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Renewal Application for Optional Liquor 2AM License 3 :-waG.ie-f amem License Type: 2AM-100K-5001 Expires On: May 6, 2016 ID Number: 14397 DBA Saint Ansus Grill hic. Sal's Angus Grill 12010 Keystone Ave N Hugo MN 55082 Business Phone: 6514396625 if any of the above licensee information is not correct, please make corrections as necessary. ensee must report previous 12 month on sale alcoholic beverage gross receipts by checking one of the boxes below. Next he box you check is your 2 AM license fee. Make check payable to: Alcohol and Gambling Enforcement Division .GED). Mail this application and check to: AGED, 445 Minnesota St, Suite 222, St. Paul, MN 55101-5133. _$300 2 AM license fee - Up to $100,000 in on sale gross receipts for alcoholic beverages _$750 2AM license fee - Over $100,000, but not over $500,000 in on sale gross receipts for alcoholic beverages _$1000 2AM license fee - Over $500,000 in on sale gross receipts for alcoholic beverages _$200 2AM license fee - 3.2% On Sale Malt Liquor licensees or Set Up license holders _$200 2AM license fee - Did not sell alcoholic beverages for a full 12 months prior to this application Yes _No Does the city or county that issues your liquor license allow the sale of alcoholic beverages until 2 AM? City Clerk/County Auditor Signature Date (I certify that the city or county of approves the sale of alcoholic beverages until 2AM) Licensee Signature 'I certify that I have answered the above questions truthfully and correctly) icensee Minnesota Tax ID Number Licensee: Prior to submitting this application to the Alcohol & Gambling Enforcement Division you must have this form signed by your local city or county licensing official Minnesota Department of Public Safety Alcohol and Gambling Enforcement Division (AGED) 445 MinnesotaStreet, Suite 222, St. Paul, MN 551015133 Telephone 651-201-7500 Fax 651-2975259 TTY 651-282-6555 dps.mn.gov