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8. Arc the premises now occupied, or to be occupied by the applicant entirely separate and exclusive from any other businessestablishment? ^^3_____9. If a drug store, state length of time the store has been in operation ______10. State whether applicant has or will be granted, an On-Sale Liquor License in conjunction with this Off Sale Liquor License, and forNothe same premises_____ ^_________11. State whether applicant has, or will be granted a Sunday On-Sale Liquor License in conjunction with the regular On-Sale Liquorfit)License <br />MM\2. If this application is for a County Board Off-Sale License, state the distance in miles to the nearest municipality_ <br />1. State whether applicant, or any of the associates in tLis application, have ever had an application for a liquor license rejected by any <br />lactic.m'lnlcipality or State Buthor»fy: if so give dates and details. <br />Pnonc <br />)5C <br />535 <br />mse <br />2 Has the applicani, or any of the associates in this application, during the five years immediately preceding this application ever had a <br />license under the Minnesota Liquor Control Act revoked for any violation of such laws or local ordinances; if so, give date and details <br />NlotrlC. <br />• I. <br />3 State whether applicant, or any of the associates in this application, and employees while employed by applicant during the past five <br />years were convicted of any Liquor Law in this state, or under Federal Laws, and if*so, give date and details _________ <br />4. During the past license year, has a summons been issued under the Liquor Civil Liabilityf Law (Dram Shop) M.S. 340A.802 <br />• «, * ^ <br />EnoYes If yes. attach a copy of the summons. <br />This licensee must have one of the following. Check one: (ATTACH CERTIFICATE OF INSURANCE TO THIS FORM.) <br />A. Liquor Liability Insurance (Dram Shop) - S50.000 per person. S100,000 more than ore person; S10,000 property destruction; <br />S50.000 and 5100,000 for loss of means of support. <br />B. A surety bond from a surety company with minimum coverages as specified in A. <br />C. A certificate from the State Treasurer that the licensee has deposited with the state, trust funds having market value of $100,000 <br />or 5100,000 in cash or securities. <br />1 certify that 1 have read the above gocitions and that the answers arc true and correct of ny own knowledge <br />Print name of applicaat St title <br />l^rVt <br />r applicaat 6t title <br />W- Vi<^A.r Oconcr <br />Signore of Applicant y <br />REPORT BY POLICE DEPARTMENT <br />This is to certify that the applicant, and '.he associates namei herein have not been convicted within iht past five years for any violation of laws <br />of the State of Minnesota, or municipal ordinances relating to intoxicating liquor except as follows <br />% . <br />i *• « • • • <br />Police Department Title Signature . <br />CV. <br />• IMPORTANT NOTICE <br />All retail liquor licensees must have a current Federal fecial Occunational Stamp. This Stamp is issued by the Bureau <| <br />Alcohol, Tc^acco, and Firearms. For Information call 612-290-349o.