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Home My WebLink About[04f] Liquor License Transfer 4(f) Council Agenda Item MEETING DATE: December 20, 2012 AGENDA ITEM: Liquor License Transfer– Requested Action: Approve the liquor license transfer from St. Joseph Amoco Liquor to Pequot Liquor LLC. SUBMITTED BY: Administration BOARD/COMMISSION/COMMITTEE RECOMMENDATION: PREVIOUS COUNCIL ACTION: BACKGROUND INFORMATION: The City Office received a request from Pequot Liquor LLC to transfer the Liquor License for St. Joseph Amoco Liquor. Per Ordinance the Police Chief completed a background check and has recommended the City Council approve the License Transfer. This license is for off sale intoxicating liquor with a license period of January 1 to June 30, 2013. BUDGET/FISCAL IMPACT: ATTACHMENTS: Request for Council Action License Application Police Chief Recommendation REQUESTED COUNCIL ACTION: Authorize the Mayor and Administrator to execute the off sale intoxicating liquor license to Pequot Liquor LLC. This page intentionally left blank u rued 0x'4 r' t Minnesota Department of Public Safety , �= ALCOHOL AND GAMBLING ENFORCEMENT DIVISION�"'�awMs,rs 444 Cedar St.,Suite 222,St.Paul,MN 55101-5133 ' '(.:/...)V 4'e- _ (651)201-7507 FAX(651)297-5259 TTY(651)2821-6555 W W W.DPS.STATE..MN.US APPLICATION FOR OFF SALE INTOXICATING LIQUOR LICENSE No license will be approved or released until the$20 Retailer ID Card fee is received Workers compensation insurance company.Name sr'Rail a ,Qc_i fn Oka 1 t..O a olicy# C 1,.... Licensee's MN Sales and Use Tax ID# 1\3 .c 44 To apply for a MN sales and use tax ID#,call(651)296-6181 Licensee's Federal Tax ID# a')..-i3 1. 3Q' If a corporation,an officer shall execute this application If a partnership,a artner shall execute this application. Licensee Name(Individual,Corporation,Partnership,LLC) Social Security# Trade Name or DBA Pa Lie-Ise Locatio I Street Address&Block No.) License Period Applicant's Home Phone# A .6;#61 31t From To City County State Zip Code Name of Store Manager Business Phone Number DOB(Individual Anplicant) If a corporation or LLC state name,date of birth,Social Security#address,title,and shares held by each officer. If a partnership,state names,address and date of birth of each partner. Partner Officer(First,middle,last) DOB . I SS# _ I Title Shares Address Ci S ante,Zi. ��qqdae "'� l6 0' ' (�`- tvve-. .p _Ac rA.0 1 b"'° 3n /r Ica' Partner Officer(First,middle,last) DOB SS# Title Shares Address,City,State,Zip Code Partner Officer(First,middle,last) DOB SS# Title Shares Address,City,State,Zip Code Partner Officer(First,middle,last) DOB SS# Title Shares Address,City,State,Zip Code 1. If a corporation,date of incorporation - —7.-O ci ,state incorporated in irk) ,amount paid in capital . If a subsidiary of any other corporation,so state and give purpose of corporation . If incorporated under the laws of another state,is corporation authorized to do business in the state of Minnesota? ❑Yes ❑No 2. Describe premises to which license applies; such a i t floor .econd floor,basement,etc.)or if entire building,so state. 3. Is establishment located near any state university,state hospital,training school,reformatory or prison? 'Wes ❑No If yes state approximate distance. (Qlo)nciL 4. Name and address of building owner: Q ") 01 i1`Q 3 42 } r___ Has owner of building any connection,directly or indirectly,with applicant? ..,'Yes ❑No 5. Is applicant or any of the associates in this application,a member of the governing body of the municipality in which this license is to be issued? ❑Yes *No If yes,in what capacity? 6. State whether any person other than applicants ha any right,title or interest in the furniture,fixtures or equipment for which license is applied and if so,give name and details. nt-y�. 7. Have applicants any interest whatsoever,directly or indirectly,in any other liquor establishment in the state of Minnesota? I$Yes ❑No If yes,give name and address of establishment. 