Agenda Packets - 2021/03/08 - Laserfiche WebLink

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Mounds View Liquor License Application Page 2 Is the maximum occuipmricy for ❑ You have or will apply for a Tobacco license for the premises to be licensed ElYou have or will apply for an Amusement Device license for the premises � be licensed ❑ You have or will apply for a Restaurant license for the premises to be I' [� Proof of insurance is attached This Is a new or transfer ucanes and the required floor plan is attached lava you ever had a license revoked? No if tes, p :;� and nrny assoaeltes in this aPPvn will strictly oornptf► with all the lams ofrnnesota governing taxation and as sale of alcohol; rules and regulations p by the Alcohol and Entraemerd Division the DWarb it of 'ub is Safety, and all ordinances of the municipality; and I hereby certify that I h need #ft application in its entirety and %rat th a Arkni NP m mn%AAMA s *� Signalure of Applicant: / � --A - Date: 0/ /28/2021 The data on this form will be used to approve your license. Some requested data is prtwte. P data is available to you and the City or State staff who need this information to perform their duties, but 4 not availgle to the public. You are being asked to answer questions and provide information PUrsuant to the application that Is required by Minnesota State Statute and the CJty of Mounds view. The Information you provide is government data in accordance with Chapter 13 of State law known as the "Minnesota Government Data Practices W. You are not required by law or ordinance to answer questions provide the inforrnaflon requested. A refusal to answer questions or provide information being requested will prevent the City of Mounds View m prooming the application for which you are appNing. The Information you provide may be claas1W as `public". "private' or'cortfldeftar pursuant the `Government Data Practices Act'. Access to this information can be obtalned by persons who are deemed eligible pursuant to the "act'. access can Include the subject(s) of the license applcation, anyone they give their informed consent to consistent with Minnesota State law, or wurt order. 1 understand that a criminal conviction will not bar me from obtaining a license unless the can the license is sought and there Is no showing of sd kient rehabilitation and present fitness to 3'fodrte 365.Q3). 1 understand that t Mficatlon of the application, including failure to reveal a the license. The information I have provided on this application is truthful. t authorize the CIty of Mounds personsiorganlmtlons named on this application. My signature constiWtes agreement of the Applicant's slpndune • Tax Clearance • Worker's Comp Law • Criminal Background Release Form • state Buyers Card (Liquor Sloss and Bars Off Liquor Only -- New Only, State Sends Renewal Dw9cily) • Applicable State (A&©E) Liquor License Application is directly related to the occupation for which n the duties of the occupation (A+unnesow I conviction, constitutes grounds for denial of to investigate the information and contact scan warning and application. PpIke GhW: ❑ Approved ❑ Denied Other (New or Renewal) ❑ Bade Ground Check ❑ Public Hea ft conducted (including malling & p> tlOn) ❑ Fire Inspection Completed