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Minnesota Department of Pubiic Safety_ <br />LIQUOR CONTROL DIVISION <br />444 Cedar St. /Suite 100L <br />St. Paul, MN 55101-2156 <br />(612)296 -6439 TDD (612)282 -6555 <br />v;-: <br />APPLICATI., `�,�N AND PERMIT <br />FOR A 1 TO 4 DAY TE'/3PO.R RY ON -SALE LIQUOR <br />(Organization or location I:mitato 3 permits in a 12 month peiiod`cc <br />TYPE OR PRINT INFORMATION <br />LICENSE <br />or <br />MR14 <br />NAIVE OF ORGANIZATION <br />I r ft-I -t Cav e,c'kc� ' .c.^�c.: f ,t) A Ass - ,�e:;ho:0 <br />DATE :ORGANi7ED <br />S ,,,,,c .. I9 602. <br />TAX EXEMPT NUMBER <br />a2 7`12 6, <br />STREET ADDRESS <br />S(5- L, *tit e_,-,...kA L - R-d.. <br />CIT 4 <br />L., f. L'�. t & <br />STATE <br />YEA/ <br />ZIP CODE <br />S-57/7 <br />NAME OF PERSON MAKING APPLICATION <br />�J <br />c It=- BJOSj <br />BUSINESS PHONE • <br />(Cc( 2_Y: 00Z 5 31 f13 <br />HOME PHONE <br />(6�/) Y96 3 /G-sr <br />DATES LIQUOR Wli,,L BE SOLD (I to 4 days) <br />i.1 Li / 5 7,c 7 <br />TYPE OFORGANIZATION <br />❑ CLUB 0 CHARITABLE 0 RELIGIOUS -OTHER NONPROFIT <br />ORG/ ITZ TION OFFICERS NAME ' <br />ztc-- - ,3-(5 <br />ADDRESS <br />72 e 5ry.,,. s i . L- .c. io,) . 557 / 7 <br />ORGANIZATION OFFICERS NAME <br />Bctic - 1) 5`a(e.-G/v` <br />ADDRESS <br />9`it &s6t 5T. G(2. pia) 561/7 <br />ORGANIZATION OFFICERS NAME <br />/Jcuts// l-(e -F.%/ e <br />ADDRS <br />at $BS Cost -u., Ln.. 4 -C 44,41 557/7 <br />Location whi e license will be used. If an outdoor area, describe <br />SI' G dr•✓l e-r f_ 0.r VC <br />SSIZ> e/,' Al Gi tf /e l'4— - ,14. „/... Ci7 /7 <br />Will the applicant contract for intoxicating liquor services? If so, give the nate 2nd address of the Liquor license providing the service. <br />Will the applicant carry liquor liability insurance? If so, the carrier' s name and amount of coverage. <br />(NOTE: Insurance is not mandatorv) 1V/, , J7, .'r (,lv,,cl.e- r%ASA4,+\y 4- 556 c<ih0n <br />a <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />CITY /COUNTY <br />DATE APPROVED <br />LICENSE DATES <br />CITY FEE AMOUNT <br />DATE FEE PAID <br />SIGNATURE CITY CLERK OR COUNTY OFFICIAL <br />APPROVED LIQUOR CONTROL DIRECTOR <br />NOTE: Do not separate these two parts, send both parts to the address above and the original signed by this division <br />will be returned as the license. Submit to the City or County at least 30 days before the event. <br />PS- 09079(8/95) <br />2 <br />