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1. Are any members, officers, agents or empolyees paid profits from the sale of beverages to club <br />members? _______________________________________________________________ <br />2. Are any employees paid salaries? <br />3. Has this club or any employee been convicted of a violation of Federal or State law or local ordinance <br />relating to alcoholic beverages? OO______________________________________________ <br />If so, give names, dates and violations <br />4. Does any wholesaler or manufacturer of alcoholic beverages own or have any interest in furniture, <br />fixtures or equipment for the licensed premises? ^OQ___________________________________ <br />If so, give details ___________________________________________________________________ <br />5. During the past license year has a Summons been issued under the Liquor Civil Liability Law <br />(Oram Shop) M.S. 340A.802? □ Yes |^No If yes. attach a copy of the Summons. <br />6. Will you serve liquor on Sunday? Yes □ No Amount of Sunday License Fee ________ <br />I certify that I have read the above questions and that the answers are true and correct of my own <br />knowledge. <br />S«9n«iur« ol Apoi*c«ni 0«it <br />IF LICENSE ISSED BY THE COUNTY BOARD. REPORT OF COUNTY ATTORNEY <br />I certify that to the best of my knowledge the applicants named above are eligible to be licensed. <br />□ Yes □ No <br />M no. state reason _______________________________________________________________________ <br />lifnsfyr* Coynfv Aitornay County Oslo <br />REPORT BY POLICE DEPARTMENT OR SHERIFF S OFFICE <br />This is to certify that the applicant, and the associates, named herein have not been convicted within the <br />past five years for any violation of Laws of the State of Minnesota, or Municipal Ordinances relating to Intoxicating <br />Liquor, except as follows ___________________________________________________________________ <br />Main*StfnMura <br />LICENSE APPROVAL OR DENIAL <br />License O Granted G Denied <br />[ SIONATUftE CITY CLERK OR COUNTY AUDITOR DATE <br />License jranted Denied <br />SIGNATURE UQUOR CONTROL DIRECTOR DATE <br />IMPORTANT NOTICE <br />ALL RETAIL UQUOR UCENSEES MUST HAVE A CURRENT FEDERAL SPECIAL OCCUPATIONAL STAMP THIS STAMP <br />IS ISSUED BY THE BUREAU OF ALCOHOL TOBACCO AND FIRE ARMS. FOR INFORMATION CALL 612-290-3496.