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f <br />_ Miinnecote Department .of Public Safely :EIVSD <br />Alcohol and Gambling Enforcement ail; ° 'V t= <br />445 Minnesota Street, Suite 222 <br />a St Paul, MN 55101 G"11Y i' F ��R o <br />6519201-7500 <br />RENEWAL OF LIQUOR, WANE, CLUB OR 3.2% I ICMME 1 <br />Licensee. P*= verify your liaanse jidbrtnatlon corbined below Make correctiam if necessary and sign, City <br />Clerk/County Auditor should submit this signed renewal wM empleted I== and licensee I*%. haWlh y for Im <br />new license period. City Clerk/CountyAuditor we also tegtared by M.S. 340A.404 S-3 to apart mly homse cancellation. <br />license Code NICIANSS LleatsePeriod Ending 12/31/2016 ID# 1196 <br />ISSEDING AUTHORITY Orono <br />lUcensee Naane Wayzata Country Club <br />Trade Name Wayzata Country Club <br />City, State, Zip Code 200 Wayata Blvd West <br />Wayzata UK 55391 <br />Bashms Pboue 952-473-8946 <br />License Fees: Off Sale $0.00 On Sale $200A0 Sawday $200.00 <br />By signing tbb reartral appticathmv applicant certlllls that there leas been nothange In ownersbip on the almvt; gemmed <br />N m m. For chanym In ownerships the Reemee named above, or fbr new licenseesr null applications shmid be used, Sr <br />bask of this appliodon far further Informatlop needed to complete thle renewal. <br />��-�. a i_ • f II. 1 �_�,�c_ ' lJ 1 _ u i � � zI - � iy� i tl � �y_ 1J.;1' Lx `. � `A Il <br />I . Licensee confirms it has no ingest whatsoever, directly or indirectly is any other liquor establishments in Mtnrresota, <br />ifs%SA devils on back ofthis appitoatlom <br />2. Licensee casfirms that It has never had a liquor license nlJ=W by any eity/townshrp/courdy in Bre state of Minnesota. <br />If aver rejected, please give deans out the buck ofthbs renbwe4 then sign below. <br />3. Licensee cornu= that far the past five years It Eras not had a liquor license revoked for any liquor law violation. <br />(state or local?, If a revocation has occurred, please give details on the back of this renewal, then sign below. <br />4. Licensee eon fin,ns that during the past five years it or its oyees have -rot been cited for nrpr civil or crirnictal <br />liquor law vidg ions. If violations have oemirred, please give details an back of this renewal, then sign below, <br />S. L.icsrusee contains that durum the past license year; asummonshes not been issued under the Liquor Liability <br />Law {Dram Shop) MS 340A.802. if yes, attach a copy of the wr arnor:a, then sign below.. <br />6. Uceraee confirns thdt Work= Coenpansetlon Insurance will be inept lir eftbct during the lieerree period. <br />Licensee has attached it liquor Ilability Insurepce eertl0cate tlateoreespbode with the license period In elty/county wWre <br />lieeense Is Issued. 5100,000 In cash or seearitles orS100,000sari qr bond nary be submitted in In afhquor liability. <br />(&2& liquerilcenow art: exempt "les are less then 525,OOD at on sal, or 550,006 it off sale). <br />Licensee SignatureDOB,_„SSII Vater <br />(Stgrratum cadfies all above rnfonn on to be oonvd and Ircenvie has been approved by ellyJam ity.) <br />!k <br />City CletVCounty Auditor Signature <br />{Signature cardfles that renewal of a liquor, wire or club license has been approved tly the city/county as stated above.) <br />County Attorney Signature Datq <br />County Board muted licenses only(St cc 1ti h see Is eligible for llcerrae). <br />Policast e-ifrSwriature pate <br />Sigsatutre certifies hoenme orasecciatea ave owked for ony aateliocal liquor law violations (criminWdvii) dams the per; five yea Report <br />vlotatrons on back, dyes s* hem <br />