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Aannesota Department of Public Safely <br />Alcohol and Gambling Enforcement <br />445 N>nnesota Street, Snits 222 <br />St Paul, NW 55101 <br />V:__,......: 651-201-7500 <br />RENEWAL OF LIiQUOq , WM, CALUB OR 3.2% LICINUS <br />. _ 1+b liom = wil'I ur apprtm orxele= d WI d r $2i) Re W ter Ice Cwd ke is reeciveJ by A CurWi wL1 mb!hg Enfiw+,&.rdnt <br />Licensee: Please verify your lioease information eotrtained below. Make cotrections if neeesse y and sign. City <br />C1erklCouuty Auditor should submit this steed mno" with compiewd license and licensee liquor liability for the <br />new license period. City C1erklCourdy Auditor are also rogt&W by NLS. 340A.404 S.3 to report any liccnso cancellation. <br />Lice Code OA1;SS Meuse Period Ending 1213112016 IDN 18397 <br />ISSUNG AliTTH017TY Orono <br />Liceusee Name City of Orono <br />Trade Name Orono Public Golf <br />City, State, Zip Code *265 Orono Orchard Rd 5 <br />Orono MN 55391 <br />Business Phone 9524731909 <br />Uc=0FM: Ori Sale GitSale $5,004.00 Sunday $"100.00 <br />By signing this renewal application, applicant certifin that there hu been no change in ownership an the above name( <br />Newsm pbr changes In ownership, the licensee nambd above, or for new license, full applications should be used. S <br />back of this application for further information needed to complete this rnewval. <br />A►noli owes signature on this renewal confltnrs $he Ing: Failure m newt any of the followleee may melt in_eW l oenaMiL <br />1. Licensee confirms it has na interest'vdi tsoever, directly or indirectly in any other liquor esUblishments in Minnesota. <br />If so, give details on back of this application. <br />2. Lie== confirms that it bas never had a liquor licama nj acted by any city/township+county in the state of eta. <br />Ifever rejected, please give details on the back of this reaewel, then sign below. <br />3. Licensee canlirms tient for the past five yeam it has not had a liquor license revoked for any liquor law violation <br />(state or local). If a revocation has ocu rre d, please give details on t— .19ck oflris tone , that sign below. <br />4. Licensee ccmfir= that during the past five yew it or its employees have not been cited far arty civil or crimisl <br />liquor law violadom. If violations have occurre4 please give details on back oftbis renewal, then sign below. <br />5. Lim cumfirms that dming the past Incense year, a summons has not been issued underthe Liquor Liability <br />Law P= Shop) AM 340A.S02. If yes, attach a copy afore summons, then sign below. <br />6. Licensee confirms that Workers Compensation insurance will be kept in effect during the license period. <br />Licensee has attaehed a liquor nubility Insurance eerdficate that corresponds with the license period in city/tounty where <br />license is issued. $100,000 in weir or securities or St00,000 surety bond may be submitted In lieu ofliquor 111sbility. <br />(3.2& liquor Heenm are exempt'ILmdes ar*less than S25AN at on sale, or $50,000 at off sale). <br />Ar <br />Licensee Sig nate � r . ` ` .' I _ DOBE ;,SSS �4 Dater <br />(Sig inure certifies all alwh it1V=1 `` to be correct and license has been approved by city/munty,3 <br />3� ' <br />City Clc&CovntyAuditor Signature Date <br />(Signature certifies that renewal of a liquor, wine or club license has been approved by the city/comty as stated above.) <br />County Attorney Signature <br />County Board, issued licenses <br />Police/Sheriff Signature <br />Sigmbre certifies licensee or aaso <br />violations on b" that sign h= <br />Vic k4aaA I SAO/#% <br />fl)C X <br />is eligible for license). <br />for idy statMocd ligsor law violetices ( <br />P <br />during Ike peat five years Report <br />