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r- <br />i <br />» •• <br />, t <br />•1' <br />i • <br />Mionetou Depantaeat of pHbUc Safety <br />AkoM and GmMii* EirtwcMmt <br />444 Cedar Stteet. Suite 133 <br />SlPiu1.MN35101-SI33 <br />651-296-W79 •TTY 651-282^55 • Fax 651-297-5259 <br />SM, <br />RENEWAL OF LIQUOR, WINE, CLUB OR 3.2% LICENSES <br />No UCCOM wilt be ^proved or relcMed umil the $20 Retailer U) CMd fce it fcoeived by MN Liquor Courol • (3-2H Lkcaics exempt) <br />Please verify your license infbtmatioa contained below. Make conections if necessaiy and sign. City <br />Cletk/Couiuy Auditor should submit this sifaMl renewal with completed license and licensee Ikpior UabiliQr for the new license <br />period. CMy Clcrk/Coanly Auditor arc abo required by M^. 340A.404 S. 3 to report any Ikciue <br />License Code_3.20FSL <br />Ciiy/Coumy where license approved. Or on o <br />License Period Ending ^ ^ /£00& ID# IB.^95 <br />Moyageur Service Centers, IncLicensee Name <br />TradeName O’Sullivan’s Holiday <br />Licensed Location address <br />£4£0 Shadywood Rd <br />City, State. Zip Code <br />Orono, MM 5539£ <br />Business Phone <br />952-471-0955 ’ . <br />y .irBSWB UEES- Off Sate % OnSaleS Sundays <br />By slBiIng tMs rcaewal applicM&Lawpllcant ccrtllcs that there has bm M^tenge U owumUp ou^a&vc named <br />llcetMae. For chaages In owtMrsMp, the Bcenace tuuMd above, or Ibr new Uccnsccs, full appBcatitm should be used. See <br />hock aflhto application fsr Ihrthcr Informatloo needed to complete this renewal <br />*1 <br />% • <br />—Ir—Ur—thgioilowlaatFnthiramrgpoctamrofthctoBowtaewlllresnltlniiDea. <br />1. Lieensee confirms it has no interest whatsoever, directly or indirectly in any other liquor establishments in <br />Minnesota. If so, give details on ba^ of this application. <br />2. Licensee confirms that it has never had a liquor Ucense rejected by any city/toumshqVcounty in the state of <br />Minnesou. If ever rejei^, please give details on the back 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. I riff nsfr confirms that during the past five years it or its employees 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 past license year, a summons has not been issued under the Liquor Liability <br />Law (Dram Sh^) MS 340A.802. If yes, attach a copy of the summons, then sign below. <br />6. Licensee confirms that Wotken Compensation insurance is in etfect for the full license period. <br />Lieensee has attached a Hqnor IfoMlHy Inanraiice certilcaic that corresponds with the Uccnac period in cUy/county <br />where llcmBelslMned.mMi>fo<»*«^-«M**“” >*<>*■**>■*<*** *"***“*^**<***^****’^tty. (3J% liquor Mcensea art ep^upt if aulas arc has than $25,000 at on sale, or $50,000 at off sak). <br />yBgBMs.^igaaiiiit.Pile // <br />(SignMure ceniftes all above ^formation to be correct and license has been approved by city/coumy .) <br />rin> nerir/Tounty Aiiditnr Signature !>•» <br />(Signature certifies that renewal of a liquor, wine or club license hu been approved by the city/boumy as stated above.) <br />^0mjiy_2dltlCBBX.2igSltlUB.__________ Date <br />County Board issued licenses only (Sigyl^ certifies <br />VJMi;(ifFSitMniit <br />eligible for license). <br />Jltt.// <br />[^iauor tiw V(Signature certifies licensee or1istociatarh|d^ been cited during the past five years for any state/locaniquor law violations <br />(criminal/civii). Report violations on back, men sign here. <br />PS y093*9o