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Application For Branch License - Minnesota

Application For Branch License Form. This is a Minnesota form and can be used in Alcohol And Gambling Enforcement Division Statewide .
 Fillable pdf Last Modified 10/15/2010
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Minnesota Department of Public Safety ALCOHOL AND GAMBLING ENFORCEMENT DIVISION 444 Cedar Street, Suite 222, St. Paul, MN 55101 (651) 201-7506 TDD (651) 282-6555 FAX (651) 297-5259 APPLICATION FOR BRANCH LICENSE Wholesaler of: Intoxicating Liquor $3,000 plus $150 OET* surcharge Total due: $3,150 Wholesaler of: Malt Beverages $25 plus $5 OET* surcharge Total due: $30 License Expiration Date: I, License Number: Date Approved: as (Owner, Partner or Officer) for and in behalf of (Trade Name) (Home Office Address) (City) (Zip Code) Phone Number , Fax Number hereby apply for a wholesale branch license to sell alcoholic beverages containing more than 3.2 % of alcohol by weight, as herein designated, at: The branch establishment shall be under the management of Name of Firm Signature of Affiant MAKE CHECK PAYABLE TO: ALCOHOL & GAMBLING ENFORCEMENT DIVISION AMOUNT RECEIVED *Office of Enterprise Technology American LegalNet, Inc. www.FormsWorkFlow.com
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