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TYPE OR PRINT INFORMA <br />Minnesota Department of Public Safety <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br />444 Cedar Street Suite 222, St, Paul MN 55101 -5133 <br />(651) 201 -7507 Fax (651) 297 -5259 TTY (651) 282-6555 <br />W W W.DPS.STA'FE.MN.US <br />APPLICATION AND PERMIT <br />FOR A 1 TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />NAME OF ORGANIZATION <br />Saint John's Church of Little CanadE <br />DATE ORGANIZED <br />1851 <br />'TAX EXEMPT NUMBER <br />ES 23330 <br />STREET ADDRESS <br />380 Little Canada Road East <br />CITY <br />Little Canada <br />STATE <br />Mn <br />ZIP CODE <br />55117 <br />NAME OF PERSON MAKING APPLICATION <br />Rev. David Kohner. <br />BUSINESS PHONE <br />(51) 484 -2708 <br />HOME PHONE <br />( ) same <br />DATES LIQUOR WILL BE SOLD <br />Friday, March 30, 2012 <br />TYPE OF ORGANIZATION <br />CLUB CHARITABLE <br />REI dG)OUS OTHER NONPROFIT <br />Road East <br />ORGANIZATION OFFICER'S NAME <br />Father David Kohner <br />ADDRESS <br />380 Little Canada <br />ORGANIZATION OFFICERS NAME <br />ADDRESS <br />ORGANIZATION OFFICERS NAME <br />ADDRESS <br />Location license will be used. If an outdoor area, describe <br />school gymnasium /fish fry dinner <br />Will the applicant contract for intoxicating liquor service? if so, give the name and address of the liquor licensee providing the service. <br />no <br />Will the applicant carry liquor liability insurance? If so, please provide the carrier's name and amount of coverage. <br />yes Catholic Mutual (see attached certificate) <br />APPROVAL <br />APPLICATION MUST BE. APPROVED BY CITY OR COUNTY <br />ENFORCEMENT <br />CITY /COUN'T'Y <br />BEFORE SUBMITTING <br />DATE APPROVED <br />LICENSE DATES <br />TO ALCOHOL <br />& GAMBLING <br />CITY FEE AMOUNT _ <br />DATE FEE PAID <br />33GNAIOJRE erne CLERIC OR COUNTY OFFICIAL, APPROVED DIRECTOR ALCOI tOf.. AND GAMBLING I;NI ?OltC?MEN'f <br />AOTIs. Subnut this Cm •m [o the crty or cmmty 30 (lays prior to evert Ieorward application signed by city and /or 00 tatty to the address <br />above. Lfthe application is approved the Alcohol and Gambling Enforcement Division will return this application to In used as the License for the event <br />PS-09079 (12/09) <br />