06/10/1996 Council Packet - Laserfiche WebLink

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LIQUOR CONTROL DIVISION 444 CEDAR ST -SU 1 TE 100 L Safety ST. PAUL r11 55101-2156 ION IN 55101 (612)296-6430 TTY(612)282-6555 RENEWAL OF LIQUOR, WINE, OR CLUB LICENSE Na license lie approred or relesse�l u t e $20 Retalier ID; Card lee is received by MN'Lign Control Licensee: Please verify your license information contained below. Make corrections if necessary and sign. City Clerk/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 C M B S License Period Ending 06/30 /96 City/County where license approved Lino Lakes Licensee Name J i m & A n n Mi 1 ler ' s 1 n c. Trade Name Miller ' s on Main ID# 4715 Licensed Location address 8001 Lake Dr City, State, Zip Code Lino L ak e s, MN 55014 Business Phone ( 612) 786-7106 LICENSE FEES: Off Sale $ 100.00 On Sale $ 3,000.00 Sunday $ 200.00 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 the following will result in fes. 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 had a liquor license revoked for any liquor law violation (state or local). If a revocation has occurred, 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 S100,000 in cash or securities or $100,000 surety bond may be submitted in lieu of liquor liability. Licensee Signature (Signature certifies ‘AL. Date �7G`,.L ormation to be correct and license has been approved by city/county. 689 City .Clerk/County Auditor Signature / U f'71 ' Vi' t/ 1 ate (Signature certifies that an on -sale intoxica liqu r license has been approved by the city/county as sta ed above). County Attorney Sienature 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