Laserfiche WebLink
Minnesota Department of Public Safety <br />of E c'+T?. LIQUOR CONTROL DIVISION <br />444 Cedar St. /Suite 100L I� �4*- <br />ifroik <br />St. Paul MN 55101 -2156 is <br />(612)296 -6439 TDD (612)282 -6555 _' <br />,kLrrsssX� ./ <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 period <br />or <br />TYPE OR PRINT INFORMATION MR I# <br />NAME <br />L(f <br />OF ORGANIZATION <br />Cuom<dc eQCreec lion 7-.SjoC , <br />DATE ORGANIZED <br />(a- 17- (0-2- <br />TAX EXEMPT NUMBER <br />29 cif 2(v <br />STREET ADDRESS <br />sr S , C i 4-ge CO <141(.1 <br />t 2d • <br />CITY <br />L i".fI CGao,c% <br />STALE <br />el./ AZ <br />ZIP CODE <br />5s7/7 <br />NAME OF PERSON MAKING APPLICATION <br />CA V1CLA L., FE, keY <br />BUSINESS PHONE <br />(651) 668(1 — 2727, <br />HOME PHONE <br />(6a) Y2Y -- 2S ?? <br />DATES LIQUOR WILL BE SOLD (1 to 4 days) <br />TYPE OF ORGANIZATION <br />❑ CLU.JB ❑ CHARITABLE 0 RELIGIOUS 0 OTI-IER NONPROFIT <br />ORGANIZATION OFFICERS NAME <br />I ?IG kcrCcl % ,B °SS (t/ <br />ADDRESS �7 <br />72. nr�c>YI S' LC h-✓ 5-5// / <br />ORGANIZATION OFFICER'S NAME <br />(0,h4 5- oc,-cs <br />ADDRESS <br />2.53c; /17 C/*/te,, c( LC i1--/ SS /!% <br />ORGANIZATION OFFICER'S NAME <br />cu. d = .1„R y <br />ADDRESS ( / <br />Z 2(p z.q A.,re >Cef L,C /1t r✓ 55(0 I <br />Location where license will be used. If an outdoor area, describe / <br />0 cl ii -p,FLe C=ry- t<<c�a F--, ZC G tt /( ar, d f-erva rs Leure 4.,44 c y tr /> er <br />Will the applicant contract for intoxicating liquor services? If so, give the name and address of the Liquor license providing the service. <br />Will the applicant carry liquor liability insurance? If so, the carrier' s name and /j•rmount o coverage. o c> <br />(NOTE: Insurance is not mandatory) 7 $ / ✓YI /✓ Jon .i Urt Z'rvr'i n =7 -3S UC 7 57,/ J " `'u s <br />l <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />CITY /COUNTY <br />DATE APPROVED <br />CITY FEE AMOUNT <br />LICENSE DATES <br />DATE FEE PAID <br />SIGNATURE CITY CLERK OR COUNTY OFFICIAL <br />APPROVED LIQUOR CONTROL DIRECTOR <br />NOTE: 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 />2 <br />