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r <br />E <br />I <br />t <br />t ■ <br />S <br />E <br />C <br />T <br />1 <br />0 <br />N <br />2 <br />C <br />0 <br />N <br />T <br />1 <br />N <br />U <br />E <br />D <br />8 Under what classilication is Ihe license applied tor: EXCLUSIVE OFF-SALE LIQUOR STORE. DRUG STORE. <br />COMBINATION ON & OFF LIQUOR. OR GENERAL FOOD STORE.................. . _____ ____ <br />9. Are the premises now occupied, cr be occupied by me applicant entirely separate and exclusive trom any <br />other business establishment^____________ <br />to. If a drug store, state length ol time the store has been m operation . __ ______________ <br />11. State whether applicant has. or will be granted, an On Sale Liquor License m conjunction vxiiti this Otf-Sale <br />Liquor License, and tor the same premises ___________________— ...-----------------------------— <br />12. Slate whether applicant has. or will be granted a Sunday On-Saie Liquor License m conjunction with the regular <br />On-Sale Liquor License ___________________ ___— ............. — — ------------------------- <br />13. If Ihis application is for a County Board Oil Sale License, state ihe distance >n miles to the nearest municipality <br />8 <br />E <br />C <br />T <br />I <br />O <br />N <br />I <br />1. Stale whether applicant, or any of the associated m this application have ever had an application tor a Liquor <br />LIcanse rejected by any municipality or State authority, it so give date and details <br />Vc>o <br />2. Has tha applicanl. or any ol the associated m this application, during the live years immediately preceding <br />this application ever had a license under the Minnesota Liquor Control Act revoked tor any violation ol such <br />latM or local ordinances: it so, give date and details <br />_________________---------------------------------------------------------------------------------------------------------------------------------------------------------------------- <br />& Stato whether applicant, or any of the associates in this application, and employees while employed by applicant <br />during Ihe past five years were convicted of any Liquor Law m this state, or under Federal Laws, and if so, give <br />date and details. <br />4. During the past licensa year has a summons been issued under the Liquor Civil Liability Law (Oram Shop) <br />M.S. 340A802. □ Yes No. If yes. attach a copy of the summons. <br />S <br />E <br />C <br />T <br />I <br />O <br />N <br />This Licensee must have one of the following: <br />CHICK ONI <br />[S A. Liquor I >ab«lily insurance (Dram Shop) — $50,000 oer person. $100,000 more than one person, $10X)00 <br />property destruction; $50,000 and $100,000 for loss of moans of support. ATTACH "CERTIFICATE OF <br />_ INSURANCE TO THIS FORM.on <br />W B. A Suraty bortd from a surety company with mmimum coverages as spec'iied above in A. <br />D C. A corlllicale from the State Treasurer that the Licensee has deposit'd tha State. Trust Funds having <br />markst value of StOO^XW or $100j000 in cash or securities <br />that the answers are true and correct ol my own knowledge. <br />---------------- <br />IT BY POLICE DEPARTMENT <br />This is to certify that the applicanl. and the asaoctates. named herein have not been convicted within the past ftve <br />lor any vioiaUon ol Laws of tha State of Minnesota, or Municipal Ordinances relating to Intoxicating Liquor. <br />except as foHowa. <br />IMPORTANT NOTICE <br />AU RETAIL LIQUOR LICENSEES MUST HAVE A CURRENT FEDERAL SPECIAL OCCUPATIONAL STAMP THIS <br />STAMP IS ISSUED BY THE BUREAU OF ALCOHOL. TOBACCO AND FIREARMS FOR INFORMATION CALL