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r <br />h rilOV 6 1891 <br />MINNESOTA DEPARTMENT OF PUBLIC SAFETY <br />LIQUOR CONTROL DIVISION <br />333 SIBLEY • ST. PAUL. MN 55101 <br />PHONE (61*>) 296*6434 <br />PS90l6ill 891 <br />application fob club on sale retail liquor license <br />t. II k... .....nniAtoH h\/ an officer of the club seeking a license. This application and the proof <br />Thia application shall be ^ ^ j , rtt or the county auditor. To qualify for a license a <br />Of liquor liability continuous existence for at least three years, have an elected <br />s^les .0 members and bon. (ide only The annua, bcense fee is se. by s.a.u,e <br />(mT wOa SoSI. Granling of a license by ihe c,,y or county rs drscrelronanr. <br />TYPC OH PHINT <br />Club N»m* Of DBA <br />Csrporwion N«m« <br />r.n^otrg C.Uib rOoa ^ <br />BSI __yLpcsiion (SlfMt <br />^nn iOmdhi IL 1^£6d <br />Muinciptlity <br />DroOiQ <br />auililme OwpHf t N»W <br />From /- /- Jol3-5l-9a <br />Counrv <br />Hmoepin <br />Sa5 ahddh'ii/ ?nacl <br />unx.inm ^ \ — <br />i Ara there any delinquent ^ W <br />! taxaa o« the property? -------------— <br />t m 1 1 1 MuJM . / ■ A ------------------------------------------------- <br />Club MfT|b9«T s N«m« <br />fmrL n. Pilhr^rhf <br />iHim U tn •«•»«« <br />C. Kra+ion iiV\L\Zr=rtA. Tviia <br />T' iLYcd <br />3§a§I HoAtimlcn ftoirit 12d. LOtsf <br />kWi?<atcai 5SM/ <br />Iu JI'mUS oi ao.rb <br />•SariJ^K 1 / hsPrlPtCP <br />Intis' xrv'irq f^uenoe, 2ou±k. <br />minntapDl^, fTTiy 554Oi _ <br />j n^if- T' •*—r~^ <br />T\ai 1"T" rvAP 11 <br />5440 k^rtKcmc'toad <br />The licansaa must have one of the following; <br />! CNtCKOM -ennAn <br />! a A Liquoc U«.ilily insurance fOr.m Shop) - .50,000 per perptrc s100,000 ;!l*" <br />^oparty destruction; S50.000 and SI00.000 for loss of means of support. ATTACH CERTIFICATE OF <br />1 insurance * to THIS FORM <br />, os A <br />□ B. A Surety bond from a surety company with minimum coverage as specified above m A. <br />! □ c A certificaie from the Slate Treasurer that the License, has d«»5,l«f wrih the State, Trust Funds <br />haying, marbel value of $100,000 or .100,000 in cash or secuniies <br />JIW WT wiww « <br />I Vatarant or Fraiar nal <br />Jfqaniiation ‘Vn-trmfvr 60 <br />'lumbar of Years m <br />:urrant Quarters ^0^ <br />of the Club <br />Nuiftber of Club <br />Members <br />Will the Club be ^ <br />Issued a Lawful □ Yes i^No <br />Gambling License^ _______