08-13-2003 Council Agenda - Laserfiche WebLink

Home Browse Search

Minnesota Department of Public Safety o?Tr 4 LIQUOR CONTROL DIVISION , 444 Cedar St. /Suite 100L a St. Paul, MN 55101 -2156 %; (612)296 -6439 TDD (612)282 -6555 APPLICATION AND PERMIT FOR A 1 TO 4 DAY TEMPORARY ON -SALE LIQUOR (Organization or location limited to 3 permits in a 12 month period TYPE OR PRINT INFORMATION LICENSE y')-1- ,ems .mob` 'a $ rr 3: f '[`�� ,1 /- / cc/ or MAW „NANIOF, Q17 P it'll-qv \ .S ORGANIZATION LL-� nJC- DATE TAX EXEMPT NUMBER STt2EF,T ADDRESS w� 7 el L/ -> (MG 1,i`\.e 1\) CITY L 1+te (Gs.:l a'u,tL S'L'ATE IV ZIP CODE Sri/ / 7 NAME OF PE) SO*I MAKING APPLICATION �0rs t,- SoL^./rrian [JSINESS PCIONEI 1) 16bL/et.!/ HOME PHONE oc oDbiJS )ATES LIQTJOR WILL BE SOLD (1 to 4 days) CVE OF ORGANIZATION .3'C11113 0 CHARITABLE ❑ RELIGIOUS t8^O"I'I -IFR NONPROFIT V .L 2-2 -, C o 3 ORGA 4 ZAjg ION OFFIC'ER'S NAME MD vl i7 L-1 i nit_. h ADDRESS r) /+ SS // �/. 2, ee. , rte- N ' j Tiff l .114n it t14t4 ORGANIZATION OFFICER'S NAME ADDRESS ORGANIZATION OFFICER :S NAME ADDRESS .ocotion where license will he used. If an outdoor aµ'ea, describe eN■e I l L� C:IV L q- +(Q ce ,. e, ztk ., 5 17 , Will the applicant contract for intoxicating liquor services? If so; give the name and address of the Liquor License providing the service. Will the applicant carry liquor liability insurance? If so, the _c-arrr-t (NOTE: Insurance is not mandatory) J4 e (� , iM Ni `�J DI K s name and a soont of cgverage. S 11(7 (3 ) • in l art , 1r APPROVAL APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL CITY /COUNTY DATE APPROVED LICENSE DATES CITY FEE AMOUNT DATE FEE PAID SIGNATURE CITY CLERK OR COUNTY OFFICIAL APPROVED LIQUJOR CONTROL DIRECTOR NOTE: Do not separate these two parts, send hoth parts to the address above and the original signed by this division will be returned as the license. Submit to the City or County at least 30 days before the event. PS- 09079(8/95)