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Minnesota Department of Public Safety <br />LIQUOR CONTROL DIVISION <br />444 Cedar St. /Suite 100L <br />k: �-. —z= St. Paul, <br />'is�'• DTI <br />N 55101-2156 <br />1 <br />TDD (612)282 -6555 <br />AND PERMIT <br />ON -SALE LIQUOR <br />to 3 permits in a 12 month period <br />LICENSE <br />J <br />�� t / <br />>Pa,.)�` <br />(612)296 -6439 <br />APPLICATION <br />FOR A 1 TO 4 DAY 1 EMYIPORARY <br />(Organization or location limited <br />TYPE OR PRINT INFORMATION <br />or <br />Wahl <br />F 0,3GAN11,6yTION0 <br />DA 1 E ORGANIZED <br />TAX EXEMPT <br />NUMBER <br />STREET ADDRESS <br />51:5 r., I, t.(�4,rtd YJ <br />ITY <br />L , sr ot <br />STATE <br />Pn ;) <br />ZIP CODE <br />SSW7 <br />NAM OF PERSON SING APPLICATION <br />MIT700 7 p � l � J i ? • _ <br />BUSINESS PHONE <br />( 6-51 7l,, , • 41 OS i <br />-TOME PHONE <br />614 Yeq - ,2 S 77 <br />DAILS LIQU WILL BE, -$'OLD (1 to 4 days) TYPE OF ORGANIZATION <br />(�yo - .. _ CLUB - CHARITABLE : RELIGIOUS OTHER NONPROFIT <br />OR TION O ICER'S NAME ADDRESS <br />1iinX, I etS-S sue, / .1��� /la �z I9�°�I <br />OR' NIZATION O IC R'S NAME DRESS <br />Ail n e1et e. Q9 4 40. ,pt. d hl v ,M a t.,AS7gin <br />�'j <br />ORGANrI ION O EE4CER;S%NAME ADDRESS <br />/ <br />%�f /t k J Lr2j2j/ F / <br />e A/ �'"° "` i J n h P.. O , mr t SL . Jt.. :�11.� -. /r <br />Location where license will be used Ilan outdoor area, describe a <br />'" <br />Will the applicant contract for intoxicating liquor senices? if so. zive the name and address of the Liquor license providing the service. <br />Al, , <br />Will the applicant carry liquor liability inner anode? If so, •e ca tripe s name a9d amount of, •veraee. 7 <br />(NO I E: Insurance is not mandatory) ) _ 0 A . ' 1 ^' . 9 :- 0f iil , Wiz.. <br />APPROVAL <br />.APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />CITY /COUNTY <br />DAZE APPROVED <br />LICENSE DATES <br />CITY FEE AMOUNT <br />DATE rEE PAID <br />1 .SIGNATURE CITY CLERK OR COUNTY OkFICIAL <br />APPROVED LIQUOR CON1ROL 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- 1191179(8/95) <br />