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/ Renewal Application for Optional Liquor 2AM License <br />t <br />Alcohol & Gambling Enforcement License Type: 2AM-100K-5001 Expires On: May 6, 2018 ID Number: 14397 <br />DBA <br />Saint Anaus Grill Inc. <br />Sal's Angus Grill <br />12010 Keystone Ave N <br />Hugo <br />MN 55082 <br />Business Phone: 6514396625 <br />If any of the above iicensec information is not correct, please make corrections as necessary. <br />Licensee must report previous 12 month on sale alcoholic beverage gross receipts by checking one of the boxes below. Next <br />to the box you check is your 2 AM license fee. Make check payable to: Alcohol and Gambling Enforcement Division <br />(AGED). Mail this application and check to: AGED, 445 Minnesota St., Suite 222, 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 />$1000 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 the city or county that issues your liquor license allow the sale of alcoholic beverages until AM? <br />City Clerk/County Auditor Signature <br />Date <br />(I certify that the city or county of _ approves the sale of alcoholic beverages until 2AM) <br />Licensee Signature _ <br />(I certify that I hav e above questions truthfully and correctly) <br />Licensee Minnesota Tax ID Number (Required): j JOS06o '�—1 <br />Date 3-141-10 <br />Licensee: Prior to submitting this application to the Alcohol & Gambling Enforcement Division you must have this form <br />signed by your local city or county licensing official <br />Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division (AGED) <br />445 MinnesotaStreet, Suite 222, St. Paul, MN 55101-5133 <br />Telephone 651-201-7500 Fax 651-297-5259 TTY 651-282-6555 <br />dps.mn.gov <br />