Fillable LICENSE APPLICATION City of Duluth City Clerks Office (City of Duluth)

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LICENSE APPLICATION City of Duluth City Clerks Office (City of Duluth)

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City of Duluth – City Clerk’s Office For Office Use Only
411 W First Street – City Hall 330 Date: __________________________
Duluth, MN 55802-1189 License No.____________________
Phone: (218) 730-5500
Fax: (218) 730-5923
LICENSE APPLICATION
GOVERNMENT DATA PRACTICES ACT -
CLASSIFICATION
WARNING: The data you supply on this form will be used to process the license you
are applying for. You are not legally required to provide this data, but we will not be able to process the license without it. Some of the data
will be classified as public data if and when the license is granted. Private financial information including a tax identification number and
social security number are classified as private data and will be available to governmental personnel and other governmental agencies
whose access is necessary to perform their official duties.
LICENSE
FEE
TEMPORARY ON SALE LIQUOR – 1
ST
DAY/EVENING =
$298.00
PLUS $148.00 EACH ADDITIONAL DAY =
$__________
TOTAL =
$______________
LICENSEE BUSINESS NAME & ADDRESS: TRADE NAME OR NAME OF EVENT:
______________________________________ ___________________________________________
______________________________________ BUSINESS PHONE NO: ______________________
______________________________________
MANAGER’S NAME & ADDRESS: OWNER OF BUSINESS PREMISES: ___________________
_____________________________________ __________________________________________________
_____________________________________ EVENT LICENSE DATE (S): __________________________
_____________________________________ __________________________________________________
Rain Date? Yes No If Yes, List Date: ___________________________________
Contact State Health Department at 723-4642 For Application for Beer and/or Food.
Security Personnel Questions? Call 730-5421
No
If Yes, Contact City Clerk’s Office For Dancing License Application
Will Dancing Be Allowed? Yes
I HEREBY STATE THAT ALL INFORMATION HERE IS TRUE AND CORRECT AND THAT I SHALL COMPLY WITH ALL PROVISIONS
OF THE ORDINANCES OF THE CITY OF DULUTH AND LAWS OF THE STATE OF MINNESOTA AND THEIR AMENDMENTS.
_____________________________________________________________
SIGNATURE OF APPLICANT
MAILING ADDRESS
___________________________________________________
___________________________________________________
EMAIL: _____________________________________________
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CITY OF DULUTH
APPLICATION FOR ALCOHOLIC BEVERAGE LICENSE
1. Name of Applicant (individual, partnership, corporation or association) that owns the business to be licensed:
___________________________________________________________________________________________
2. Trade Name: _____________________________________________________________________________
3. Address of place to be licensed: ______________________________________________________________
4. Designated Serving Areas (i.e. round floor, second, deck, etc.) ______________________________________
___________________________________________________________________________________________
5. Name and address of owner of building: ________________________________________________________
________________________________________________________
________________________________________________________
Any connection with applicant? __________________ Who receives the rent? ________________________
6. Who will direct the operation of the business or serve as manager on the premises?
List name, address & title: __________________________________________________________________
__________________________________________________________________
7. If partnership, give name of each partner and percentage of ownership, and, if limited partnership, give details:
___________________________________________ __________________________________________
___________________________________________ __________________________________________
___________________________________________ __________________________________________
8. If corporation, list all stockholders, directors, officers and the percentage of stock or number of shares owned by
each:
___________________________________________ __________________________________________
___________________________________________ __________________________________________
___________________________________________ __________________________________________
9. State approximate distance of this establishment from the nearest academy, college, university, church or school:
___________________________________________________________________________________________
10. State whether any consideration, money or property, has been paid, or will be paid, given, exchanged or pledged,
by anyone, and to whom, for the purchase or operation of this business. State the amounts in detail.
Failure to answer all questions truthfully on this application and Affidavit “A,” which is made a part thereof,
will be just cause for revocation of your license.
I (we) hereby certify that the applicant will be the sole owner and operator of this business to be conducted under the license and I (we)
will notify the City Council in writing of any change in ownership in this business before the change is made, for the approval of the
Alcohol, Gambling and Tobacco Commission and City Council. I (we) have read the foregoing questions and answers to said questions
are true of my (our) knowledge. I (we) will comply with all the provisions of the Alcoholic Beverage Code and the laws and regulations
of their amendments.
Signature: ____________________________________________________ Date: ___________________
Signature: ____________________________________________________ Date: ___________________
- 1 of 2 -
CITY CLERK’S OFFICE AFFIDAVIT “A” ALCOHOLIC BEVERAGE
330 CITY HALL LICENSE APPLICATION
DULUTH, MN 55802
To be completed by each individual license, or each member of partnership, or two major stockholders
of a corporation, or two primary officers of a club and the person who will be directing the operation of the
business on the licensed premises.
NOTE: Type or print legibly and provide all information requested. Failure to do so may delay the
issuance of this license.
RENEWALS: If this affidavit is made relative to the annual renewal of an existing license, fill out items
1-4, and 11 & 12 of this application. Items 5-10 need be answered only as they relate to any changes
in your status since the filing of your last affidavit.
1. License Applicant
(Individual, Partnership, Corporation or Club)
2. Address of licensed premises ______________________________________________________
3. Your Name ____________________________________________________________________
(First) (Middle) (Last) ( Jr./Sr.) (Date of Birth)
4. Home Address _________________________________________________________________
(Address) (City) (County) (State) (Zip)
5. Other home addresses in last 10 years:
6. Other names you are, or have been known by, including maiden name: ______________________
7. Your position in the business: ______________________________________________________
(Owner, partner, president, treasurer, manager, etc.)
