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Minnesota Department of Public Safety <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br />444 Cedar Street Suite 222, St. Paul MN 5510 [ -5133 <br />(651) 201 -7507 Fax (65 I) 297 -5259 TTY (651) 282 -6555 <br />W W W,DPS.STATE.MN.US <br />APPLICATION AND PERMIT <br />FOR A I TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />NAME OF ORGANIZATION <br />LITTLE CA•! {l-'bA 72Ecke4nom Ass0 <br />DATE ORGANIZED <br />J�,Js ltlb "L <br />TAX EXEMPT NUMBER <br />2-9 cf Z <br />STREET ADDRESS <br />Sic L lT'rcCI C'e+,4 4 DA i2ce <br />CITY <br />Lrrae G/f4itW <br />STATE <br />'4I') <br />ZIP CODE <br />CS- i 17 <br />NAME OF PERSON MAKING APPLICATION <br />—Fr/VA-ill '��hvac yvte}cJ:a K'j <br />BUSINESS PHONE <br />(GS�d)�°��F�' "7G >�6 <br />HOME PHONE te;GU d >S`/ <br />(G>sl)54S'7.`�LOit 2b�i''2`C�7 <br />DATES LIQUOR WILL 135 SOLD{ <br />t <br />_ z � i i <br />TYPE OF ORGANIZATION <br />CLUB CHARITABLE RELIGIOUS <br />ADDRESS 2)L)2,.l L.e,fGtlgr.[) <br />L, rat CA-Ai 4p,4 4W <br />TREK NONPROF72' <br />ORGANIZATION OFFICER'S NAME <br />�Ci�"16� 2,wtv1& 5‘.<4 <br />UJm <br />SC/ 0 ci <br />ORGANIZAT ON OFFICER'S NAME <br />kiVtA h4 Mo E Lit t>J <br />ADDRESS (f) et 8 L_ t cd 0 J A.0 C <br />L e r t'� CA -ru,A Utz brut CC/I) <br />ORGANIZATION OFFICER'S NAME <br />NA -Nicii 'R H©/IM4 <br />ADDRESS 7-1 e../ C; 4 zc &' t L.4 <br />JAtsg4ls F4giGII15 M.j STS-7 17 <br />Location license will be used. If an outdoor area, describe ;/ <br />'1\ 11.X c tt.c 1t7 c /v l3F✓IeJ. r <br />•IoIUEE2 P/+(2..K L r rrt51 CA-- i:9eto ill A) S.s )1'7 <br />Will the applicant contract for intoxicating liquor service? If so, give the name and address of the liquor licensee providing the service. <br />NC <br />Will the applicant carry liquor liability insurance? If so, please provide the carrier's name and amount of coverage. <br />CAPUT0L kN\bEAAlitf ( p Nab/ CP0131gbci2, as— oditc. <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY <br />ENFORCEMENT <br />CITY/COUNTY <br />BEFORE SUBMITTING <br />DATE APPROVED <br />LICENSE DATES <br />TO ALCOHOL & GAMBLING <br />CITY FEE AMOUNT <br />DATE FEE PAID <br />SIGNATURE crry CLERK OR COUNTY OFFICIAL APPROVED DIRECTOR ALCOIIOI, AND CAiMMRLI NG ENFOt CENIILNT <br />NOTE: Submit this form to the city or county 30 days prior to event. Forward application signed by city and /or county to the address <br />above. If the application is approved the Alcohol and Gambling Enforcement Division wilt return this application to be used as the License for the event <br />P8-09079 (12/09) <br />6 <br />