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Minnesota DeparUnent of Public Safety ~ ' <br /> `fit ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br /> 444 Cedar Street Suite U3, St. Paul MN 55101-5133 +e t <br /> ~~~~MIHNEb~ r.~ w' <br /> (GS 20]-7507 Fax (651) 297-5259 TTY (GS I) 282.6555 <br /> W W W.DPS.STATE.MN.US <br /> APPLICATION AND PERMIT <br /> FORA 1 TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE <br /> <br /> 'TYPE OR PRINT' 1NFORMA'I']ON <br /> <br /> NAME OP ORGANI'!.A'1'ION DATE ORGAN]%ED "1'AX ERGMPT' NUMBER <br /> Saint John's Church of Little Canad 10-07-1851 ES 23330 <br /> STREET ADDRESS CITY S1'A"I'E 'LIP CODE <br /> 380 Little Canada Road Little Canada Mn 55117 <br /> NAME OP PERSON MAKING APPLICATION BUSINESS PI40NE IiOMF.. PRONE <br /> Rev. David Kohner ~i51) 484-2708 ~i51) 493-4710 <br /> DATES LIQUOR WII,I. Bli SOLD 'fYPL' OF ORGANILATION <br /> October 3, 2009 <br /> ORGANILAT[ON O1'FICEC2'S NAME ADDRL'SS <br /> Rev. David Kohner 380 Little Canada Road <br /> ORGANII,ATION OFFICER'S NAMI ADllRESS <br /> ORGANI'LAT10N OPPICGR'S NAME ADDRESS <br /> Location license will be used. If an outdoor area, describe <br /> Church grounds and gymnasium <br /> Wiil the applicant contract for intoxicating liquor service? If so, give the name and address of the liquor licensee providing the service. <br /> no <br /> Will the applicant cant' liquor liability insurance? If so, please provide the carrier's name and amount ofcoverage. <br /> YES Catholic Mutual/Archdiocese of Saint Paul and Minneapolis <br /> APPROVAL <br /> APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL & GAMBLING <br /> ENFORCEMENT <br /> CITY/COUNTY DATE APPROVED <br /> CITY FEE AMOUNT LICENSC DATES <br /> DATE FEE PAID <br /> SIGNATURC CITY CLERK OIi COUNTY OFPICIA[. APPROVLD DIRF.CI'OR ALCOI{OL AND GAMDLWG SNBORC1iMIiNT <br /> NOTE: Submit this form to the city or county 30 days prim to event. Forward application signed by city and/or county to the address <br /> above. If the application is approved the Ateohol and Gambling I:nfaecment Division will relw~n tlds application to be used as the License for the event <br /> PS-09079 (OS/OG) <br /> <br />