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Minnesota Department of Public Safety <br />q LIQUOR CONTROL DIVISION <br />444 Cedar St. /Suite 100L <br />F_. z St. Paul, MN 55101 -2156 <br />al- (612)296 -6439 TDD (612)282 -6555 <br />APPLICATION AND PERMIT <br />FOR A 1 TO 4 DAY TEMPORARY ON -SALE LIQUOR <br />(Organization or location limited to 3 permits in a 12 month period <br />TYPE OR PRINT INFORMATION <br />LICENSE <br />�^ <br />d� <br />\ 4Wa <br />‘!1� <br />or <br />URA, <br />NAME OF ORGANIZATION <br />Saint John's Church of Little Canada <br />DATE ORGANIZED <br />10 -07 -1851 <br />TAX EXEMPT NUMBER <br />ES 23330 <br />STREET ADDRESS <br />380 Little Canada Road <br />CITY <br />St. Paul <br />STAIE <br />Mn. <br />ZIP CODE <br />55117 <br />NAME OF PERSON MAKING APPLICATION <br />Robert J. Fitzpatrick <br />BUSINESS PHONE <br />(651) 484 - 2708 <br />HOME PHONE <br />(651) 484 -2708 <br />DATES LIQUOR WILL BE SOLD (I to 4 days) <br />October 6th and 7th, 2001 <br />TYPE OF ORGANIZATION <br />= CLUB r CHARITABLE XXRELIGIOUS = OTHER NONPROFIT <br />ORGANIZATION OFFICERS NAME <br />Rev. Robert J. Fitzpatrick <br />ADDRESS <br />380 Little Canada Road St. Paul, Mn. 55117 <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 />School gym <br />Will the applicant contract for intoxicating liquor services'? If so. give the name and address of the Liquor license providing the service. <br />no <br />Will the applicant carry liquor liability insurance? If so t, he carrier' s name and amouat of coverage. <br />NOTE: Insurance is not mandatory) yes Catholic Mutual Ins. rc iocese of St. Paul /Mpls. <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />1 CITY /COUNTY <br />DATE APPROVED <br />LICENSE DAZES <br />CITY FEE AMOUNT <br />DATE l'hE PAID <br />APPROVED LIQUOR CONTROL DIRECTOR <br />1 SIGNATURE CITY CLERK OR COUNTY OFI•ICIAL <br />NOTE: Do not separate these two parts, send both parts to the <br />I will be returned as the license. Submit to the City or County <br />address above and the original signed by this division <br />at (east .30 days before the event. <br />PS- 09079(8/95) <br />Page 13 <br />