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m MinncMHj Dcpaiuneni of Public Safely <br />Alcohol and Ganbliiig EaforcraMtil <br />444 Cedar Street Suite 133 <br />StPaul. \LN 55101-5133 <br />651O***MTV • m' 65I-282-6555 • Fx» 65I-N7-525V <br />RENEWAL OF LIQUOR, WINE, OR CLUB LICENSE <br />No iKcme will he apfnncu or rrlea«cd ui;ul ihr SM Reutier ID Cud lee i» iecn\rd by MN Liquor Cooiral <br />Lktmct: Pleaic %erify your license infumutiun contained below. Malic correctioni if neceuory and sign. Cily <br />Gerk/County Auditor should submit thi’ signed renewal with completed license and licensee liquor liability for the new <br />license period. Clly Gerk/Counly Auditor arc also rci|uircd by hlii. 340A.404 S. 3 to report any license <br />caoccUalion. <br />License Code MCLONSL___________ Lwense Period Ending 12/31/2001 ID# 391 <br />Ciiy/Couaiy where license approsed (llQCAAA's name is changed, do nut use this (unn. Contact this office.) <br />LicenseeName Woodhill Country Club Inc. <br />Trade Name Woodhill Country Club <br />Licensed Location address 200 Woodhill Rd <br />City. State. Zip Code Orono, MN SS391 <br />Bu>inc»IW *73-7333 <br />‘\S>- <br />LiCE.\SE t£ES Off Sale S On Sale $ 100.00 j ^CC.CC <br />By signing this rencsial application, applicant certlllcs that there has tiecn no change In ossnership on the abosc <br />named licensee. Fur changes in ownership, the licensee named abosr, or fur new licensees, full applications should <br />be used. See back of this application for further information needed to complete Ihb renewaL <br />AppUcanfa signature on this rnKs«al confirms the following: Failufe to report anv of the lolliiwinf will result In flan. <br />1. Licensee confirms it has no interest whaiv<ser. duectly or indirectly in any other liquor establishments in <br />Minnesuu. If so. give details on back of this appl>catioa <br />2. Licensee confirms that it has never had a liquor license reyected by any city/tow nship^county in the state of <br />Mmnesou. If ever reyecicd. please give details on the back of this renewal, then sign below. <br />3. Licensee confirms thiu for the past five years it has not had a liquor license revoked for any liquor law violation <br />tstJte or local!. If a revocation has occuned. please give details on the hack of this renewal, then sign below. <br />4. Licensee confimu that lunng the past fisc years it or its employees have not been cited for any civil or criminal <br />liquor law violations. If siolaiions have occurred, please give details on bock of this renewal, then sign below <br />5. Licensee confirms that dunng the past license year, a summons has not been issued under the Liquor LiabiUty <br />Law tDram Shop) .MS 340A 802. If yes. attach a copy of the summons, then sign below. <br />6. Licensee confirms that Workers Compensation insurance is in effect for the full license penod <br />Licensee has attached a liquor liabHily insurance ceniflcale that corresponds with the license period in rily/counly <br />where liceme b issued. SlOOdMW in cash or scairitlcs «r $100,000 surety boiKi mas be submitted in lieu of liqiMir <br />Bability. <br />Licensee Signature ^ _________Date <br />(Signature certifies all above information to be conrect and license has been approved by city/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 city/county as stated abosc. <br />County Anofocy Signanire ______________________ Date ___________________ <br />County Board issued licenses only (Signature certifies licensee b eligible for license). <br />Police/Shcriff Signature _________________________ Date ___________________ <br />(Signature ccrtiries licensee or associates have not been cited during the pau five yean for any state/local liquor law violatioos <br />(ciiinioal/civil). Repoit violations on back, then sign here. <br />PS 9093-98