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m:r <br />Minnesota Dep:_'.ment of Public Safety <br />Alcohol and Gambling Enforcement <br />444 Ceair St.. Suite 133 <br />St. Paul.V.N 55101-5133 <br />612-296-6430 • TTY 6i;-;32-6555 • FAX 612-297-5259 <br />_______RENEWAL OF LIQUOR. WINE, OR CLUB LICENSE______ <br />No license N^ill be approved or released until the >1. Retailer ID Card tcj is received by MN Liquor Control <br />Licensee; Please verify your license information comatr.ed 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 Clcrk/County Auditor are also required by M.S. 340.A.404 S. 3 to report any license <br />cancellation. <br />License Code Cr 5*. <br />City/County w here license approved C r o r. g <br />Licensee Name Navarre Liquors Inc. <br />License Period Ending 12/31/.1.3.39 ID #—£i£Ai <br />I <br />Trade Name <br />3421 Shoreline Zr <br />Licensed Location address <br />Navarre, M.N <br />City. State. Zip Code <br />Business Phone <br />A • Vs/ <br />LICENSE FEES; Off Sale S O". Sale S Sunday S <br />By signing this renewal application, applicant certifies L“.u: there has been no change in ownership or the above named <br />licer.see. For changes in ownership, the licensee named arove. or for new licensees, lull applications should be used. <br />See back of this application for further information necviei to complete this renewal. <br />Ap :licant*s slanature on this renewal confirms the foll.-ming; Failure to report anv of the following will result in fincs. <br />Licen.see confirms it has no interest whatsoever, c.reotly cr imlirectly 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/township/county in the state of <br />Minnesota. If ever rejected, plea.se give details cr. ;.he back of this renewal, then sign below. <br />3. Licensee confirms that for the past five years it his not had a liquor license revoked for any liquor law violation <br />(state or local). If a revocation has occurred. ple.:.>e gi\e details on the back of this renewal, then sign below. <br />4. Licen- . e confimis that during the past five years or its employees have not been cited for any civil or criminal <br />liquor law violations. If violations base occurrec. plea>e give details on back of this renewal, then sign below. <br />5. Licensee confirms that during the past license yc_'. a summons has not been issued under the Liquor Liability Law <br />(Dram Shop) MS 340.A.8(32. If >c>. attach a copy ■:: the summons, then sign below. <br />6. Licensee confirms that Workers Compensation i.-.s-.-ance is in effect for the full license period. <br />Licensee has attached a liquor liability insurance cenificale that corresponds with the license period in city/county <br />where license is issued. $100,000 in cash or securiUerocSlOO. 000 surety bond may be submitted in lieu of liquor <br />liability. <br />Licensee Si riatuiy^ <br />(Signature certifies all abovcinfCTnrrtion to b^^nVcct ar j license has been approved by city/county. <br />Citv Clerk/Couniv .Auditor Sisinature Date <br />J (Signature certifies that renewal of a liquor, wine or clur license has been approved by the city/county as stated above. <br />Countv Attorne' Signature Date <br />County Board issued licenses only (Signature certifies I;..*nsee is eligible for license). <br />Police/Sheriff Signature Date <br />(Signature certifies licensee or associates have not beer. ;.;ed dunng the past live years for any state/local liquor law <br />violations (criminal/civil). Report violations on back, tret sign here.PS 9093-93