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Minnesota Jepavtri enr of :Pubic Sac` <br />LIQUOR CONTROL DiYISION <br />( uuar StiSui _ 1 OL <br />Stu 1, NUN 55 IC, -7156 <br />(612)296-6439 IUD (6! 2)232-3555 <br />� P? 1�{.. -h i I N AND PERfilRf <br />FOR A 1 TO + DAY TEM ?OR R V ON-SALE - - R LICENS17. <br />;{ raanization o,raion :United co 3 permits in a ;numb pe;iod`s4 <br />or <br />TYPE OR PRINT 1NFOR:NLA_1ION <br />NAME GE ORGAi+IZ.ATION <br />y <br />l rl �`C.� LL .�.�,i�Ly K-Q.G I��c.:� /u .'l /S ,c. �. r1U� <br />DATE ORGANIZED <br />d <br />j v n-L' � / 42). <br />TAX EXEMPT NUMBER <br />X % 51,2 CP <br />1 STREET ADDRESS <br />S-( 5 L ('trio L6�- A. a, R. g2,, <br />CITY CO3-4,1*. <br />Little. e. <br />STATE <br />yvl,/t/ <br />ZIP CODE <br />- .57 / 7 <br />NAME OF PERSON MAKING APPLICATION <br />I[R uc-`E- P10475 <br />BUSINESS PHONE <br />(kii) iS& - yci`i <br />ROME 'HONE <br />(LYI) l't b 5, c <br />DATES LIQUOR WILL I3E SOLD )o 4 days) <br />A-T 0 CC. 2,1 '''`' <br />TYPE OF ORGANIZATION <br />❑ CLUB 0 CHARITABLE 0 RELIGIOUS XOTHER NONPROFIT <br />ORGANIZATION OFFICER'S NAME <br />'R c_. V.-- :i3o5 <br />ADDRESS <br />72 6 6ry;,.e, S.71, L- .e. M/ '). 55 0 7 <br />ORGANIZATION OFFICER'S NAME <br />1 3 � t y y - \ 4 S ' e 3 d / ` <br />ADDRESS <br />-2`t Flo De3d1-cD :57 L L. Any STVf7 <br />ORGANIZATION OFFICER'S NAME <br />NcuKt, k€ -iPel. T <br />ADDRESS <br />„2 835 Cvs1-r Ln , L..C. m g . 557/7 <br />Location where license will be used. If an outdoor area, describe <br />;2_6,2- \ 'W«.. int er, xv,. 7 5 r ilk PI 5 Sc t+,cc( — 1-1 -4.1, <br />Wi,111-",c,,e -.-n- Dcv,.(c:e <br />Will the applicant contract for intoxicating liquor services? If so, give the name and address of the Liquor license providing the service. <br />I <br />IWill the applicant carry liquor liability insurance? If so, the carrier' s name and amount of coverage. <br />(NOTE: Insurance is not mandatory) 1144 . ..) " Lt,,n,cl-z_r s.,,'i- s -..y Q S5 c cc-b o n <br />I APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />I CITY /COUNTY <br />DATE APPROVED <br />LICENSE DATES <br />CITY FEE AMOUNT <br />DATE FEE PAD <br />1 <br />SIGNATURE CITY CLERK OR COUNTY OFFICIAL <br />APPROVED LIQUOR CONTROL DIRECTOR <br />INOTE: 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(8/93) <br />