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r. <br />irf <br />‘■tv <br />1 Are any members, officers, agents or empolyees paid profits from the sale of beverages to dub <br />members? NO___________________ ____ <br />2. <br />3. <br />Are any employees paid salaries?YES <br />Has this club or any employee been convicted of a violation of Federal or State law or local ordinance <br />relating to alcoholic beverages? _____________________________________________________ <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?________N?______________________________ <br />If so. give details__________________________________________________________________ <br />5. During the past license year has a Summons been issued unde' the Liquor Civil Liability Law <br />(Dram Shop) M.S. 340A.802? □ Yes El 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 hme ifad^^t^bove questions and that the answers are true arul correct pf my own <br />knowledge. <br />EIS <br />A^ic«ni <br />wreci p <br />IF LICENSE I8SED 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 />If no. state reason____________________________________________ <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 />UCENSE APPROVAL OR DENIAL <br />License Granted Denied <br />SIQNATUflE CITY CLERK OR COUNTY AUDITOR DATE <br />License Granted 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.