Minnesota Department of Public Safety

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1 Minnesota Department of Public Safety Alcohol and Gambling Enforcement Division (AGED) 445 Minnesota Street, Suite 222, St. Paul, MN 55101-5133 Telephone 651-201-7500 Fax 651-297-5259 TTY 651-282-6555 www.dps.state.mn.us Application for Optional 2 AM Liquor License License type code: 2AM License Expiration Date________________ ID#________________ (For Office Use Only) Licensee Name: _______________________________________________________________________________ Trade Name: __________________________________________________________________________________ Licensed Location Address: ______________________________________________________________________ City, State, Zip Code: ___________________________________________________________________________ Business Phone: _______________________________________________________________________________ If the above named licensee is a corporation, partnership, or LLC, complete the following for each partner/officer: __________________________________________________________________________________________________________________ Partner/Officer Name (First Middle Last) DOB Social Security # Home Address ________________________________________________________________________________________________________________________ Partner/Officer Name (First Middle Last) DOB Social Security # Home Address ________________________________________________________________________________________________________________________ Partner/Officer Name (First Middle Last) DOB Social Security # Home Address Licensee must report previous 12 month on sale alcoholic beverage gross receipts by checking one of the boxes below. Next to the box you check is your 2 AM license fee. Make check payable to: Alcohol and Mail this application and check to : AGED, 445 Minnesota St., Gambling Enforcement Division (AGED). Suite 222, St. Paul, MN 55101. $300 2 AM license fee - Up to $100,000 in on sale gross receipts for alcoholic beverages $750 2 AM license fee - Over $100,000, but not over $500,000 in on sale gross receipts for alcoholic beverages $1,000 2 AM license fee - Over $500,000 in on sale gross receipts for alcoholic beverages $200 2 AM license fee - 3.2% On Sale Malt Liquor licensees or Set Up license holders $200 2 AM license fee - Did not sell alcoholic beverages for a full 12 months prior to this application Yes No Does your city or county licensing official allow the sale of alcoholic beverages until 2 AM? City Clerk/County Auditor Signature Date _______________________________________ ________________ (I certify that the city or county of _____________________________ approves the sale of alcoholic beverages until 2 AM) Licensee Minnesota Tax ID Number (Required)______________________________________ Licensee Signature ______________________________________________________ Date________________ (I certify that I have answered the above questions truthfully and correctly) Licensee: Prior to submitting this application to the Alcohol and Gambling Enforcement Division, it must be signed by your local city or county licensing official.

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