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'®R Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement <br />444 Cedar Street, Suite 1.33 <br />St. Paul, MN 55101-5133 <br />651-201-7507 - 7TY 651-282-6555 - Fax 651-297-5259 <br />RENEWAL OF LIQUOR, WINE, CLUB OR 3.2% LICENSES <br />Tit <br />Licensee: Please verify your license information contained below. Make corrections if necessary and sign, City <br />Clerk/County Auditor should submit this signed renewal with completed license and licensee liquor liability for the new license <br />period. City Clerk/County Auditor are also required by M.S. 340A.404 S. 3 to report any license <br />cancellation. <br />License Code License Period Ending .1, 2 /31. F!O fb# 2762 <br />City/County where license approved, [-a k e E 3. 111 o <br />Licensee Name D =i C -r-, a i x En t e r p i s e. s I n c- <br />Trade Name <br />Twin Point "["<-aver,n <br />Licensed Location address <br />-X111,99 Stillwatev Blvd Iq <br />City, State, Zip Code <br />Lake Ellincil MN 55042� <br />Business Phone <br />fidi1 / 7 *7 7 0 2 3 9 <br />LICENSE FEES: Off Sale $ On Sale $ Sunday <br />"Mi lt]g�cmxt certifies that re has he By signing this renewal applica 0, the daTHRAUe in ownership on the aliNe"IfitUd <br />licensee. For changes in ownership, the licensee named above, or for new licensees, full applications should be used. See <br />back of this application for further information needed to complete this renewal. <br />Applicant's signature on this renewal confirms the following: Failure to report any of the following -will result in fines <br />1. Licensee confirms it has no interest whatsoever, directly or indirectly in any other liquor establishments in <br />Minnesota. If so, give details on back of this application. <br />2. Licensee confirms that it has never had a liquor license rejected by any city/township/county in the state of <br />Minnesota. If ever rejected, please give details on the back of this renewal, then sip below. <br />3. Licensee confirms that for the past five years it has not had a liquor license revoked for any liquor law violation <br />(state or local). If a revocation has, occurred, please give details on the back of this renewal, then sip below. <br />4. Licensee confirms that during the past five years it or its employees have not been cited for any civil or criminal <br />liquor law violations. If violations have occurred, please give details on back of this renewal, then sign below. <br />5. Licensee confirms that during the past license year, a summons has not been issued under the Liquor Liability <br />I Law (Dram Shop) MS 340A.802, If yes, attach a copy of the summons, then sign below. <br />6. Licensee confirms that Workers Compensation Insurance is in effect for the full license, period. <br />Licensee has attached a liquor IW' Ity, insurance certificate that corresponds with the license period in city/county <br />where license Is issued. $100 00 i cash or securities or $100,000 surety bond may be submitted in lien of liquor liabil- <br />ity. (3.2% liquor licenses e ex pt if sales are le an on sale, or 0 at off sale). �E= <br />T gob <br />Licensees !0-!tip <br />(Signature certifies r1I above information to be correct and license has been approved by city/county.) <br />City Clerk/County Auditor Signature Date <br />(Signature certifies that renewal of a liquor, wine or club license has been approved by the city/county as stated above.) <br />County Att=4 Signature Datr <br />County Board issued licenses only (Sigisamire certifies licensee is eligible for license), <br />Police/Sheri ff Si pature Date <br />(Signature certifies licensee or associates have not been cited during the past five years for any state/local liquor law violations <br />(criminal/civil). Report violations on back, then sign here. <br />PS 9093-05 <br />