Minnesota Department of Public Safety ALCOHOL AND GAMBLING ENFORCEMENT 444 Cedar Street – Suite 133 St. Paul, MN 55101-5133 Phone (651) 201-7507 Fax (651) 297-5259 TDD (651) 282-6555 TOUR BOAT APPLICATION TO SELL INTOXICATING LIQUOR (Operating on Lake Superior, St. Croix River and Mississippi River) LICENSE FEE(S) $1,500 Each Vessel $75.00 Sunday Liquor - $30.00 Duplicate Sunday License (Make check payable to: ALCOHOL AND GAMBLING ENFORCEMENT DIRECTOR) LICENSE NUMBER _____________ DATE APPROVED__________ LICENSE EXPIRATION DATE ______________________ WORKERS COMPENSATION INS. CO. ________________________ POLICY NUMBER _______________POLICY PERIOD ____________________________ STATE ________ STATE TAX ID NUMBER______________________________ FEDERAL TAX ID NUMBER ________________________________________ APPLICANT’S NAME AND TITLE ______________________________________ PHONE NUMBER ______________________ TOUR BOAT CARRIER’S NAME ______________________________________________________________________________ MAIN ADDRESS OF CARRIER _______________________________________________________________________________ BODY OF WATER BOATS WILL TRAVEL ______________________________________________________________________ TOTAL NUMBER OF BOATS_________ TOTAL NUMBER OF BOATS BEING LICENSED FOR SUNDAY LIQUOR ________ GIVE HOME PORT CITY FOR EACH VESSEL : (If home port is located outside a city, then give county) (Attach a separate sheet if necessary) NAME OF BOAT ______________________________________ HOME PORT __________________________________________ NAME OF BOAT ______________________________________ HOME PORT __________________________________________ NAME OF BOAT ______________________________________ HOME PORT __________________________________________ NAME OF BOAT ______________________________________ HOME PORT __________________________________________ NAME OF BOAT ______________________________________ HOME PORT __________________________________________ NAME OF BOAT ______________________________________ HOME PORT __________________________________________ If this application is for a vessel(s) commencing operation in Minnesota for the first time, give date operations will begin _____________________________________ Licensee is required to provide proof of liquor liability insurance for the full license period and must submit a Coast Guard Certification for each vessel along with application. LICENSEE SIGNATURE ________________________________________________________________ DATE _______________ OFFICE USE ONLY Amount Received ____________________ Refund Amount______________________________ Refund Made To _____________________________ PS009103 (05/06) American LegalNet, Inc. www.FormsWorkflow.com