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Minnesota Department of Public Safely <br />Alcohol and Gambling Enforcement <br />444 Cedar Street, Suite 133 <br />St. Paul. MN 55101-5133 <br />651-296-6979 •TTY651-282-6555 • Fa.x 651-297-5259 <br />w <br />______RENEWAL OF LIQUOR, WINE, OR CLUB LICENSE <br />' No license will be approved or released until the S20 Retailer ID Card fee is received by NIN Liquor Control <br />Licensee: Please verify your license information contained below. Make corrections if necessary and sign. City <br />Clerk/County Auditor should submit this signed renewal with completed license and licensee liquor liability for the new <br />license period. City Clerk/County Auditor are also required by Kli>. 340.\.404 S. 3 to report any license <br />cancellation. <br />License Code MCL0N5S___________License Period Ending 13/31 /gOOO id#. <br />City/County where license approved 0ron O <br />LicenseeName Spring Hill Golf Club Inc. <br />Trade Name Spring Hill Golf Club <br />Licensed Location address Sth five N <br />2821 <br />City. State. Zip Code Orono, MN 55391 <br />Business Phone < ^ 12) 473-1500 <br />jcB.cO <br />l.irEXSE FEES: Off SaleS On Sale S Sunday S 200.00 <br />By signing *his renewal application, applicant certifies that there has been no change in ownership on the above named <br />licensee. For changes in ownershtp the licensee named above, or for new licensees, full applications should be used. <br />Sec back of thb application for further information needed to complete this renewal. <br />Applicant ’s signature on this renewal confirms the following: Failure to report an\ of the following will result in fines. <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 application. <br />2.Licensee confirms that it has never had a liquor license rejected by any city/townsl ’p/county in the state of <br />Minnesota. If ever rejected, please 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 criminal <br />liquor law violations. If violations have occurred, please give details on back of this renewal, then sign below. <br />3.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 Workers Compensation insurance is in effect for the full license period. <br />Licensee has attached a liquor liability insurance certificate that corresponds with the license period in ciiy/county <br />where license b issued. $100,000 in cash or securities or $100,000 suretv bond may be submitted in lieu of liquor <br />liability. <br />_______________________________________________________ <br />(Signature certifies all above ififormation tq^ correct and license has beet/approved by city/county.) <br />Licensee Signature hUDate /o// %l0 o <br />City Clerk/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 above. <br />County Attorney Signature_________________________________________________Date ____________ <br />County Board issued licenses only (Signature certifies licensee is eligible for license). <br />Police/Sheriff Signature____________________________________________________Date ____________ <br />(Signature certifies licensee or associates have not been cited during the past five years for any siate/local liquor law violations <br />(criminal/civil). Report violations on back, then sign here. <br />PS 9093-98