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/ <br />Liouoa cxvrnKx. oivisiom . <br />444 ST-SUITC 100 L C S«fctV <br />ST PAUL rii $5101-215* SION ST. PAW. m MN 55101 <br />toi^)^viM>4J0 i'lY(612)282^^555 <br />RENEWAL OF LIQUOR, WINE, OR CLUB LICENSE <br />LIgmMAi Please verify your license informatioo contained below Make corrections if necessary and ^8^- l^ty <br />Clerk/Conatv Auditor sh^ submit this signed renewal with completed license and Ucensee Uqiror for the new <br />license penod. Chy Oerk/Cormfy Auditor are also required by MA W0A.404 S. 3 fo report any Ucense <br />License Code.MCLONSS Period Endme 12/31/95 p «-----LL9S <br />o^ao. CO <br />100.00 <br />City/County where license appnned Or Ono <br />Licensee Name Wayzata Country Club Inc. <br />Trade Name wayzata Country Club <br />Licensed Location address 200 Wayz aza Blvd/Box 151 <br />City. State.Zip Code Orono, MN 55 391 <br />Business Phone (612) 473-3346 <br />1.ICF.NSE FEES; Off Sale $ On Sale S 300.00 Sunday $ <br />Bv signint this renewal application. appUcant certifies that there has been no change in ownership, corporate ofliem, <br />partn^home addresses. Of telephone numbers, ifehanees base occurred dimng the past 12 months, please give details <br />OQ the back of this renewal, then sign below. <br />ApplSranf- on thb renewal confirms the followina; FaUurt tO rtPOlt MT Ilf thC foflgwjag wjfl m«lt la <br />fiB£2t <br />Licensee confirms that it has never had a Uquor Ucense rejected by any city/township/county in the slate of <br />Minnesota. If ever rejected, please give details on the back of this renews then sign below. <br />Licensee confirms that for the past five years it has not had a Uquor Ucense revoked for any liquor law vioUtion <br />(state or local). If a revocauon has occurred, please give details on the back of this renewal, then sign below. <br />Licensee confinns that dunng ±e past five years it or its cmplovecs have not been cited for any civil or crm^al <br />Uquor law violaUons If vioUtions have occurred, please gn e details on back of this renewaL dicn si^^low <br />Licen.see conlinns that dunng the past Ucense year, a summons has not been issued under the Liquor LiabUity Law <br />(Dram .Shop) MS 340A.802. If > es. attach a copy of the summon-s. then sign below, <br />j. Licensee confirms that Workers Compensation insurance is in effect for the fuU Ucense penod. <br />Ucensee has attached a Uquor liabiUty insurance certtfkate that corresponds with the license c^/county <br />w here Ucense b bsued. S100.000 in cash or securities or S100.000 surety bond mny be submitted in lieu of Uquor <br />UabiUtv. <br />1. <br />2. <br />3 <br />4. <br />5 <br />Date / Ol icensee Signature ------------------------^-----j-----^ <br />(Signature certifies aU'ii^c inlormauon to be correct has been approved by atv/county <br />Date <br />Date^ <br />rin- rierlci'Cnunr.- .Auditor Simature------------------------------------------------------------------------------—— ----- <br />(Signature certifies that an on-sale intoxicalmg Uquor Ucense has been approved by the cit>/counl> as stated above). <br />County Attorney SignstUfC_________^------- <br />County Board issued Ucenses only (^^^atiue certifies lu <br />Police-Sheriffgjnir^T- -----------------DuK <br />(Simature certillcs UceiLsee or associates hai^’not beCfi cited dunng the past five years for an.v state/1d(ial <br />vnolalions (cnminal/civTl). Report violations on back, then sign here. PS <br />iioble for U<