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Minnesota Deparment of Publin, Safety <br />ALCOHOL AND GAMELENCi ENFORCEMENT DIVISION <br />444 Cedar Seel: Suite 133, St. Paul 'AN 55101-5133 <br />(651) 201-7507 Fax (651) 297-5259 TTY (651) 232-6555 <br />\AWAVDPS.STATENLNES <br />APPLICATION AND PERMIT <br />FOR A 1 TO DAY TEMPORARY ON-SALE LIQUOR LICENSE <br />TY PS OR PRINT rsToRmATIoN <br />NAME OE ORGANIZATION <br />,..-7S444) fl. 6/:(k•i■J <br />I DATE ORGANIZED TAX EXENOTINILTASER <br />LI <br />=ET ADDRESS <br />dr, <br />OF PERSON MAKING APPLICATION <br />(7o13/40 /Ad/-/ K <br />DATES LIQUOR WILL BE SOLD - <br />ORGANIZATION OFFICERS YAME <br />4.<4 vt-D <br />ORGANIZATTON OFFICERS NAME <br />;d/, t7 <br />CITY STATE ZIP CODE <br />rruc-k A../t STs7 <br />BUSINESS PHONE HOME PHONE' <br />(65-) 7"-? <br />TYPE OF ORGANIZATIQN-------, <br />CT i1 7R CT-TA: ITAB5L RFT OTDUS OTT-17R NONPROFIT <br />ADDRESS <br />1 7> 8.0 Latailr ADAr 24ts'N flic-rce c201{-AA, <br />ADDRESS <br />"4' AKTC— H7 <br />ORGANIZATION OFFICER'S NAME <br />'ADDRESS <br />LazatIon hcansta ha used, If an outdoor area, citicnbe.. <br />CF:& Lei-4- 62; fl2t CY". 2— — 5-7444 . <br />thit applicant contrac iibt intoxicating- liquor titaAlcit? lf so, the ritane and adthass of the I iquot licensee provlding int sarilice. <br />/ <br />0VS: appllaint crE\Ty Sucr 11E0'.71ty irShratte: 15 30. TI:EItt P'-91 BB; S nazne Luc. ananur.taptICON-Cta.2a, <br />ROY: <br />APPLICATION ‘IL'ST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL & GAMBLING <br />ENFORCEMENT <br />CITY/COUNTY <br />CITY FEE AMOUNT <br />DATE FEE PAID <br />DATE APPROVED <br />LICENSE DATES <br />SIGNATURE CITY CLEIG3 OR COUNTY OFFICIAL APPROVED DIRECTOR ALCOHOL AND GAMBLING ENFORCEMENT <br />NOTE: Submit this form to the city or county 30 days prior to oVc1t. Forward application signed by city antlfor county to the address <br />alshve. if Ins tpplicarish is apprc,s0 thc Alcohol and Cramb00?, Ezforesmsat 1)1:on will :chant this sprUitation to us used & tha licsasc for the cvsst <br />38 <br />n-09079 (0,St.75) <br />