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Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement <br />444 Cedar St.. Suite 133 <br />St. Paul. ,\IN 55101-5133 <br />612-296-6430 • TTV 612-282-6555 • FAX 612-297-5259 <br />RENEWAL OF LIQUOR. WINE, OR CLUB LICENSE <br />No license will be approved or telea.sed until the S20 Retailer ID Card fee is received by MN Liquor Control <br />% <br />ii <br />i I <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 M.S. 340A.404 S. 3 to report any licen.se <br />cancellation. <br />License Code .nr’t^i License Period Ending ID #—231 <br />City/County where license approved C r o n o <br />LicenseeName Woodhill Country Club Inc <br />Trade Name VJoodhill Country Club <br />Licensed Location address CCO UucdMill RJ <br />City, State, Zip Code Cronu, MM C5331 <br />Business Phone t C : 2 5 473-7333 <br />LICENSE FEES: Off Sale S On Sale S ICO.OC Sunday S <br />By sign!’ j ihis renewal application, applicant certifies that there has been no change in ownership or the above named <br />licens.'.*. For changes in ownership, the licensee named above, or for new licensees, full applications should be used. <br />See back o;‘ this application for further information needed to complete this renewal. <br />Applicant's signature on this renewal confirms the following: Failure to report anv of the following will result in lines. <br />1. Licensee confirms it has no interest whatsoever, directly or indirectly ..i 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, 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). If a revocation has occurred, please give details on the back of this renewal, then sign below. <br />4. Licensee confir"is that during the past five years it or its employees have not been cited for any civil or criminal <br />liquor law viob.ions. If violations have occurred, please give details on back of this renewal, then sign below, <br />5. Licensee confirms that during the past license year, a summons has not been issued under the Liquor Liability Law <br />(Dram Shop) MS 340A.802. If yes. attach a copy the summons, then sign below. <br />6. Licensee confirms that Workers Compensation in>urance is in effect for the ful; nse period. <br />Licensee has attached a liquor liability insurance certificate that corresponds with the lfic‘*nse period in city/county <br />where licease is issued. $100,000 in cash or securities or $100,000 surety bond may be »i4*r.»'Ued in lieu of liquor <br />liability. <br />Licenser -i,f8n.vJre , ft- _____________ Date <br />(Si.uat .ic vciufics all above information to be correct and license has bvcn approved by city/county. <br />City Clerk/Couiuy Auditor Signature Date <br />(Signature certifies that renewal of a liquor, w ine or club license has been approved by the city/county as stated above. <br />Couiitv Attomev Sisnature Date <br />County Board issued licenses only (Signature certifio 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 state/local liquor law <br />violations (criminal/civ il). Report violations on back, then sign here.PS 9093-98