Laserfiche WebLink
ST MN ALC GAMB ENF <br />6512975259 <br />06/05 '02 09:35 N0.756 01/01 <br />Minnesota Department of Public Safety <br />1RF LIQUOR CONTROL DIVISION <br />444 Cedar $t. /Suite IOOL <br />St. Paul, MN 55101 -2156 <br />u ° A (612)296 -6439 TDD (612)282 -6555 <br />APPLICATION AND PERMVICT <br />FOR A 1 TO 4 DAY TEMPORARY ON -SALE LIQUOR <br />(Organization or location limited to 3 permits is a 12 month period <br />TYPE OR PRINT INFORMATION <br />LICENSE <br />r� <br />tt <br />0.. .- <br />°f <br />mn <br />• OF <br />NAME OF ORGANIZATION <br />O ORGANIZATION h t. rGa1 Cif .41e* <br />DATE ORGANIZED <br />/0-0 .9- les I <br />TAX ;` EMPT NUMBER <br />S g 333 0 <br />STREET , �',,. �y <br />380 i Ca rtada �sCY <br />CITY <br />LtT fc a ttacto <br />ETATE <br />Mb) <br />ZIP OMB <br />.5s 1 17- <br />NAME OF PERSON MAKING APPLICA'ITON <br />%av- 1,nbey+ S tlz. lick <br />BUSINESS PHONE <br />((di) `E$4' - ,2,08' <br />HOME PHONE <br />WI) 184-27 e> s' <br />DATES LIQUOR WILL- BE SOLD (1 to 4 days) <br />Yu hP . W 00 ,� <br />o <br />TYPE OF ORGANIZATION <br />❑ CLUB 0 CHARITABLE flELIGJOUS <br />❑ OTHER NONPROFJT <br />ORGANIZATION° OFFICFR'S NAM) <br />... ► o i_ ..Y - ' . i►ca-f-r i <br />ADDRESS <br />: 0 4+41e. a t . , cc P, <br />ORGANIZATION OFFICER'S NAME <br />ORGANIZATION <br />ADDRESS <br />OFFICER'S NAME <br />i..ocatzou <br />ADDRESS <br />where license will be used. If an outdoor area, describe <br />Will the applicant contract for iA.toxieafing bquor s¢Mces? 1f so, give the name and address of the Liquor license providing the sctviC , <br />hd <br />Will the applicant carry liquor [lability inanranoe? If so, the carricl s name and amotwt of coverage. , p <br />(NOTE: Insurance is not mandatory) tl.4Pn n� i e V�v {l a " C nl S. / t� Ylt/tGQI d(5° Fp p1 $f 5 ' <br />•�'� <br />APPROVAL <br />'fJC <br />AP _ <br />ATfoN MIST J E APPROVED BY CITY OR COUNTY BEFORE SUBM1TTll'ic TO LIQUOR CONTROL <br />DAi± APPROVED <br />LICENSE DATES <br />(Z, .65- Off, <br />CITY /COUNTY L i / / �� ( El, <br />CITY FbE AMOUNT �S,� AC.Q <br />' r 4.a <br />DATE E PAID <br />it <br />SIGNATURE Y CLERK OR COUNTY pkkiClAL <br />APPROVED LIQUOR CO OL 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 />