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RENEVg~b FOR OPTIONAL 2:00 A.M. CLOSING <br /> CITY OF RAMSEY <br /> <br />Licensee Name: <br /> <br />Trade Name: <br /> <br />Licensed Location Address: <br /> <br />City, State, ZIP Code: <br /> <br />Business Phone: <br /> <br />Fee fi~r Optional 2:00 a.m. Closing: $300 <br /> <br />By signing this renewal application, applicant certifies that there has been no change in ownership on the <br />above named licensee. For changes in ownership, the licensee named above, or for new licensees, full <br />applications should be used. See back of this application for further information needed to complete this <br />renewal. <br /> <br />Applicant's signature on this renewal confirms the following: Failure to report any of the <br />following will result in fines: <br /> <br />I. Licensee confirms it has no interest whatsoever, directly or indirectly in any other liquor establishments in <br /> Minnesota. If so, give details on back of this application. <br />2. Licensee confirms that it has never had a liquor license rejected by any city/township/county in the state of <br /> Minnesota. if ever rejected, please give details on the bac~ of this renewal, then sign below. <br />3. Licensee confirms that for the past five years it has not had a liquor license revoked for any liquor law <br /> violation (state or local). If a revocation has occurred, please give details on the back of this renewal, then <br /> sign below. <br />4. Licensee confirms that during the past five years it or its employees have not been cited for any civil or <br /> criminal liquor law violations. If violations have occurred, please give details on back of this renewal, then <br /> sign below. <br />5. Licensee confirms that during the past license year, a summons has not been issued under the Liquor <br /> Liability Law (Dram Shop) MS 340A.802, If yes, attach a copy of the summons, then sign below. <br />6. Licensee confirms that Workers Compensation insurance is in effect for the full license period. <br /> <br />Licensee has attached a liquor liability insurance <br />license period in City where license is issued. ~ <br />lhcensec Signature: ~]).ff~~ <br />City Clerk Signature: <br /> <br />certificate <br /> <br />Date: <br />Date: <br /> <br />that corresponds with the <br /> <br />Police Signature Date: <br />(Signature certified licensee or associates have not been cited during the past five years for any <br />state/local liquor law violations (criminal/civil.) Report violations on back - then sign here. <br /> <br /> <br />