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TYPE OR <br />Minnesota Department <br />of Public Safety <br />DIVISION <br />St. /Suite 100L <br />MN 55101 -2156 <br />TDD (612)232 -6555 <br />AND PERMIT <br />ON -SALE LIQUOR <br />to 3 permits in a 12 month period <br />LICENSE <br />o" _ LIQUOR CONTROL <br />' °'� -.e °�* 444 Cedar <br />z= St. Paul, <br />(612)296 -6439 <br />�\ <br />4 <br />"',. o„ " <br />APPLICATION <br />FOR A 1 TO 4 DAY TEMPORARY <br />(Organisation or location limited <br />PRINT INFORMATION <br />Or <br />1APIS <br />NAME OF ORGANIZATION <br />Little Canada Recreation Association <br />DAIS ORGANIZED <br />June, 1962 <br />TAX EXEMPT NUMBER <br />29426 <br />STREET ADDRESS <br />515 Little Canada Road , <br />CITY <br />Little Canada <br />STATE <br />MN <br />ZIP CODE <br />55117 <br />NAME OF PERSON MAKING APPLICATION <br />Rick Boss <br />BUSINESS PHONE <br />( ) <br />HOME PHONE <br />(65b 490 -3165 <br />DAZES LIQUOR WILL BE SOLD (1 to 4 days) <br />August 4 and 5, 2001 <br />TYPE OF ORGANIZATION <br />T CLUB T CHARITABLE -2 RELIGIOUS 3 OTHER NONPROFIT <br />ORGANIZATION OFFICER'S NAME <br />Rick Boss <br />ADDRESS <br />72 E. Bryan Street, Little Canada, MN 55117 <br />ORGANIZATION OFFICER'S NAME <br />Katie Soucha <br />ADDRESS <br />2530 McMenemv Street, Little Canada, MN 55117 <br />ORGANIZATION OFFICER'S NAME <br />Linda Fahev <br />ADDRESS <br />2926 LaBore Road, Little Canada, MN 55109 <br />Location <br />Spooner <br />where license will be used If an outdoor area. describe <br />Park, Little Canada, MN 55117 <br />Will the applicant contract for intoxicating liquor services'? If so. eve the name and address of the Liquor license providing the service. <br />Will the applicant <br />(NOTE: <br />carte liquor liability insuranoel If so. the carrier' s name and amount of coverage. <br />Insurance is not mandatory) MN Thins and p rear; t 1 nr) As Roc i ati on <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />CITY /COUNTY <br />CITY FEE <br />DATE <br />DATE APPROVED <br />LICENSE DATES <br />AMOUNT <br />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- 09079(81951 <br />PAGE 21 <br />