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Minnesota Department <br />a tE�'ii � LIQUOR CONTROL <br />:,. 444 Cedar <br />of Public Safety <br />DIVISION <br />St. /Suite 100L <br />MN 55101 -2156 <br />TDD (612)282 -6555 <br />AND PERMIT <br />ON -SALE LIQUOR <br />to 3 permits in a 12 month period <br />LICENSE <br />v' ° "'°� <br />St. Paul, <br />z' <br />..:41C-" t_:. (612) 296 -6439 <br />gy isa•" <br />APPLICATION <br />FOR A 1 TO 4 DAY FEMPORARY <br />(Organization or location limited <br />TYPE OR PRINT INFORMATION <br />or <br />AARltt <br />NAME O ORGAZAT ON. <br />!,17i_ d Ci f r r. i /inn /J-)(> <br />,• (Mo. L !M <br />DATE ORGANIZED <br />/ Z • / ) '6:1- <br />M <br />TAX E EMPT MBER <br />„2`> v,2 6 <br />STREET ADDRESS <br />�1C) �f7 /`� Ir' r ,(i /��� =,. (_C34.' /.ei:i /c.. i') <br />CITY <br />i r .._L7 flak- <br />(q / /�' <br />STALE <br />.�iL� <br />ZIP CODE <br />J _� <br />NAME OF PERSON MAKING APPLICATION <br />1, s i /1 in A ; 4 h %.77. <br />BUSINESS PHONE <br />(as/) 166 laci7 <br />HOME PHONE <br />(L.Si) L/•S V - , 7"' 2 9 <br />DAIES LIQUOR WILL BE SOLD (1 to 4 days) <br />(i,))(1 .lit Q,15 ra- .9-(.0-$3 <br />TYPE OF ORGANIZATION <br />= CLUB = CHARITABLE ^ RELIGIOUS OTHER NONPROFIT <br />ORGANIZATION OFFICER'S NAME <br />• It i (r_ ei P ) >' ; % II <br />ADDRESS <br />17.:',2 e t, .72 ne.- /< _ CS7/ <br />ORGANIZATION OFFICERS NAME <br />I: i triOe 15 7 fir-0 he Li <br />ADDRESS / r <br />hi <br />ORGANIZATION OFFICER'S N <br />4i 1=, . .`x Chc<_, <br />ADDRESS <br />1; 6 -Pk, 7nef,gle.;7(. ` 'ra A. .0 • S .. i/ <br />Location where license will be used. Ilan outdoor area. descnbe <br />c`F, - _.T°�h)�LS I:.. 0.. _:5C..hf /) / Ci'+i on <br />I <br />I Will the applicant contract for intoxicating liquor services? If so. give the name and address of the Liquor license providing the service. <br />A/C <br />Will the applicant carry liquor liability insurance? If so, the carrier' s name and amount of coverage. .ei <br />J <br />NOTE: Insurance is not mandatory) 07%/ J( *- i l,✓I /rT' i,f 1 2`l ( "`' 70!)/ <br />I <br />APPROVAL <br />. APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />CITY /COUNTY <br />DALL APPROVED <br />LICENSE DALES <br />CITY FEE AMOUNT <br />DAIL FEE PAID <br />LNATURE CITY CLERK OR COUNTY OFFICIAL <br />APPROVED LIQUOR CONTROL DIRECTOR <br />NOTE: Do not separate these two parts. send both parts to the <br />will be returned as the license. Submit to the City or County <br />address above and the original signed by this division <br />at least 30 days before the event. <br />PS- +)9079(8/95) <br />