Laserfiche WebLink
Minnesota Department <br />4:TA1. �.. LIQUOR CONTROL <br />444 Cedar <br />St. Paul, <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 />\� <br />f *�� <br />T� <br />+ (612)296 -6439 <br />APPLICATION <br />FOR A 1 TO 4 DAY TEMPORARY <br />(Organization or location limited <br />TYPE OR PRINT INFORMATION <br />�✓ <br />Or <br />MAUI <br />NAME OF ORGANIZATION <br />4,tile CL,_,..: t • &crc,A,G, 4ssoci44,,,, <br />DATE ORGANIZED <br />1U,QE i94,A <br />TAX EXEMPT NUMBER <br />actytte <br />STREET ADDRESS <br />SlS G, HI? deotad& g-j.• <br />CITY ' / <br />Lihic. (di3N4c 4 <br />STATE <br />/14 4I <br />ZIP CODE <br />5S/ /7 <br />NAME OF PERSON MAKING APPLICATION <br />Rt -iC 136S3 <br />BUSINESS PHONE <br />((S))744- -Yea? <br />HOME PHONE <br />(&C4 4/9G>- L31 S <br />DATES LIQUOR WILL BE SOLD (1 to 4 days) <br />,k,4 / Z,3 Zoo 3 <br />TYPE OF ORGANIZATION <br />0 CLUB ❑ CHARITABLE ❑ RELIGIOUS N'OTHER NONPROFIT <br />ORGANt�A(T ONn OFFICER 5 NAME <br />R IGI` 13055 <br />ADDRESS p <br />7a e &ye ,J 7 T. -11 <tC 6)- dt. MNS /// <br />ORGANIZATION OFFICER'S NAME <br />K ol h-e _Sou c AA. <br />ADDRESS /L <br />2.33 0 1G1 c Ih a,, ,. „rr Lf1#k d,,,JA Ali 5 3112 <br />ORGANIZATION OFFICER'S NAME <br />L, nA:, Fake' <br />ADDRESS <br />24 L6' L-t, g&r e. IQ, L, true C•,,,.,At1 lfi' <br />Location where license wilYbe used. If an outdoor area, describe <br />Seoo;-er Pc- rk, L., 14 -/c C't, -w.-aw h1,v s -sip <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 curry liquor liability insurance? If so, the carrier' s name and amount of coverage. <br />(NOTE: Insurance is not mandatory) Ii' /,V. 7o„iT j2s,vtrLW ,tr „oc Ass o c , 441-1 DIV <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />1 CITY /COUNTY L / /7L /a lJw44 7 <br />DATE APPROVED <br />LICENSE DATES <br />CITY FEE AMOUNT <br />DATE FEE PAID <br />I <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 (east 30 days before the event. <br />PS- 09079(8/95) <br />