sign. City Cleric/County Auditor should submit this signed renewal with completed license and licensee liquor liability for the new license period. City Clerk/County Auditor are also required by M.S. 340A.404 S. 3 to report any license cancellation. License Code CM B S License Period Ending 06/30/9 6 City/County where license approved Lino Lakes Licensee Name Nathe Brothers Inc. 2814 Trade Name ' 4 9 Club Licensed Location address 6007 Hodgson R d City, State, Zip Code Lino Lakes, MN 5 5 014 Business Phone ( 612) 4 8 4— 9 9 8 5 LICENSE FEES: Off Sale $ 10 0.0 0 On Sale $ 3 , 0 0 0 .0 0 Sunday $ 2 0 0.0 0 By signing this renewal application, applicant certifies that there has been no change in ownership, corporate officers, partners, home addresses, or telephone numbers. If changes have occurred during the past 12 months, please give details on the back of this renewal, then sign below. Applicant's signature on this renewal confirms the following: Failure to report any of thefolowlngwiilresult is fines. 1. Licensee confirms that it has never had a liquor license rejected by any city/township/county in the state of Minnesota. If ever rejected, please give details on the back of this renewal, then sign below. 2. Licensee confirms that for the past five years it has not hada liquor license revoked for any liquor law violation (state or local). If a revocation has occurind, please give details on the back of this renewal, then sign below. 3. Licensee confirms that during the past five years it or its employees have not been cited for any civil or criminal liquor law violations. If violations have occurred, please give details on back of this renewal, then sign below. 4. Licensee confirms that during the past license year, a summons has not been issued under the Liquor Liability Law (Dram Shop) MS 340A.802. If yes, attach a copy of the summons, then sign below. 5. Licensee confirms that Workers Compensation insurance is in effect for the full license period. Licensee has attached a liquor liability insurance certificate that corresponds with the license period in city/county where license is issued $100,000 in cash or securities or $100,000 surety bond may be submitted in lieu of liquor liability. City Clerk/County Aq for Signa (Signature certifies that an on -sale into Coun>ay Attorney Signature (moi 11c-r"..PL Date — -q4 liquor license has been approved by the city/county as stated above). Date County Board issued licenses only (Signature certifies licensee is eligible for license) Police/Sheriff Signature Date (Signature certifies licensee or associates have not been cited during the past five years for any state/local liquor law violations (criminal/civil). Report violations on back, then sign here. PS 9093-94