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08/08/2005 15:36 6517684043 <br />CITY LITTLE CANADA <br />PAGE 03 <br />Minnesota. Department <br />au LIQUOR CONTROL <br />te 444 Cedar <br />of Public Safety <br />DIVISION <br />St, /Suite TOOL <br />NLV 55101- 2156 <br />2 <br />TDD (612)2 8 -6551 <br />AND PERMIT <br />ON -SALE LIQUOR <br />to 3 permits in a 12 month period# <br />LICENSE <br />/ g <br />a i <br />t:x St. Paul, <br />,,_ (612)296 -5439 <br />APPLICATION <br />FOR A 1 TO 4 DAY TEMPORARY <br />(Organization or Location limited <br />T . FE OR PRINT INFORMATION <br />I �• <br />�;„�' <br />of <br />A1BIG <br />NANt OF ORGANIZATION <br />alt • 3•:5,s-; 5 o 4.0 • <br />.DATE ORGANIZED <br />/b- o ? • I S S ! <br />TAX EXEMPT NRMCBER <br />Es 9333 0 <br />STREET ADDRESS <br />380 2 -i/4id, Cta nada. "Poaa <br />CITY <br />Chan Canada <br />STALL, <br />nil °C) <br />ZIP CODE <br />CY, /q' <br />Nal1E OP PERSON tY,- 1,NG PLiCATION <br />g.cl.warc Sohn end o\nre.C- <br />BUSYNESS PHONE <br />(bst) 484 -a';o8 <br />HOME PHONE <br />(46i) <br />DATES LIQUOR WILL BE SOLD (1 to 4 days) <br />SuYnda y Se. env' oe,+r 2.S 2 00.58 <br />TYPE OF ORGANIZATION <br />CLUB 0 CHARITABLE 7f RELIGIOUS is OTHER NONPROFIT <br />ORGANIZATION OFFICERS NAME t <br />£ck 1-rd ...3olnv\ `1�©\nr-22c <br />ADDRESS c� 1 <br />/988 NutAn,:• \ A-ve <br />ORGANIZATION OFFICER'S NAME <br />ADDRESS SA .'Z t WI N ss / o S <br />ORGANIZATION OFFICER'S NAME <br />r tt :h <br />ADDRESS <br />loo. w ere �wxyc will he usecL It an outdoor area, des Cnbe <br />5 +•. Sohti s ,8chool Corr\ o-vsa Groun■c <br />Will the applicant contract for intoxicating liquor services? If so. give the name and address of the Liquor license providing the service. <br />0 <br />Will the applicant carry liquor Liability insurance? If sa, the carrier's name and <br />(NOTE_ Insurance is not mandatory) a i,,r4_, a w/ al <br />to <br />oun <br />/ t <br />coy <br />ge. <br />• <br />• <br />APPLICATION <br />CITY/COUNTY <br />II,'ST BE APPROV <br />APPROVAL <br />A BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />CITY FEE AMOUNT <br />DATE FEE PAID <br />DATE APPROVED <br />LICENSE DATES <br />5IGt"ATl /RE cITY CLERK OR COUNTY OFFICIAL, I APPROVED LIQUOR CONTROL DIRECTOR <br />4OTE: 9)o not separate there two puttk send both parts to the address above and the original signed by this division <br />will be r etnrned as the license. Submit to the City or County sc least 30 dove before the event. <br />P5- 419079051 <br />