Laserfiche WebLink
Minnesota Department of Public Safety <br />vo't. . LIQUOR CONTROL DIVISION <br />°�.: 444 Cedar St. /Suite 100E $* <br />St. Paul, MN 55101 -2156 Ski ) <br />iss <br />(612)296 -6439 TDD (612)282 -6555. <br />ta,s "" . <br />APPLICATION AND PERMIT <br />FOR A 1 TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />(Organization or location limited to 3 permits in a 12 month period <br />of <br />TYPE OR PRINT INFORMATION MR lit <br />NAME OF ORGANIZATION <br />, -1- :y,_ ), n' s s'<. b. 4 t. i <br />DATE ORGANIZED <br />1=i y 9• <br />TAX EXEMPT NUMBER <br />2- 3 33 0 <br />STREET ADDRESS 9 <br />;169 -1 Plc Ill z,,,e,r.y 1:,L,t L;kfl �.C.c:-,a<<<.) Pit,%, Ss' a <br />CITY <br />L,; tH Cc_r\aL- <br />STALE <br />rhl oV. <br />ZIP CODE <br />s 5 - /I7 <br />NAME OF PERSON MAKING APPLICATION <br />Carci >ac Schmc,. e_ +2_ <br />BUSINESS PHONE <br />("1) 1/W' /— 3o3S <br />HOME PHONE <br />05'1 ) `i d'% - C /i06 <br />DATES LIQUOR WILL RE SOLD (1 to 4 days) <br />ON ay , 3 o e 3 <br />TYPE OF ORGANIZATION <br />❑ CLUB 0 CHARITABLE PRELIGIOUS ❑ OTHER NONPROFff <br />ORGANIZATION OFFICER'S NAME <br />Mary Kcof (ZQwa,v �St.L.,,i ?cird<.i f 1 � <br />ADDRESS <br />ly Shitinacc.k DR) Pial fernrik:, @t,". S5(1.5 <br />ORGANIZATION OFFICER'S NAME <br />ADDRESS <br />ORGANIZATION OFFICER'S NAME <br />ADDRESS <br />Location where license will be used. If an outdoor area, describe <br />.St. ',Tr) b 10 s S<:tinc 1 -" a621 N1 Me. ixe... Th. y Ri, L;t / /c. C.;c,•.L; rvr,a!,_fis /rj <br />Tat lei,' — :.L ,v 5chcc i 5'y n1 ,.,,,:( C'cc(,.4cR_1 ('- <br />Will the applicant contract for intoxicating liquor services? If so, give the name and address of the Liquor license providing the service. <br />N c <br />w e. 6- e Ltce,.. S.t ,.S td -le C %FlQni ? <'I'i 0 d <br />4%4�h '� yr. -a <br />it <br />Will the applicant carry liquor liability insurance? If so, the carrier' s name and amount of coverage. <br />(NOTE: Insurance is not mandatory) Y e s <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />CITY /COUNTY L r Hu Cc:,,a,i._ JA' (Lin s•C. y Co . <br />DATE APPROVED <br />LICENSE DATES <br />CITY FEE AMOUNT / <br />DATE FEE PAID <br />APPROVED LIQUOR CONTROL DIRECTOR <br />SIGNATUJRE CITY CLERK OR COUNTY OFFICIAL <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 />