8. Are the premises now occupied or to be occupied by the applicant entirely separate and exclusive from any other business establishment? ❑Yes,. No 9. State whether applicant has or will be granted,an On sale Liquor License in conjunction with this Off Sale Liquor License and for the same premises. ❑Yes ';(No ❑Will be granted 10. State whether applicant has or will be granted a Sunday On Sale Liquor License in conjunction with the regular On Sale Liquor License. ❑Yes KNo ❑Will be granted 11. If this application is for a County Board Off Sale License,state the distance in miles to the nearest municipality.)n I 1 f'9--- 12. State Number of Employees LIZ 13. If this license is being issued by a County Board, has a public hearing been held as per MN Statute 340A.405 sub2(d)? _ 14. If this license is being issued by a County Board,is it located in an organized township? If so,attach township approval. 1. State whether applicant or any of the associates in this application,have ever had an application for a liquor license rejected by any municipality or state authority; if so,give dates and details. no 2. Has the applicant or any of the associates in this application,during the five years immediately preceding this application ever had a license under the Minnesota Liquor Control Act revoked for any violation of such laws or local ordinances; if so,give dates and details. 3. Has applicant,partners,officers,or employees ever had any liquor law violations or felony convictions in Minnesota or elsewhere,including State Liquor Control penalties? ❑Yes No If yes,give dates,charges and final outcome. 4. During the past license year,has a summons been issued under the Liquor Civil Liability Law(Dram Shop)M.S.340A.802. ❑Yes l'ANo If yes,attach a copy of the summons. This licensee must have one of the following: (ATTACH CERTIFICATE OF INSURANCE TO THIS FORM.) Check one ❑ A. Liquor Liability Insurance(Dram Shop)-$50,000 per person,$100,000 more than one person; $10,000 property destruction; $50,000 and$100.000 for loss of means of support. or ❑ B. A surety bond from a surety company with minimum coverage as specified in A. or ❑ C. A certificate from the State Treasurer that the licensee has deposited with the state,trust funds having market value of $100,000 or$100,000 in cash or securities. I certity that I have read the above questions and that the answers are true and correct of own Knowledge. Print name of applicant&title Signature of Applic s Date CP I(Ylc - P,.Q.oTeP 11410-/Z REPORT BY POLICE\SHERIFF'S DEP,'TMENT • This is to certify that the applicant and the associates named herein have not been convicted within the past five years for any violation of laws of the State of Minnesota or municipal ordinances relating to intoxicating liquor except as follows: Police/Sheriffs Department Title Signature PS 9136-(2009) County Attorney's Signature IMPORTANT NOTICE All retail liquor licensees must register with the Alcohol,Tobacco Tax and Trade Bureau. For information call(513)684-2979 or 1-800-937-8864 r - CITY OF St Jr)4lsrL1 Memorandum To: Mary Generous CC: From: Peter E.Jansky.,Chief of Po1i Date: 12/05/2012 Re:Background Check Moores We have done a criminal background check on Michael Alan Moores. Records check was clear. *AV AW.':::;,-4,46.40:441,';.ittOitirgiRni,141:45iNANVATAfkr, MMU 1 City of St. Joseph Informed Consent Date: it-rt(Uj' The following named individual has made application with the City of St.Joseph for an intoxicating liquor license. Last Name of Applicant (please print): (Y O(Si2-e)� First Name(please print)inithrul, Full Middle Name(please print): 41x2....in Maiden,Alias,of Former(please print): Date of Birth: _ Gender: (M or F): J t Social Security Number: _ - Driver's License Number: _ , _ — yU Current Address:31Ib Oti QL (,f -.CJoi rnb Street Address City State Zip I authorize the Minnesota Bureau of Criminal Apprehension to disclose all criminal history record information to the City of St. Joseph for purpose of securing the liquor license as listed above with the City of St.Joseph. The expiration of this authorization shall be for a period of no longer than one year from the date of my signature. 111044 Signature of Applicant Date STATE OF MINNESOTA COUNTY OF STEARNS Z On this 114, day of 0)3‘) t 201\before me, a notary public within and for said County,personally appeared M'I to me personally know,who,being by me duly sworn,did say that he is the -0.-10,.: / c�~ of J m r1 L.v .the corporation making application for a liquor license in the City of St.Joseph. f •�, K ILOn.RP`t4 KEEN M,�N (SEAL) MCRS 31,2O 1 6 y Notary Public