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During the past license year, has a summons been issued under the Liquor Civil Liability Law (Dram <br /> <br /> Shop) M.S. 340A.802. If yes, attach a copy of the summons. <br /> -h'cs .'I No 8. Will you serve liquor on Sunday.'? Amount of Sunday License Fee. ' <br /> i Yes '~g~b&~ 9. Is this establishment located in an organized township? If so, attach township approval: <br /> ZJYcs(iNo 10. Has a restaurant license been issued by the state or local health department for this establishment? <br />N-amcCcrti ['ye'-"~/t~- /~'ff'~ L ~'te''t' ~( ~''/~'-of thatl have read thc above questions and that the answers are true ~~own knowledgeD~e/5//_,~~ <br /> applicant (please print or type) /~lican~;s signature <br /> <br />Thc Licensee mt,st have one of the following: <br /> <br />Check {)ne <br /> <br />Of <br /> C, <br /> <br />Liqnor Liability Insurance (Dram Shop) - $50,000 per person; $100,000 more than one person; $10,000 property destruction; <br />$50,000 and $100,000 for loss of means of support. ATTACH "CERTIFICATE OF INSURANCE" TO THIS FORM. <br /> <br />A Surety bond fi'om a surety company with minimum coverage as specified above in A. <br /> <br />A certificate from thc State Treasurer that the licensee has deposited with the State, Trust Funds having amarket value of$10,000 r <br />$1003)00 in cash or securities. <br /> <br /> REPORT BY COUNTY ATTORNEY <br />[ ccrtii'y that to thc best of my knowledge tl~e. applicants., ... ,nam~}d'. ~,~.-~-~.~'ove are eligible to be~liceflJ~d~'~. ,.. . ~.. Yes [] No If no, state reason <br /> 4,: .:,..!~,...~ . ,~ <br /> <br />Signalurc County Attorney <br /> <br />County Date <br /> <br /> REPORT BY SHERIFF <br />I ccrtil~, that to thc best of my knowledge, the applicants named above have not been convicted within the last five years for any violations of <br />State law or municipal ordinance relating to the sale of liquor, except as follows: <br /> <br />Signature Shcriff County Date <br /> <br /> IMPORTANT NOTICE <br />ALI, RETAIl, I,[QUOR I,ICENSEES MUST HAVE A CURRENT FEDERAL SPECIAL OCCUPATIONAL STAMP. THE BUREAU OF <br />ALCOI IOL, TOBACCO AND FIREARMS ISSUES THIS STAMP. FOR INFORMATION CALL (651) 726-0220 <br /> <br /> NOTICE <br /> A S30.00 servit:c charge will be added to all dishonored checks. You may also be subjected to a civil penalty of $100.00 or 100% of the value of the check, <br /> whichever is greater, plus interest and attorneys fees. MS 604.112t <br /> <br />(PS 9015-2004) <br /> <br /> <br />