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PS 9016 (tl . 891 <br />MINNESOTA DEPARTMENT OF PUBLIC SAFETY <br />LIQUOR CONTROL DIVISION <br />333 SIBLEY • ST. PAUL, MN 66101 <br />PHONE (612)296-6434 <br />APPLICATION FOR CLUB ON SALE RETAIL LIQUOR LICENSE <br />Thi$ application shall be completed by an officer of the club seeking a license. This application and the proof <br />of liquor liability insurance must be filed with the city clerk or the county auditor. To qualify for a license a <br />club must have at least fifty members, been in continuous existence for at least three years, have an elected <br />governing board and limit sales to members and bona fide quests only. The annual license fee is set by statute <br />(M.S. 340A.408). Granting of a license by the city or county is discretionary. <br />TYPE OR PRINT <br />Carportiion Nime <br />MAYZATA CXXKfRY CXUB <br />Loc Mkki (Sumi Address) <br />200 NAYZATA BLVD <br />Municipaiitv <br />NAYZATA <br />Club TraOfl Name or DBA <br />WAYZATA COUNTRY CLUB <br />License Period <br />From 1-1-92 To 12-31-91, 612, 473 8846 <br />Suildiny Owner's Nome <br />NAYZATA CXXIOTRY CLUB <br />Counly <br />HENNEPIN <br />Sieie <br />MN <br />Zip Cede <br />55391 <br />0u<‘ '’ ng Ownof s Address <br />SAME <br />Are there any delinquent <br />taxes on the property?□ Yes No <br />Club Mendger s Name <br />JOHN A. DOWNEY <br />Namd ol Mambay ol Managing Board <br />Naifia of Mambar of Manogir^ Board <br />Address <br />Address <br />Noma of Mambar of Managing Board Address <br />No<na of Mambor of Managing Board Address <br />The Licensee must have o.ie of the following; <br />CHECK ONE <br />E2 A. Liquor Liability insurance (Dram Shop) — $50,000 per person, S100.000 more than one person; $10,000 <br />property destruction; $50,000 and $1(X},000 for loss of means of support. ATTACH “CERTIFICATE OF <br />INSURANCE * TO THIS FORM <br />OP <br />O B A Surety bond from a surety company with minimum coverage as specified above in A. <br />OR <br />C. A certificate from the Slate Treasurer that the Licensee has deposited with the State. Trust Funds <br />having e market value of $100,000 or $100,000 in cash or securities <br />I Give Date of Club Chencr <br />if Vetarene or Fraternal <br />Organiiation <br />C mg of fncgrgoFOtion <br />JUNE 30, 1956 <br />1 Number of Years of <br />Continuous Existence 35 <br />of the Club <br />Number of Years in <br />Current Quarters 35 <br />Number of Club <br />Members <br />Will the Club be <br />Issued a Lawful □ :.s Ql No <br />Gambling License? <br />-•V* T