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!LGo <br /> Akobal&Gambling Entorcamont <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 651-201-7507 Fax 651-297-5259 TTY 651-282-6555 <br /> www.dps.state.mn.us <br /> Application for Optional 2 AM Liquor License <br /> License type code: 2AM License Expiration Date ID# <br /> (For Office Use Only) <br /> Licensee Name: i f&r dou Prope ti e, Trio <br /> Trade Name: 1lO() HE}% <br /> Licensed Location Address: 00 ()Lb `Is W . S tJui <br /> y, State, <br /> City, ZipCode: Ilelt) Brit-Fan m 5'61 i <br /> Business Phone: Ii/a - 2 ga- 33).5 <br /> If the above named licensee is a corporation,partnership,or LLC, complete the following for each partner/officer: <br /> Anna} A lock In;mock) II-0-69 SO-1.3-DV ll IV rledo Ave &). Erookdqn ark <br /> Partner/Officer Name (First Middle Last) DOB Social Security# Home Address nl 1'-1 5608 <br /> Partner/Officer Name (First Middle Last) DOB Social Security# Home Address <br /> Partner/Officer Name (First Middle Last) DOB Social Security# Home Address <br /> Licensee must report previous 12 month on sale alcoholic beverage gross receipts by checking one of the boxes <br /> below. Next to the box you check is your 2 AM license fee. Make check payable to: Alcohol and <br /> Gambling Enforcement Division (AGED). Mail this application and check to : AGED, 444 Cedar St., Suite <br /> 133, St. Paul, MN 55101-5133. <br /> ❑ $300 2AM 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 /> ❑ $1,000 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 /> V" $200 2 AM license fee - Did not sell alcoholic beverages for a full 12 months prior to this application <br /> aYes ❑No Does your city or county licensing official allow the sale of alcoholic beverages until 2 AM? <br /> City Clerk/County Auditor Signature Date <br /> (I certify that the city or county of NE(° ElefAMM approves the sale of alcoholic beverages until 2 AM) <br /> Licensee Minnesota Tax ID Number(Req ired <br /> Licensee Signature 4uf _ Date • _ /( <br /> (1 certify that I have answered the above e 'on rid Me <br /> Licensee: Prior to s ' ing is application to the Alcohol and Gambling Enforcement Division, it must be <br /> signed by your local city or c unty licensing official. <br /> (2AM-5/06) <br />