Laserfiche WebLink
Minnesota Department <br />ov' - ;s?HT LIQUOR CONTROL <br />'.�� 444 Cedar <br />z ' St. Paul, <br />t <br />of Public Safety <br />DIVISION <br />St. /Suite 100E <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 />a,,tr �, <br />J� A1. <br />3 J ; <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 />or <br />Watt <br />NAM OFORfT <br />it 7#12 CCuXll14.7 4'CRPQ XD7 7S=6 - <br />DT O <br />%o( /% P--- <br />BER <br />MET NUMBER <br />/7? <br />ADDRESS <br />`/a •S /S- F tM /C ranod't ? <br />77,74'„ dc/xJ�i_ <br />STATE <br />/2A) <br />ZSTREET <br />ZIP CODE <br />- SS7/7 <br />NA4 OF.PERSON MAKING APPLICATION <br />/, /.ti13.9 L6 . Fah a_. /- <br />BUSINESS PHONE <br />(65/) 266 • +105? <br />HOME PHONE <br />(s) �f (P 1- a 3 79 <br />DATES LIQUORR WILL, BE Sot, (1 to +days) <br />-5,97-- &7 7• ,9 /7,4 h <br />TYPE OF ORGANIZATION <br />= CLUB 2 CHARITABLE = RELIGIOUS XOTHER NONPROFIT <br />GANIZATION OFFIC S NAME <br />017/9,09 F . ,w // <br />ADDRESS <br />9 E ,fiRey,49-,2 A- e- »2e S9/7 <br />ORGANIZATION OFFICER'S NAME <br />1 A19-/E ,5C )i_- <br />ADDRESS <br />513 17c f /2f 7 �d % /703 512 <br />1 0 GANIZ•1TION FF CER'S NAME <br />�/ VA? //9 /2Fv <br />,ADDRESS 6 <br />gJ� /2.6ttL D k- X5205 <br />location where License wt1Lb'e used. Ilan outdoor area, describe <br />h ' i as <br />J~%, • a ,.5 O/2. a ci <br />AI d ' m .ir a,/� S • e /YI.3 // <br />OF <br />Will the applicant contract for intoxicating liquor services? If so. eve the name and address of the Liquor license providing the service. <br />N0 <br />Will the applicant carry liquor liability insurance? If so, the carrier' <br />(NOTE: insurance is not mandatory) V`'e, o <br />a e and amo of <br />verage. <br />)/� / /1 <br />90' %3Ci.Q13 <br />� <br />//)f %� <br />r <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />CITY /COUNTY <br />DAIb APPROVED <br />LICENSE DATES <br />CITY FEE AMOUNT <br />DATE FEE PAID <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 <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- 09099(8/95) 1 <br />Page 48 <br />