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r, <br />I <br />,**% <br />• • . <br />i-. <br />i <br />>0 ^ <br />y: <br />V% <br />f <' <br />'J <br />Mimetoa Dcputmem of Public Safety <br />444 Cbdar Street, Suite 133 <br />St Paul. MN S3 101-SI33 <br />651-296-6979 •TTY 6S1-282-6555 • Fax 651-297-5259 <br />RENEWAL OF LIQUOR, WINE, CLUB OR 3.2% LICENSES <br />No lioeMe will be approved or ttkned until the S20 Retailer U) Cud fee ii received by MN Liqw Cooirol • (3^ Liceoics eunpt) <br />LicMMee: Pleaie verify your liceme information cotuamed below. Make corrections if necessary and sign. City <br />Cleik/Couniy Auditor should submit diis signed renewal with compieied liceoae and itcensee liquor liability for the new license <br />period. Chy Ckilt/Couniy Auditor are also required hy M.S. 340Av404 S. 3 to report any hcensc <br />License Code.MCLONSS <br />City/Coumy whete license approved. <br />Licensee Name Uayzata Country Club Inc. <br />TradeName Wayzata Country ^ — <br />Licensed Location address / <br />£0121 Wayzat4 Blvd/ieii 164- <br />City. State. Zip Code <br />License Period Ending l£/31/£00fe^_______^ <br />.iV^ <br />Business Phone <br />UCENSEfEBS: Off Sales <br />MN 55391 <br />952/473-8846 <br />On Sale $ Sunday $ <br />0.00 £00.00 £00.00 <br />By aifulag this rancwnl appNcntloii, appUcaut certMcs that there has been no change in ownership on the above named <br />UeeasN. For chaafH In ownership, the Ucenicc named above, or for new licensees, Bill applications should be need. Sec <br />back ef this appUaUion for further iofonnation needed to complete this reoewaL <br />Anpltcanl’a slgnatnre aw tfcla reaewal cenai nts Ae ieli»Trlnt; to repor t anv of the fOMawing will reanlt In ines <br />1. Licensee confirms it has no interest whatsoever, directly or indirectly in any other liquor establishments in <br />Minnesota. If so, give details on back of this appUcation. <br />2. Licensee confirms that it has never had a liquor license rejected by any city/township/county in the state of - <br />Minnesota. If ever rejected, please give details on the back of this renewal, then sign below. <br />3. Licensee confirms that fbr the put five years it hu not bad a liquor license revoked for any liquor law violation <br />(sute or local). If a revocation hu occurred, please give details on the back of this tenew^ thra sign bdow. <br />4. Licensee confirms that during the put five years it or its enqdoyeu have not been cited for any civil or criminal <br />liquor law violations. If violations have occurred, please give details on back of this renewal, then sign below. <br />5. Licensee confirms that during the put license year, a summons hu not been iuued under the Liquor Liability <br />Law (Dram Shop) MS 340A.802. If yu, attach a copy of the summons, then sign belcw. <br />6. Licensee confirms that Workers Compensation insurance is in effect for die Bill license period. <br />LKenaec hu attached a Hqnor HebUlty tnanrasice certificate that correspoods with the license period in city/county <br />where license is iisned. $lfO,MO In cast- or aeasrltiu nr SltMOO surety bond may be anbniilted in lieu of hqnor Mckil <br />hy. (33% Mqnor licenms met exempt if sales a« leu than $2S4W) at on sale, or SW/WO at off suL-). <br />I .Sign Dale <br />(Signature certifiu all above information to be conect and license hu been approved by city/county.) <br />_______________ ____ D rIC <br />(Signatuiv certiAu that renewal of a liquor, wine or dub license hu been approved by the city/county u stared above.) <br />CqqBty Awnmey Sigaatute Datg <br />Couuty Board issued licenses only (Signature certifies I <br />Bnliea/Stieritr Siynattne_______ <br />is eiigible for license). ^ y <br />^ ________ n.. ///fz/oT <br />(Signature certifiu licensee or SSsociatufiavomt been cued during the put livr years for any state/local liquor law violations <br />(criinioai/civii). Repon violations on back, dm sign here <br />PS 9093-98 <br />• • <br />•• •• • <br />, f <br />• < <br />. !