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5. Is/are appl's t(s), a member of the governing body of the municipality in which this license is to be issued? <br />Yes JJ1No If Yes, in what capacity? <br />6. Have applicants interest whatsoever, directly or indirectly, in any other liquor establishment in t e state of <br />?�0 L' uW6L'-C?A Hroc�E <br />Minnesota. es No If yes, give name and address of establishment. <br />5' <br />7. Are the premises now occupiSOur to be occupied by the applicant entirely separate and exclusive from any other <br />business establishment? F7,Kes rJo <br />8. State whether applicant has or will be granted, an On Sale iquor License in conjunction with this Off Sale <br />Liquor License and for the same premises. D'es Mll be granted <br />g. State whether applicant has or will be gr nted a Sunday On Sale Liquor License in conjunction with the regular <br />On Sale Liquor License. ❑'es be granted <br />10. If this application is for a County Board Off Sale License, state the distance in miles to the nearest municipality. <br />i l . If this license is being issued by a County Board, has a public hearing been held as per MN Statute 340A.405 <br />sub2(d)? <br />12. If this license is being issued by a County Board, is it located in an organized township? <br />If so, attach township approval. <br />Violations <br />1. Has applicants) had a liquor license revoked in the last 5 years; Ayes E36 1f so, give dates and details. <br />2. Has applicant, partners, officers, or employees ever had any liquor law violations or felony convictions in <br />Minnesota or elsewhere? Qes <br />If yes, give dates, charges and fsnal outcome <br />3. During the past license y , has a summons been issued under the Liquor Civil Liability Law (Dram Shop) M.S. <br />340A.802. Dyes CD6 If yes, attach a copy of the summons. <br />REPORT BY POLICEISHERIFF'S DEPARTMENT <br />This is to certify that the applicant and the associates named herein have not been convicted within the past five years for any felonies or <br />municipal ordinances relating to intoxicating liquor except as follows: <br />Approved. <br />Ben Zender Police Chief <br />Po11celUXpX( Department Title Signature <br />NVIe Zikmund X <br />06QJa(Signaturc of City Administrator <br />