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Minncvou Deptnineni of PuMk Safety <br />Alrolial and Gambling Enbrcrmcnl <br />444 Cedar StRti. Suite I3J <br />=*- St. Paul. MN 35101-5133 <br />63I-296-M79 • TTY 63l-:82-6335 • Fm 63I-297-3M9 <br />RENEWAL OF LIQUOR, WINE. OR CLUB LICENSE <br />No bcente »ill be approted or releaied uaii) die S20 Retailer ID Card fee it receitcd by MN Lii)uor ConOul <br />x: Please verify your license information contained below. MaVe corrections if necessary and sign. City <br />Clerfc/County Auditor should subnut this signed rettewal with completed license and licensee liquor liability for the new <br />license penod. City Clerk/County Auditor arc also required by M5. MO A .404 S. i to report any license <br />caoccUallon. <br />License Code HCLONSS License Period Ending 12/31/2001 |D# SBSl <br />City/Couniy where license appiosed. (iflRAAA's name is changed, do not use this form. Contact this office.) <br />Spring Hill Golf Club Inc. <br />Spring Hill Golf Club <br />Licensee Name <br />Trade Name <br />Licensed Location address 725 6th Ava N <br />City. State. Zip Code Orono, MN 55391 <br />Business Phone <612) 473-1500 <br />I irrxsF FEES Off Sale $On Sales 100.00 Sunday S 200.00 <br />By iigning this renewal application, applicant cciiines that there has been no change in ownership on the above <br />named licensee. For changes In ownership, the licensee named above, or for new licensees, full applications should <br />be used. See back of this appllcallon for further informatioa needed to complete thb renewoL <br />;. ' .censee confirms it has no interest whatsoever, directly or indirectly in any other liquor establishments in <br />Minitevou. If so. g>ve details on back of ihit application. <br />2. Licensee confinm that it has never had a liquor license rejected by any city/low nship/county in the stale of <br />Minnesota. If ever reiecied, 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!. Il a revocation has occutted. please give details on die tvick of Uiis iciicwal. then sign below. <br />4. Licensee confirms that dunng the past five years it or ns emptoveev have not been cited for any civil or cnmuial <br />liquor law violations. If violaiions have occunesL please give details on back of this renewal, then sign below. <br />5. Licensee confirms that dunng the past license year, a summons has not been issued uivder the Liquor LtabiUly <br />Law (Dram Shop) MS 340A.802 If yes. auach a copy of the summons, then sign below. <br />6. Licensee confirms (hat Workers Compentaiion insurance is in effect for the full license period. <br />Llceiur* has allachcd a liquor llabllily Insurance ceiiificate that corresponds with the license pcrhid in city/counly <br />where license b Issued. $1004)00 In cash or securities or $1004100 surely bond mas be submitted in lieu of liquor <br />llabllily. ^ <br />Licensee Signature Dale t <br />o be con^(Signature cenifies all above information to be con^and license has been approved by ciiy/county.) <br />City CIcrk/County Auditor Signature_________________________________Date_____________ <br />(Signature certifies that renewal of a liquor, wine or club license has been approved by the ciiy/county as stated above. <br />County Attoovey S.graiure______________________Date <br />County Board issued bcenses only (Signature cemfies Itccnsce u eligible for bcense). <br />Police/Sheri IT Signature__________Dale <br />(Signature certifies licensee or usociates have not been cited during the past five years for any stalc/Iocal liquor law violations <br />(chmioal/civU). Report violations on back, then sign here. <br />PS 9093-98