CC PACKET 02241987 - Laserfiche WebLink

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� � L If this restaurant is in conjunction with another business(resort,etc.),describe the business. • OTHER INFORMATION 1. Have the applicant or associates been granted an on-sale non-intoxicating malt beverage(3.2)and/or a"set-up"license in conjunction with this wine license?ei(Yes ❑ No 2. Is the applicant or any of the ssociates in this application a member of the county board or the city council which will issue this license? ❑Yes RNo If yes,in what capacity? (If the applicant is the spouse of a member of the governing body,or another family relationship exists,the member shall not vote on this application.) 3. During thep�st license year has a summons been issued under the liquor civil liability law(Dram Shop) (MS. 340A 802). ❑ Yes ❑UGo If yes attach a copy of the summons. { 4. Has the applicant or any of the associates in this application been convicted during the past five years of any violation of federal,state or local liquor laws in this state or any other state? ❑ Yes (6 No If yes,give date and details. 5. Does any person other than the applicants, have any right,title or int n the furniture,fixtures uip ent' licensed premises? CKYes ❑ Flo If yes give names and details. ��v��lA� 6. Have the applicants any interests,directly or indirectly, in any other liquor establishment in Minnesota? ❑ Yes A No If yes, give name and address of the establishment. I CERTIFY THAT I HAVE READ THE ABOVE 1LffZT4G4,3 AND THAT THE ANSWERS ARE TRUE AND CORRECT OF MY OWN KNOWLEDGE. 9 �� Signet a of Applicant Date REPORT BY POLICE OR SHERIFF'S DEPARTMENT This is to certify that the applicant, and the associates, named herein have not been convicted within the past five years for any violation of Laws of the State of Minnesota, Municipal or County. Ordinances relating to Intoxicating Liquor, except as follows Police,Sheriff Department Name Title Signature •