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Minnesota Department <br />cx ..1 LIQUOR CONTROL <br />� .,; 444 Cedar <br />t --._;z, St. Paul, <br />r, (612)296 -6439 <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 periods <br />LICENSE <br />jk <br />= <br />APPLICATION <br />FOR A 1 TO 4 DAY TEMPORARY <br />(Organization or location limited <br />TYPE OR PRINT INFORMATION <br />or <br />MRBt <br />NAME OF ORGAMZATION <br />/,,f//�. [.a.r,'c.7arzeaSLan gsso <br />DATE ORGANIZED <br />c5nr 19tZ= <br />TAX EXE»1P i : ER <br />d?V244 <br />STREET k a, �A <br />gyre, ca4 <br />STATE <br />ZIP CODE <br />NAME OF PERSON 'BAKING APPLICATION <br />2/NOR G. h"zh.CA4 <br />BUSINESS PHONE <br />(051 In -a/77 <br />HOME PHQNE <br />(4asA y8V- �s79 <br />DAIES LIQUOR WILL BE SOLD (1 to 4 days) <br />/6':78.40 <br />TYPE OF ORGANIZATION <br />Ed CLUB ❑ CHARITABLE ❑ RELIGIOUS h OTHERNONPROFIT <br />O GANIZATION OFFICERS NAME <br />) G%)/92to 3053 / ✓ <br />ADDRESS r� (� �/ /l_ ,�. ///7 <br />/Q E. U&w9/7 J`4 • ,44 t�lnsmfr. ,mo <br />1 ORC NIZATION OFFICERS NAME <br />/ Vie. Soch4_ <br />ADDRESS Gl 1/ <br />02530772c 2c�1£m 641ra a4:srn,) /7 <br />ORGANIZATION OFFIC�ER'S NAME <br />,G,,�09 2 , f,2 h <br />ADDRESS <br />029,6 ,L,9i0ee.. V .G c DiN sow?. <br />ILocation where license will be awn. Lf an outdoor area, describe <br />5,1 - Johr7s sck,o/ er, /oe lot, ;w) A /int ea. nac 4 <br />c9:9 <br />Will the applicant contract for intoxicating liquor services? If so, 4ve the n eianndd address of the Liquor license providing the service. <br />S/ . 14u/ , /)7^/ -5S /0/ <br />Will the applicant cany liquor liability insurance? If so, the carrier' s name and amount of coverage. <br />(NOTE: Insurance is not mandatory) <br />I APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />1 CITY /COUNTY <br />DAIS APPROVED <br />LICENSE DA1'ES <br />CITY FEE AMOUNT <br />1 <br />DATE FEE PAID <br />1 <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(8/95) <br />Page 18 <br />