STATE OF MINNESOTA DEPARTMENT OF PUBLIC SAFETY ALCOHOL AND GAMBLING ENFORCEMENT DIVISION PS 9012-02 (9/03) BOND No.________ SURETY BOND ALCOHOL & GAMBLING ENFORCEMENT DIRECOR MANUFACTURERS OR WHOLESALERS ___________ Know all men by these presents That we _________________________________________________________ ______________________________________________________________________________________________ as principal, and ________________________________________________________________________________________________, a corporation organized and existing under the laws of the State of _______________________________________________ and duly authorized to transact a corporate surety business in the State of Minnesota, as surety, are held and firmly bound unto the State of Minnesota in the penal sum of _________________________________________________________________ dollars, good and lawful money or the United States, to be paid to the State of Minnesota, for which payment we bind ourselves, our heirs, executors, administrators, successors and assigns, jointly and severally, firmly by these presents. Sealed with our hands and seals this ________________________ day of _________________________________ , 20 ____ Whereas, The above bounden principal desires to carry on the business of handling intoxicating liquor as a ______________ __________________________________________________________________ and is about to be granted a license for that purpose (Manufacturer or Wholesaler) in pursuance with the provisions of Minnesota Statutes, Chapter 340A, as amended. NOW, THEREFORE, The condition of this obligation is such that if the principal shall comply with the terms of said license or any modifications, extensions or renewals thereof, and with the provisions of the above entitled act of the legislature of the State of Minnesota, and as it may at any time be amended and supplemented, and all other acts and laws of the State of Minnesota, and with the rules, regulations and decisions lawfully made and issued by the proper authorities of the State of Minnesota relating thereto, and that if the said principal shall further pay to the state, when due, all taxes, license fees, penalties and other charges payable by him or her under said act or any other law relating to the manufacture, distribution or sale of intoxicating liquors, and in accordance with the rules, regulations and decisions lawfully made and issued by the proper authorities of the State of Minnesota relating thereto, and all other lawful debts, obligations and undertakings which may be or become owing to the State of Minnesota on account of manufacture, importation, use or disposition of any intoxicating liquor manufactured or imported by, issued to, received or possessed by such principal of said license, or any modification, extension or removal thereof, and that if said principal shall not comply with the provisions of said act this bond shall be forfeited to the State of Minnesota as in said act provided; then this obligation shall be void, otherwise to remain in full force and effect. The surety company consents to be bound by this obligation, not withstanding any informality in its execution. This bond is for the license period commencing ______________________________________________________________ And ending ______________________________________________. Witness our hand and seals this ____________________________ day of _________________________________ , 20____ Signed, sealed, and delivered in the presence of - _______________________________________________________________ (Seal) ________________________________________________________________________________________________________________________________ (Seal) _________________________________________________________________________________________________________________________________ (Seal) _________________________________________________________________________________________________________________________________ (Seal) as to principal _________________________________________________________________________________________________________________________________ (Seal) ____________________________________________________________________ as to surety ACKNOWLEDGEMENT OF PRINCIPAL STATE OF MINNESOTA } }ss. County of ___________________________ } On this _____________ day of _____________________________ , 20____ , before me, a notary public within and for said County appeared _______________________________________________________________ to me known to be the person signing as principal herein, and stated that he signed the same of his own free will and accord. __________________________________________________ Notary Public ___________________________________________ County, (SEAL) Minnesota My Commission expires ______________________________ NOTE: SEE OTHER SIDE FOR ACKNOWELEDGEDMENT FOR CORPORATION AND SURETY. American LegalNet, Inc. www.FormsWorkflow.com FOR CORPORATION STATE OF MINNESOTA } }ss. County of ___________________________ } On this _______________ day of _______________ , 20_____ , before me personally appeared ______________________ ____________________________________________ to me personally known, who being by me duly sworn, did say that he/she is Attorney-in-Fact of the __________________________________________________________________ , that the seal affixed to the foregoing instrument is the corporate seal of that corporation and that said instrument was executed in behalf of the corporation by authority of its board of directors, and said _________________________________________________________ acknowledged said instrument to be the free act and deed of said corporation. _________________________________________________________ Notary Public _________________________________________ County, Minnesota. (SEAL) My Commission expires _____________________________________ ACKNOWLEDGEMENT OF SURETY STATE OF MINNESOTA } }ss. County of ___________________________} On this _______________ day of ________________ , 20_____ , before me personally appeared _____________________ ________________________________________________ to me personally known, who being by me duly sworn, did say that he is Attorney-in-Fact of the ___________________________________________________________________ , that the seal affixed to the foregoing instrument is the corporate seal of that corporation and that said instrument was executed in behalf of the corporation by authority of its board of directors, and said _________________________________________________________ acknowledged said instrument to be the free act and deed of the corporation. Notary Public _________________________________________ County, Minnesota. (SEAL) My Commission expires _____________________________________ Approved by the Alcohol & Gambling Enforcement Director of the State of Minnesota this ___________ Day _____________________________ , 20______ __________________________________________ Alcohol & Gambling Enforcement Director American LegalNet, Inc. www.FormsWorkflow.com