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Minnesota Department <br />r LIQUOR CONTROL <br />' " ?� 444 Cedar St. <br />z St. Paul, MN <br />". _; <br />of Public Safety <br />DIVISION <br />/Suite 100L <br />55101 -2156 <br />0)282 -6555 <br />(6 60 <br />AND PERMIT <br />ON -SALE LIQUOR <br />to 3 permits in a 12 month period <br />LICENSE <br />7a Nr <br />Ala <br />Milk <br />-e <br />»less: (G12) 29G -6439 <br />€ti z15 -62091 <br />TDD <br />W-- /346 y97 <br />APPLICATION <br />FOR A 1 TO 4 DAY TEMPORARY <br />(Organization or location limited <br />TYPE OR PRINT INFORMATION <br />or <br />LIR .• <br />NAME OF ORGANIZ4TION <br />tithe_ Canada- anaian Days, Dnc, <br />DATE ORGANIZED <br />12./17 /78 <br />TAX EXEMPT NUMBER <br />STREET ADDRESS <br />S75 E Ll' #(e- Canaria, ed <br />CITY <br />L+'+le. E.anait, <br />STALE <br />414) <br />ZIP CODE <br />651/7 <br />NAME OF PERSON MAKING APPLICATION <br />SU54(n lJe /Son <br />BUSINESS PHONE <br />4/)M4-c,5°7 <br />HOME PHONE <br />1/401) 4183-455{/ <br />DATES LIQUOR WILL BE SOLD (1 to 4 days) <br />A you s - 3,+, 5 2-001 <br />TYPE OF ORGANIZATION <br />CLUB 0 CHARITABLE RELIGIOUS 4 OTHER NONPROFIT <br />ORGANIZATION OFFICER'S NAME <br />Susan Me.lson Pre idenf 7 <br />ADDRESS <br />61 abore R4, Lill - /e. Cunad nu) 551/7 <br />I <br />ORGANIZATION OFFICER'S NAME <br />Lisa Olson Vice. Presi'dent' <br />ADDRESS <br />ag <br />7 q 71 under Bay y PA 1_144le (nat mil ssI( 7 <br />ORGANIZATION OFFICER'S NAME <br />Debra. S in na , SeCre+& -i <br />ADDRESS <br />2829 Payne Ibie. LiIfle(anada_,/'71/11 fS /(7 <br />Location where license will be used. If alt outdoor area, describe <br />)ponntor- Part 550 EL 2d LJ'-ff-le (An a4&, /)1A) <br />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 />No <br />Will the applicant cam liquor liability insurance? If so, the carrier' s name and amount of coverage. <br />(NOTE: Insurance is not mandatory) M I nn eso fA- aoi n f Minkru ,''f 1'n y A'SSOG' On `. D /ioc /! o <br />1 <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />CITY /COUNTY <br />DATE APPROVED <br />LICENSE DATES <br />• <br />CITY FEE AMOUNT <br />DAIE 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 <br />will be returned as the license. Submit to the City <br />the <br />or County <br />address above and the <br />at least 30 days <br />original signed by this division <br />before the event. <br />PS -09079(8/95) <br />Page 90 <br />