Laserfiche WebLink
Yes <br />Yes <br />1. <br />2. <br />3. <br />Are any members, officer, agents or employees paid profits from the sale of beverages to club <br />members? <br />Are any employees paid salaries? <br />Has applicant, partners, officers or employees ever had any liquor law violations in Minnesota or <br />elsewhere? If yes, give names, dates, and final outcome:_____________________________ <br />Yes 4.£) <br />Yes <br />^^^No <br />I certify that I have read the above questions and that the answers are true and correct of my own <br />knowledge. <br />5. <br />6. <br />Does any wholesaler or manufacture of alcoholic beverages ow or have any interest in furniture, <br />fixtures or equipment for the licensed premises? <br />If yes, give details. <br />During the past license year, has a Summons been issued under the Liquor Civil Liability Law (Dram <br />Shop) M.S. 340A.802? <br />If yes, attach a copy of the Summons. £o <br />Will you serve liquor on Sunday? Amount of Sunday License Fee S ^OO ~~_____ • <br />Signature of A(f^licant <br />/Date <br />Yes No <br />IF LICENSE ISSUED BY THE COUNTY BOARD: REPORT OF COUNTY ATTORNEY <br />I certify that to the best of my knowledge the applicants named above are eligible to be licensed. <br />If no, state reason. <br />Signature County Attorney County Date <br />REPORT BY POLICE DEPARTMENT OR SHERIFF’S OFFICE <br />This Is to certify that the applicant, and the associates, named herein have not been convicted within the past five years for any <br />violation of Laws of the State of Minnesota, or Municipal Ordinances relating to Intoxicating Liquor, except s follows: <br />Police Department or Sheriffs Name Title Signature <br />LICENSE APPROVAL OR DENIAL <br />License Granted Denied <br />Signature City Clerk or County Auditor Date <br />LICENSE APPROVAL OR DENIAL <br />License Granted Denied <br />Signature Director Alcohol & Gambling Enforcement Date <br />IMPORTANT NOTICE <br />ALL RETAIL LIQUOR LICENSEES MUST HAVE A CURRENT FEDERAL SPECIAL OCCUPATIONAL STAMP. THIS STAMP IS <br />ISSUED BY THE BUREAU OF ALCOHOL TOBACCO AND FIREARMS. FOR INFORMATION CALL (651) 2S0-3496 <br />(PS 9016-93)