8. (a). Do you, your spouse, or your children have any pecuniary interest in the ownership, operation,
management or profits of any establishment license in Minnesota to sell liquor or 3.2 beer either at retail
or wholesale? Yes _______ No ______
(b). Do you, your spouse, or your children own stock in any corporation having a pecuniary interest
in the ownership, operation, management or profits of any establishment license in Minnesota to sell liquor
or 3.2 beer either at retail or wholesale? Yes ______ No ______
- 2 of 2 -
(c). If the answer to (a) or (b) is “yes”, state the location of the establishments involved and fully
describe the nature and extent of the interest. ____________________________________________
9. Furnish the names and addresses of at least three business references, including one bank reference:
(1) ______________________________________________________________________________
(2) ______________________________________________________________________________
(3) (Bank) ________________________________________________________________________
10. (a). Have you or any corporation in which you held more than 10% stock, ever been denied a
license to sell liquor or beer? Yes _____ No _____
If yes, why? ______________________________________________________________
(b). Have you or any corporation in which you held more than 10% of the stock ever had a liquor
or beer license suspended or revoked? Yes _____ No _____
If yes, why? ______________________________________________________________
11. Have you ever forfeited bail on or been convicted of violating any law relating to the operation of a bar
or the sale, distribution, manufacture or transportation of alcoholic beverages? Gambling laws?
Prostitution or disorderly house laws? Drug laws? Receiving or concealing stolen property? Assaults?
Yes _____ No _____
If yes, state the violation, where and when it occurred, the maximum possible penalty for the violation, and
whether or not the record of the conviction has been expunged. ______________________________
12. Have you read and do you understand the laws, rules and regulations of the State of Minnesota and
the City of Duluth relative to the sale and distribution of alcoholic beverages? Yes ____ No ____
I HEREBY AFFIRM UNDER PENALTY OF PERJURY THAT THE ABOVE ANSWERS ARE TRUE AND
CORRECT.
(WITNESS) (DATE) (APPLICANT’S SIGNATURE)
K:\CLERKDOC\LICENSES\Current Licenses\templiq_Supplemental_Form.wpd
CITY OF DULUTH
SUPPLEMENTAL FORM
Additional information is being required by the Duluth Police Department. An incomplete
application will result in the delay or rejection of your application.
1. Is this the first time for this event? Yes No
If No, how many people attended this event ____________
If Yes, how many people are you expecting to attend? ____________
2. What kind of advertisement have you done? _______________________________
3. What is the age of the target group for this event? ____________
4. Will alcohol be sold or given away at this event? ____________
5. Will dancing be allowed at this event? ____________
I understand that as the applicant for this permit/license, I am responsible for the
Police/Security for this event. I will provide proof of hired security two weeks prior to the
scheduled event.
________________________________________ ____________
Applicant Signature Date
For office use only
Is a licensed Peace Officer needed for this event? _____________________
If yes, how many licensed peace officers will be required? _______________
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Minnesota Department of Public Safety
Alcohol and Gambling Enforcement Division
444 Cedar Street, Suite 222, St. Paul, MN 55101
651-201-7500 Fax 651-297-5259 TTY 651-282-6555
APPLICATION AND PERMIT FOR A 1 DAY
TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE
Name of organization Date Organized Tax exempt number
____________________________________________ _________________________ _____________________
Address City State Zip Code
______________________________________ _________________________ MN _______________
Name of person making application Business phone Home phone
___________________________________________ _______________________ ______________________
Date(s) of event Type of organization
______________________________________ Club Charitable Religious Other non-profit
Organization officer’s name City State Zip Code
______________________________________ _________________________ MN ________________
Location where permit will be used. If an outdoor area, describe.
If the applicant will contract for intoxicating liquor service, give the name and address of the liquor license providing the
service.
If the applicant will carry liquor liability insurance, please provide the carrier’s name and amount of coverage.
APPROVAL
APPLICATION MUST BE APPROVED BY THE CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT
_______City of Duluth/St. Louis County______________ _____________________________________________
City/County Date Approved
______________________________________________ _____________________________________________
City Fee Amount Permit Date
_____________________________________________
Date Fee Paid
______________________________________________ _____________________________________________
Signature of City Clerk or County Official Approved Director Alcohol and Gambling Enforcement
NOTE: Submit this form to the city or county 30 days prior to event. Forward application signed by the city and/or county to the address above.
If the application is approved the Alcohol and Gambling Enforcement Division will return this application to be used as the permit for the event.
DULUTH LEGISLATIVE CODE.
CHAPTER 8.
BEVERAGES.
Article 1. Alcoholic Beverages.
Subdivision II. Licenses.
Sec. 8-44. To whom licenses issued--intoxicating liquor.
...(e) Temporary on sale liquor licenses shall be issued only to:
(1) Clubs, charitable organizations, religious organizations and other nonprofit organi-
zations in existence for at least three years;
(2) A registered political committee;
(3) A state university; or
(4) A brewer who manufactures fewer than 3,500 barrels of malt liquor in a year;
in connection with a social event sponsored by the licensee. The license shall be issued for a limited length
of time, not to exceed four consecutive days. Temporary on sale licenses to any one organization or for
one location shall not exceed more than three four-day, four three-day, six two-day or 12 one-day licenses,
in any combination not to exceed 12 days per year. No more than one license shall be issued to any one
organization or for any one location within any 30 day period unless the licenses are issued in connection
with an event officially designated a community festival by the city. The city may authorize the temporary
on sale liquor license on premises other than premises the licensee owns or permanently occupies. The
license may provide that the licensee may contract for intoxicating liquor catering services with the holder
of a full-year on sale intoxicating liquor license used by the city;...
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LICENSE APPLICATION City of Duluth City Clerks Office (City of Duluth)

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Completed 3 August 2020

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