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HE,,. Minnesota Department <br />y sz i �, <br />:.� ^t ' Alcohol and Gambling <br />=�° `- :: i_.. 1,14 Cedar <br />of Public Safety <br />Enforcement Division <br />St —Suite 133 <br />MN 55101 -5li3 <br />TDD (651)282-6555 <br />AND PERMIT <br />ON -SALE LIQUOR LICENSE <br />,, <br />i '` <br />` <br />aF,,q <br />• /, e <br />'I <br />a. a St. Paul, <br />YyR 'i ce yuy <br />!Hs d <br />(651)296 -6439 <br />APPLICATION <br />FOR A TEMPORARY <br />TYPE OR PRINT INFORMATION <br />,� ■IN <br />"eon.," <br />NAME OF ORGANIZATION <br />Little Canada Canadian Days <br />DATE ORGANIZED <br />12317/78 <br />TAX EXEMPT NUMBER <br />N/A <br />STREET ADDRESS <br />515 Little Canada Road <br />CITY <br />Little Canada <br />STAI b <br />MN <br />ZIP CODE <br />55117 <br />NAME OF PERSON MAKING APPLICATION <br />Susan Nelson <br />BUSINESS PHONE <br />(651) 696 -6507 <br />HOME PHONE <br />( 651) 483 -4541 <br />DATES LIQUOR WILL BE SOLD <br />August 4 , 5 , 6 , 2000 <br />TYPE OF ORGANIZATION <br />C CLUB CCHARITABLE ERELIGIOUSZZtOTHER NONPROFIT <br />ORGANIZATION OFFICER'S NAME <br />Susan Nelson, President <br />ADDRESS <br />762 Labore Road, Little Canada, ?IN 55117 <br />ORGANIZATION OFFICER'S NAME <br />Carl Nelson, Treasurer <br />ADDRESS <br />762 Lahore Road, Little Canada, MN 55117 <br />ORGANIZATION OFFICER'S NAME <br />Debra Sinna, Secretary <br />ADDRESS <br />2929 Payne Ave.. Little Canada, MN 55117 <br />Location where license will be used. If an outdoor area. describe <br />Spooner Park, Eli Road, Little Canada, MN <br />Will the applicant contract for intoxicating liquor services? If so. give the name and address of the liquor licensee providing the service. <br />No <br />Will the applicant carry liquor liability insurance? If so, the carrier's name and amount of coverage. <br />(NOTE: Insurance is not mandatory.) Minnesota Joint Underwriting Association 50/100/10 <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL & GAMBLING ENFORCEMENT <br />CITY /COUNTY Little Canada DATE APPROVED <br />CITY FEE AMOUNT 'waived LICENSE DATES <br />DATE FE1PAID <br />SIGNATURE CITY CV/ERK OR COUNTY 0FFItyIAL APPROVED Alcohol k Gambling Enforcement Director <br />Note: Do not separate these two parts. send both parts to the address above and the original signed by this division <br />will he returned as the license. Submit to the city or County at least 30 days before the event. <br />PS-09079 m /9 %1 <br />D., flea Q7 <br />