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AleeFal s Gaadun, Ex!veeO <br />Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division (AGED) <br />444 Cedar Street, Suite 133, St. Paul, MN 55101-5133 <br />Telephone 651-201-7507 Fax 651-297-5259 TTY 651-282-6555 <br />www.dps.state.mn.us <br />Application for Optional 2 AM Liquor License <br />License type code: 2AM License Expiration Date ID# <br />_TFor ice Use Only) <br />Licensee Name: <br />Trade Name: <br />Licensed Locati< <br />City, State, Zip ( <br />Business Phone: <br />G.5 <br />If the above named licensee is a corporation, partnership, or LLC, complete the following for each partner/officer: <br />phcd Al 1pin WriAni l' (0/30i -v G711 t6r-gt_e1-16,2c/r t//p�/ (17 lz�-<v'i/e <br />Partner/Officer Name (Fir�t Middle Last) <br />Social Security # <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 />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, 444 Cedar St., Suite <br />133, St. Paul, MN 55101-5133. <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 />J9 $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 />❑ $200 2 AM 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 allow the sale of alcoholic beverages until 2 AM? <br />City Clerk/County Auditor <br />1 nSignature Date <br />(I certify that the city or county of V 6hi ��ap""pro/ve's the sale of alcoholic beverages until 2 AM) <br />Licensee Minnesota Tax I her (Requir ) O O l(� 7 1 <br />Licensee Signa Date <br />(I certify that I have==M) <br />e a ove questions ally and correctly) <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 />(2AM-5/06) <br />