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Minnesota Department of Public Safety <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br />444 Cedar Street Suite 133, St. Paul MN 55101 -5133 <br />(651) 201 -7507 Fax (651) 297.5259 TTY (651) 282 -6555 <br />W W W .DPS.STATE.MN.US <br />APPLICATION AND PERMIT <br />FOR A 1 TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />TYPE OR PRINT INFORMATION <br />NAME OF ORGANIZATION <br />Little Canada Canadian Days, Inc. <br />DA'FIE ORGANIZED <br />12/17/1978 <br />TAX EXEMPT NUMBER <br />STREET ADDRESS <br />515 8 Little Canada Rd <br />CI'T'Y <br />Little Canada <br />STATE <br />MN <br />ZIP CODE <br />55117 <br />NAME OF PERSON MAKING APPLICATION <br />Susan Nelson <br />BUSINESS PHONE <br />(612) 743-3203 <br />HOME PHONE <br />(651) 483-4541 <br />DATES LIQUOR WILL BE SOLI) August 1 -3, 2008 <br />TYPE OF ORGANIZATION <br />CLUB CHARPI'ABLF RFIIGIOIIS OTHER NONPROFIT <br />ADDRESS <br />762 Lahore Rd, Little Canada, MN 55117 <br />ORGANIZATION OFFICER'S NAME <br />Susan Nelson, President <br />ORGANIZATION OFFICER'S NAME <br />Joseph Gilles, Vice President <br />ADDRESS <br />2538 McMenemy Rd, Little Canada, MN 55117 <br />ORGANIZATION OFFICER'S NAME <br />Lynda Beaudoin, Treasurer <br />ADDRESS <br />2442 Rice St 11165, Little Canada, MN 55113 <br />Location license will be used. If an outdoor area, describe <br />Spooner Park, 350 Eli Rd, Little Canada, MN 55117 <br />Will the applicant contract for intoxicating liquor service? If so, give the name and address of the Liquor licensee providing the service. <br />Will the applicant carry liquor liability insurance? If so, please provide the carrier's name and amount of coverage. <br />Minnesota Joint Underwriting Association <br />APROVAL <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 />CI'rY FEE AMOUNT <br />DA'I'E FEE PAI D <br />SIGNATURE. CITY CLERK OR COUNTY OFFICIAL APPROVED DIRECTOR ALCOHOL AND GAMBLING ENFORCEMENT <br />N0'J'E: 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 will return this application to be used as the License for the event <br />PS- 09079(05/06) <br />2 <br />