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Minnesota Department of Public Sa etv <br />LIQUOR CONTROL DIVISION <br />444 Cedar St./Suite IDOL <br />St. Paul_ YfN 55101-2156 <br />(612296-6430 IDD 012)232-6555 <br />APPLICATION AND PERMIT <br />FOR A 1 TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />(Organization or location limited to 3 permits in a 12 month periods# Li? 2. - 4e, LP- / S47_, <br />i YPE OR PRINT INFORMATION <br />NAME- OF ORGANIZATION <br />Sq>0�-rMct‘73 <br />STREET ADDRESS <br />y 3 c'a -.y,.a A N <br />NAVE OF PERSON MAKING APPLICATION <br />DATES LIQUOR WILL BE SOLD (1 to 4 days) <br />�u 3 -LS 2,001-1 <br />ORGAIIZATION OFFICERS NAME <br />DIN-‘1 k OLSTA{ I <br />ORGANIZATION OFFICER'S NAME <br />ORGANIZATION OFFICER'S NAt'vE <br />DATE ORGANIZED <br />IS M% <br />TI (Cui r Ctr <br />TAX E:OEMPT NUIVOEER <br />StA rE ZIP CODE <br />%S.-C.»? <br />BUSINESS P[4ONE Oiv1E PHONE <br />kSh `1617 -NbJ I doS)) Licip —oby5 <br />I'YPE OF ORGANIZATION <br />0 CLLR E C[-IARITABLE 0 RELIGIOUS ETHER NONPROFIT <br />.ADDRESS <br />2-gri3 PAN Ng. 1\v t, L.!'1Tt£ ..l.l 1-vir/117 <br />ADDRESS <br />ADDRESS <br />Location where license will be used. If an outdoor area, describe <br />�7oN�E2 QA2<2_gco C E�vi ,217 L TTL✓ (.AN, PA CI /7 <br />Will the applicant contract for intoxicating liquor sen ices? If so, give the name and address of the Liquor license providing the senvice. <br />NJ 0 <br />Will the applicant carry liquor liability insurance? If so, the carrier' s name and amount of coverage. 41. <br />NOTE Insurance is not mandatory) yE 5 , M iN . C D 7 NT- l.{.N,�. E�.I�2�Tc(ZS �' S7, J a Dna 100, 000 <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING ro LIQUOR CONTROL <br />:.ITY; COUiNTY <br />DATE ,APPROVED <br />.ITY FEE AMOUNT LICENSE DATES <br />)ATE FEE PAID <br />;? A "URL <br />i <br />RK D t ,:. ^,Oti T" OFFICIAL APPROVED LIQUOR CONTROL DIRECTOR <br />GTE: Do nor senarare These nvo parrs. send both parrs to he address above and the original signed by rhis division <br />be returner' a.s rhe license. $comic to rhe C;iv or Caunry at least in days before the event. <br />-4- <br />