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:l <br /> 1 <br /> <br />444 CEDAR ST-,.~JITE 100 L <br /> <br />RENEWAL OF LIQUOR, WINE, OR CLUB LICENSE <br /> <br /> Licensee:. Please v ~er~ your license information contained below. Make corrections if necessary and sign. City <br />Clerk/County Auditor should submit tiffs 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 ONSS License Period Ending 06/30/96 <br />City/County where lic4ntse approved R ams e y <br /> <br />ID# 3300 <br /> <br />Licensee Name Super' Bow ] I nc. <br /> <br />Trade Name Super Bowl <br /> <br />Licensed Location address 6 7 2 0 R i v e r d a ] e D r <br /> <br />City, Statc, ZipCodc Ramsey, HN 55303 <br />Business Phone ( 61 2 ) 4 2 1 - 7 77 9 <br /> <br />LIC]ENSE FEES: Off Sale $ On Sale $ 4,0 00. 0 0 Sunday $ 2 0 0.00 <br /> <br />By siLmlng this renewal application, applicant certifies that there has been no change in ownership, corporate officers, <br />partners, home addr~ses, or telephone numbers. If changes have occurred during the past 12 months, please give details <br />on the back of this renewal, then sign below. <br /> <br />Applicant's si_enature on this renewal confirms ~be following: Failure to report any of the following wig result hl <br />f'mes. <br /> <br />1. Licensee eom'mas that it has never had a liquor license rejected by'any city/township/county in the state of <br /> Mirmesota.: [fever rejected, please gSve details on the back of this renewal, then sign below. <br />2. Licensee coafums that for the past five years it has not had a liquor license revoked for any liquor law violation <br /> (state or local). Ifa revocation has occurred, please give details on the back of this renewal, then sign below. <br />3. Licensee confmns that during the 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 cOnfirms that during the past license year, a summons has not been issued under the Liquor Liability Law <br /> (Dram Sh~p) MS 340A.802. If yes, attach a copy of the summons, then sign below. <br />5. Licensee confums that Workers Compensation insurance is in effect for the full license per/od.. <br /> <br />Licensee has attached a liquor liability insurance certificate that corresponds with the license period in cRy/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 />Lie. e~see Signature2 Date <br />(Signature certifies: all above information to be correct and license has been approved by city/county. <br /> <br />.City Clerk/County t~uditor Signature Date <br />(Signature certifiea that an on-sale intoxicating liquor license has been approved by the city/county as stated above). <br /> <br />.County Attorney Sjgnatur. e <br />County Board issued licenses only (Signature certifies licensee is eligible for license) <br /> <br />Date <br /> <br />police/Sheriff Si~ature <br /> <br />Date <br /> <br />(Signature certitici; licensee or associates have not been cited during the past five years for any state/local liquor law <br />violations (crimin~civfl). Report violations on back, then sign here. PS 9093-94 <br /> <br /> <br />