06/12/1995 Council Packet - Laserfiche WebLink

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LIQUOR CONTROL DIVISION 444 CEDAR ST -SUITE 100 L Safety ST. PAIL PIN 55101-2156 ION 4N 55101 (612)296-6430 TTY(612)282-6555 RENEWAL OF LIQUOR, WINE, OR CLUB LICENSE No license wilt be approved or released mttil the $20 Retailer ID Card fee is received by MN Liquor 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 CMB S License Period Ending City/County where license approved Lino Lakes Licensee Name Nathe Brothers Inc. Trade Name 49 Club Licensed Location address 6 0 07 Hodgson Rd 06/30/95 ID# 2814 City, State, Zip Code Lino Lakes, MN 55014 Business Phone ( 6 1 2) 4 8 4— 9 9 8 5 LICENSE FEES: Off Sale $ 1 0 0. 0 0 On Sale $ 3, 000 . 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 the following will result in 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 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. $100,000 in cash or securities or $100,000 surety bond may be submitted in lieu of liquor liability. 71 / Licensee Signature / Lr Date S / / (Signature certifies all above information to be correct and license has been approved by city/county. / City Clerk/County Auditor Sienature (217 e -4 L— Date /5 9S (Signature certifies that an on -sale intoxi ting li uor license has been approved by the city/county as ted ove). County Attorney Signature Date County Board issued licenses only i u es licensee is eligible for license) Police/Shea Signature Date ( I0-/ (q)(Signature certifies licenseej/1IflL-__. sociates ave 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