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44~ CI~AR ST-SUITE 100 L ~ Sg. fcty <br /> SION <br />ST. PAUL I'IN 55101-2156 MN55101 <br /> (612)296-6430 TTY(612)282-6555 <br /> <br />RENEWAL OF LIQUOR, WiNE, OR CLUB LICENSE <br /> <br /> Licensee: Please vet, ify your licease ~ormation contained below. Make corrections ffnecessary and sign. City <br />Clerk/County Auditor should submit this signed renewal with completed license and licensee liquor liability for the new <br />license period. City Clerk/County Auditor are also required by M.S. 340A,404 S. 3 to report any license <br />cancellation. <br /> <br />License Code ON SS <br />City/County where license approved <br /> <br /> License Period Ending 0 6 / 30 / 9 6 <br />Ramsey <br /> <br />.]Z)# 8599 <br /> <br />Lic, enseeNarae Ba~nyar'd Entertainment I nc. <br /> <br />TradeNamc Lighthouse Grille & BaP <br /> <br />Lieensed Location address 6937 NW Hwy 10 <br /> <br />City, Statc, ZipCod¢ Ramsey, MN 55303 <br /> <br />Busiaess Phone ( 6 1 2 ) 4 2 1 - 1 4 0 0 <br /> <br /> LICENSE FlgES.: Off Sale $ Ca Sale $ 4,0 0 0.0 0 Sunday $ 2 0 0.0 0 <br /> <br />By si~ing this renewal application, applicant certifies that there has been no change in ownership, corporate officers, <br />partners, home addresses, or telephone numbers. If changes have occurred during the past 12 months, please give details <br />on the back of this refiewal, then sign below. <br /> <br />Applicant's signature on this renewal confirms the following: Failure to repor~ a~y of thefollowing will result il~ <br />f'mes. <br /> <br /> Licensee coafamas that it has never had a liquor license rejected by'~y city/township/county ia the state of <br /> Minnesota. J. fever rejected, please give details on thc back of this renewal, then sign below. <br />2. Licensee confirms that for the past five years it has not had a liquor license revoked for any liquor law violation <br /> (state or Ioc.!d). If a revocation has occurred, please give details on thc back of this renewal, then sign below. <br />3. Licensee coiffirms that during thc past five years it or its employees have not been cited for any civil or criminal <br /> liquor law Violations. If violations have occurred, please give details on back of this renewal, then sign below. <br />4. Licensee coafirms that during the past license year, a summons has not been issued under the Liquor. Liability Law <br /> (Dram Shop) MS 340A.802. Ifyes, attach a copy of the summons, then sign below. <br />5. Licensee colffirms that Workers Compensation insurance is ia effect for the full license period. <br /> <br />Licensee has attached a liquor liability insurance certificate that corresponds with the license period in city/county <br />where license is issued. $100,000 in cash or securities or $100,000 surety bond may be submitted in lieu of liquor <br />liability. <br /> <br />Licensee Si~ature . Date <br />(Signature certifies all above information to be correct and license has been approved by city/county. <br /> <br />Ci_ty Cl.erk/Coun .ly A~rlitor Signature Date <br />(Signature certifies tttat an on-sale iatoxicatiag liquor license has been approved by the city/county as stated above). <br /> <br />Coun .ty At~omey Si_~a~xtre <br />County Board issued licenses only (Signature certifies licensee is eligible for license) <br /> <br />Date <br /> <br />police/Sheriff SignalUre <br /> <br />Date <br /> <br />(Signature certifies licensee or associates have not been cited during the past five years for any state/local liquor law <br />violations (criminal/civil). Report violatioas on back, then sign here. PS 9093-94 <br /> <br />I <br /> <br /> <br />