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FROM :ST JOHN'S SCHOOL of L.C. <br />FAX NO. :651- 481 -1355 <br />Rpr. 01 2005 12:39PM P1 <br />Minnesota Department of Public Safety <br />7,, LIQUOR CONTROL DIVISION <br />444 Cedar St. /Suite 100E~ <br />St. Paul, MN 55101-2156 <br />-. (612)296 -6439 TDD (612)282 -6555 <br />APPLICATION AND PERMIT <br />FOR A 1 TO 4 DAY TEMPORARY ON -SALE LIQUOR <br />(Organization or location limited to 3 permits in a 12 mouth period <br />TYPE OR PRINT INFORMATION <br />LICENSE <br />s -.,, <br />Ia <br />- <br />or <br />NAME OF ORGANIZATION <br />ST, 3ohn'5 - sak.00 1 p -p 1. C-- <br />DATE ORGANIZED <br />O -- O — /i.51 <br />TAX XE1VEPT NUMBER <br />ETC ',z,?3,E D <br />STREET ADDRESS <br />--�i/t /,' E. i / /r' a/i <br />CITY <br />4i*{k Cc- ,cteiA- <br />STATE <br />nil /1/ r <br />ZIP CODE <br />5-5.'I/7 <br />N ME OF ,RSON MAKING APPLICA IQN <br />Ito, i Ohcrt A 17p rir�R- <br />BUSINESS PHONE <br />(k7) ilea -,-7n <br />7 <br />,RELIGIOUS <br />HOME PHONE <br />(6S1) SSa- �P�,p4 <br />0 OTHER NONPROFIT <br />D /,A 'ES I,IQ OR WILT; -BE SO (1 to 4 days) <br />r II a 9% aoS <br />TYPE OF ORGANIZATION <br />❑ CLUB 0 CHARITABLE" <br />ORGANIZATION °O.o FFICER'S NAME <br />I <br />ADDRESS <br />ORGANIZATION OFFICER'S N • t <br />ADDRESS <br />ORGANIZATION OFFICER'S NAME <br />ADDRESS <br />Location where license will be used. If au outdoor area, describe/ <br />CH", nit Ni 'E�4 €'v v,.s&etc 4 's Sc. h.BO / (Ty fri Am.e( d•(,-/-I,cicitvq J f ex- .e, <br />Will theppapplicant contract for intoxicating liquor services? If so, give the name and address of the Liquor license providing the service. <br />7 0 <br />Will the aovlieant cam diouor liability *trance ',so_ ?ht minim) <br />s name and amount of ea araec. <br />sr 1 3 La r c - r'e. // to <br />(NOTE: Insurance is not mandatory) its, c l ?-{ 2i; <br />APPROVAL <br />APPT.!CATTON MTT.ST Ttr. APPTiAV'F.n RV ( -cry (Tt rnrrN'f V R Vflix CTTa2MITTTN!_'Y'ft 1.TQTinn refs unL <br />CITY /COUNTY <br />DATE APPROVED <br />LICENSE DA'Z'ES <br />CITY FEE AMOUNT <br />DATE FEE PAID <br />SIGNATURE CITY CLERK OR COUNTY OFFICIAL <br />APPROVED LIQUOR CONTROL DIRECTOR <br />NO'I'E: 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 />