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DocuSign Envelope ID: 00550633-1436-4250-A603-68CEE44A37A2 <br />1lkohol6ll�lhy Ealaaawid <br />License type code_ <br />Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division (AGED) <br />445 Minnesota Street, Suite 1600, St. Paul, MN 55101-5133 <br />Telephone 651-201-7507 Fax 651-297-5259 TTY 651-282-6555 <br />www.dps.mn.us <br />2AM <br />Application for O tional 2 AM Liquor License <br />License Expiration Date (3 D -,-R Od.A- ID# <br />orUffice Use G y <br />Licensee Name: f \M e Y 1 C 0L n_ m u. t- tl-n c1< a, Inc. <br />Trade Name: AMC HOLLnels_ U 1 e to _ <br />Licensed Location Address: o?q 3D tp pw t-1 10 <br />City, State, Zip Code: MO6S UlCLD ) M Q rj511 a, <br />Business Phone: <br />If the above named licensee is a corporation, partnership, or LLC, complete the following for each partner/officer: <br />Partner/Officer Name (First Middle Last) DOB Social Security # Home Address <br />Partner/Officer Name (First Middle Last) DOB Social Security # <br />Partner/Officer Name (First Middle Last) DOB Social Security # <br />Home Address <br />Home Address <br />Licensee must report previous 12 month on sale alcoholic beverage gross receipts by checking one of the boxes <br />below. Next to the box you check is your 2 AM license fee. Make check payable to: Alcohol and <br />Gambling Enforcement Division (AGED). Mail this application and check to: AGED, 445 Minnesota St., <br />Suite 222, St. Paul, MN 55101. <br />$300 2 AM license fee - Up to $100,000 in on sale gross receipts for alcoholic beverages <br />$750 2 AM license fee - Over $100,000, but not over $500,000 in on sale gross receipts for alcoholic beverages <br />$1,000 2 AM license fee - Over $500,000 in on sale gross receipts for alcoholic beverages <br />$200 2 AM license fee - 3.2% On Sale Malt Liquor licensees or Set Up license holders <br />$ 00 M license fee - Did not sell alcoholic beverages for a full 12 months prior to this application <br />Yes No Does your city or county licensing official all w the sale of alcoholic beverages until 2 AM? <br />6�d'%2- 1;2 <br />City r Signature Date <br />(L certify that the city or county of approves the sale of alcoholic beverages until 2 AM) <br />Licensee Minnesota'faa ,AN, #gjt?t-,;;(Required) <br />"W l ,DIn. A hr <br />Licensee Signature ` 678ii$C( <br />(I certify that I have answered the above <br />truthfully and correctly) <br />Date1— <br />Licensee: Prior to submitting this application to the Alcohol and Gambling Enforcement Division, it must be <br />signed by your local city or county licensing official. <br />