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< ' <br /><- <br />MinaHOtt Dcfiutment of Public Safety <br />Akohel aad GaabKof Eofortenciit <br />444 Cedar Street. Suite 133 <br />ScPaul.MN3S101-S133 <br />65l-296-«979 •TTY 651-2K-6555 • Fax 651-297-5259 <br />RENEWAL OF LIQUOR, WINE, CLUB OR 3.2% LICENSES <br />Ne HeaaeewiU be mirewd Of lelmed uadi the S20 Retailer ID Card fee H received by MN Liquor Cootwi* (3.2HLiwBieieiMnip>) <br />_____[: Pleaie verify your Ucenie tnfonnation contained below. Make corrections if necessaty and sign CiO’ <br />Cletk/County Auditor should submit this signed renewal with ooinpleied license and licensee Ikpior liability for the new license <br />period. CUy CIcrk/Couiity Auditor are also required by MS. 340A.404 S. 3 to report any license <br />License Code 3.2DNSS <br />City/Couoty where license approved. <br />LicettseeName Wankstern, Grant Russell <br />License Period Ending 12/31/200^^onmo <br />18396 <br />Trade Name Lakeview Golf of Orono <br />Licensed Location address <br />City. State, Zip Code <br />Businen Phone <br />405 North firm Drive <br />Orono, MN 55364 <br />952-472-3459 <br />LICENSE PEES: Off Sale S On Sate $ Sunday $ <br />0.00 0.00 .0.00 <br />By aigatag tMs rsaewal appUcatloB, applicant certillcs that there has been no change in ownership on the above anmed <br />ikeasee. For ebaages la ownership, the Hcenaec named above, or for new Uccnsecs, Bill appUcaiions shonld be used. See <br />bach of this ^tpBimtiin for Ihrther lafarmation needed to complete this reaewaL <br />Aiinllcaat*sslinatareoB «fcteruwe—Icowgrmsthel laaiFatlare to report any of the fbUewtagtHBreealitn fines. <br />1. Licensee confirms it hu no interest whatsoever, directly or indiiecthr in any other liquor estabUshmeots in <br />Minnesota. If so, give details on back of this applicatioa <br />2. Licensee confirms that it has never had a liquor license reiected by any city/township/county in the state of <br />Minnesota. If ever rejected, i^ease give details on the bock of this renewal, then sign below. <br />3. Licensee confirms that fOr the past five years it has not had a liquor license revoked for any liquor law violation <br />(state or local). If a revocation has occurred, please give details on the back of this renewal, then sign below. <br />4. Licensee confirms that during the past five years it or its employees have not been cited for any civil or ciunimil <br />liquor law violations. If violations have occined. please give deuils on back of this renewal, then sign below, <br />5. Licensee confirms that during the past license year, a summons has not been issued under the Liquor Liability <br />Law (Dram Shop) MS 340A.802. If yes, attach a copy of the summons, then sign below. <br />6. Licensee confirms that Worken Compensation insurance it in effect for the full license peri<KL <br />Lkcnscc hat attached a Hqiior Habttty insarance ccrtificaie that corretpoods with the Ikcate period In dty/coanty <br />where IIwee It baaed. tlOO,MO la cash or sccartlles or glOMOO surety bond may be sobmitted iu lieu of liqr^r <br />Ity. (3J% Mqaor lirru|pi are exempt if talas ari jpw Iton on sale, or S5i).0Q() at off sale). <br />Dttt ^/ *** "■ •Liceniee .Signaruiq <br />(Signature certifies all above information to be correct and license has been approved by city/couaty.) <br />Qiy SigiiRtiire PRtg <br />(Signature certifies that renewal of a liquor, wine or club license has been approved by the city/coumy as stated above.; <br />CinUPiy Sigiwiuig Date <br />County Board issued licenses only (Si <br />•iffSifnamre <br />it eligible for license). <br />Jite // <br />/ <br />fSignature cettifiet licensee oTuMciatealuinmot been cited during the past five yevs for any state/local liquor law vioisricns <br />(crtminal/civil). Report violations on back, men sign here. <br />PS 9093-9* <br />’ 4 .