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Renewal Application for Optional Liquor 2AM <br />License Type: 2AM-500K+ Expires On: August 10, 2008 ID Number: 21065 <br />DBA <br />Brighton Ventures LLC <br />Champps <br />2397 Palmer Drive <br />New Brighton MN 55112 <br />Business Phone: 6516390339 <br />If any of the above licensee information is not correct, please make corrections as necessary. <br />Licensee must report previous 12 month on sale alcoholic beverage gross receipts by checking one of the boxes below. <br />Next to the box you check is your 2 AM license fee. Make check payable to: Alcohol and Gambling Enforcement <br />Division (AGED). Mail this application and check to: AGED, 444 Cedar St., Suite 133, St. Paul, MN 55101-5133. <br />$300 2 AM license fee -Up to $100,000 in on sale gross receipts for alcoholic beverages <br />.—$750 2 AM license fee - Over $100,000, but not over $500,000 in on sale gross receipts for alcoholic beverages <br />) $1000 2 AM license fee - Over $500,000 in on sale gross receipts for alcoholic beverages <br />!_ $200 2 AM license fee - 3.2% On Sale Malt Liquor licensees or Set Up license holders <br />_ $200 2 AM license fee - Did not sell alcoholic beverages for a full 12 months prior to this application <br />Yes _No Does the city or county that issues your liquor `.ense allow the sale of alcoholic beverages until 2 AM? <br />City Clerk/County Auditor Signatt <br />(I certify that the city or county of <br />2AM) <br />Licensee Signature <br />(I certify that I have <br />Licensee Minnesota Tax ID Number (Required): gCqS(D3 7 <br />Date <br />approves the sale of alcoholic beverages until <br />Date (Q tml.gr <br />Licensee: Prior to submitting this application to the Alcohol & Gambling Enfocement <br />Division you must have this form signed by your local city or county licensing official <br />Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division (AGED) <br />444 Cedar Street, Suite 133, St. Paul, MN 55101-5133 <br />Telephone 651-201-7500 Fax 651-297.5259 TTY 651-282-6555 <br />www.dps.state.mn.us <br />• <br />2amRenewal2004 <br />