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.,. " ' .... <br /> _ <br /> ' ~C~:.'~- ~ ~esom Dep~m~t Of Public S~e~ <br /> ,~~~ ALCOHOL ~D GA~L~G ENFORCEMENT <br /> ~¢[ y~*~, 444 Ced~ S~e,t- S~t, t33 <br /> <br /> ~~" (651)29~39 ~D (651 )282.6555 <br /> <br /> ~ ON OF ~ ON S~E ~/OR S~AY LIQUOR LICENSE <br /> <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br />I <br /> <br />Workerc Compcn$auon lnaurance Carrrpany <br />LICENSEE'S SALES & USE 1AX lrl~. <br />800-657-3777 <br /> <br /> Policy #. <br />:1'o apply for s~les tax numbec, call 296-618'1 or '1- <br /> <br />crry os: ~ cot~-n'oF: <br /> <br />DOB <br /> <br />Thc Licensee rmist have one f thc £ol)owing: <br />THIS FORM) <br /> <br />(ATTAClt CERTIFICATE OF INSUR.A.NCE TO <br /> <br />ChFlc O.e: <br /> ,r A. Liquor Liability lnsuranoe (Dram Shop) - $$0,000 per person: $ I00,000 more than on person: $10,000 <br />Pro~ea'ly DeslrUClion. <br /> I50,000 and $100,000 for loss of means of support <br /> <br />I <br />I <br /> <br /> B. A bond of a ~urety coml~any wi~ minimum coverage as specified above in A. <br />http://ww'~,dps.s~ate, mn.us/aicg;amb/alcengfonnslsundayliq,htm <br /> <br />6/27/2 00~_191_ <br /> <br /> <br />