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Minnesota Department <br />of Public Safety <br />DIVISION <br />St. /Suite 100L <br />MIN 55101 -2156 <br />11)D (612)232 -6555 <br />AND PERMIT <br />ON -SALE LIQUOR <br />to 3 permits in a 12 month period <br />LICENSE <br />�° � <br />1 i <br />■ L <br />o.ik LIQUOR CONTROL <br />�? 444 Cedar <br />"°"' 'z= St. Paul, <br />(612)296 -6439 <br />APPLICATION <br />FOR A 1 TO 4 DAY PEMVIPORARY <br />(Organvation or location limited <br />TYPE OR PRINT INFORMATION <br />mi. <br />Or <br />MRIS <br />NAME OF ORGANIZATION <br />f-1 -14c (a,ictcl0 e-ec _ ,45S0C- <br />DATE ORGANIZED <br />i?...I7_co ..I. <br />TAX EXEMPT NUMBER <br />7C1HIL, <br />STREET ADDRESS <br />Sty ,, ,,f J7 (anwiti Rd. <br />CITY <br />G;ri -te CuY,tzeCe <br />STAIN <br />;41 A...----- <br />ZIP CODE <br />S ii'7 <br />NAME OF PERSON MAKING APPLICATION <br />Kay i/✓ )C ,WT,✓ <br />BUSINESS PHONE <br />( ) <br />HOME PHONE <br />(&m Li90 - 3i (o r <br />DATES LIQUOR WILL BE SOLD (1 to 4 days) <br />ran, 20 - ZI Z o c 1 <br />TYPE OF ORGANIZATION <br />❑ CLUB -2 CHARITABLE RELIGIOUS - OTHER NONPROFIT <br />ORGANIZATION OFFICER'S NAME <br />K1cC .11,40 5.5 •— Prtes. <br />ADDRESS _ <br />-7z r= . SS1 '-7G✓t i-v-e , C,(., , r14- - 55% 7 <br />ORGANIZATION OFFICE'S NAME <br />KQt-1, So G6A 5-ec <br />ADDRESS <br />1 30 file_ r, L.C. (ell .A./ 53-,7 ' <br />ORGANIZATION OFFICER'S NAME <br />t,tr,d.. A.-0 — .7-4'2S, <br />ADDRESS <br />2J 2L, Lcy4)Cl'p a-d. LC. 44v 5371 <br />Location where license will be used. If an outdoor area. descnbe <br />—4`i.1 4-11-4- Cook tic( /'t , LC . ..4,1/k...4,1/k.," - SS 1/1 <br />7,9 1 S e di.eiz,{,oN 5.-,-- (- c c 1 MN Ss-F,7 c(4- L• e-e G if ✓G r j <br />Lieucl, .oar 44‘.4 c, ay? tt, <br />J <br />Will the applicant contract for intoxicating liquor services? If so, give the name and address of the Liquor license providing the service. <br />N4 <br />Will the applicant carry liquor liability insurance? If so, the carrier' s name and amount of coverage. 4 <br />(NOTE: Insurance is not mandatory) 2 S i "IA, ]'c/ •v i I,tv, de,--i...--, % in d 4'5-5-Gr. ; -75a), d :%C; <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 />CITY FEE AMOUNT <br />DATE 1-±E 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 original signed by this division <br />at least 30 days before the event. <br />PS -09079(8195) <br />Page 26 <br />