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TYPE <br />'01188r, Minnesota Department of Public Safety <br />0 Alcohol and Gambling Enforcement Division <br />3; 444 Cedar St —Suite 133 <br />w - y' St. Paul, MN 55101 -5133 <br />','185ag'Y�J6" <br />(651)296 -6439 TDD (651)282 -6555 <br />APPLICATION AND PERMIT <br />FOR A TEMPORARY ON -SALE LIQUOR LICENSE <br />OR PRINT INFORMATION <br />ora„, <br />$a� �+ e� <br />0 *` <br />i a <br />� , <br />•9?OFMMNE� <br />NAME OF ORGANIZATION <br />Little Canada Recreation Association <br />DATE ORGANIZED <br />June, 1962 <br />TAX EXEMPT NUMBER <br />29426 <br />STREET ADDRESS <br />515 E. Little Canada Road <br />CITY <br />Little Canada <br />STATE <br />MN <br />ZIP CODE <br />55117 <br />NAME OF PERSON MAKING APPLICATION <br />Rirk Rnaa <br />BUSINESS PHONE <br />( ) <br />HOME PHONE <br />(AS1 ) 490l1F,4 <br />DATES LIQUOR WILL BE SOLD <br />August 6, 7, 8, 1999 <br />TYPE OF ORGANIZATION <br />❑RELIGIOUSjt�OTHERNONPROFIT <br />T.ittla Canada MDT SS117 <br />❑ CLUB • CHARITABLE <br />ADDRESS <br />7? F_ Bryan Avanna <br />ORGANIZATION OFFICER'S NAME <br />Rick Boss <br />ORGANIZATION OFFICER'S NAME <br />Katie Soncha <br />ADDRESS <br />9 i mrmnnemy etr =at L4ttla C MN 55117 <br />ORGANIZATION OFFICER'S NAME <br />Linda Fahey <br />, <br />ADDRESS <br />747F, TaPnrn PnaA T4tt10 rpr,nAa MW 55189 <br />Location where license will be used. If an outdoor area, describe <br />Spooner Park, Little Canada, MN 55117 <br />Will the applicant contract for intoxicating liquor services? If so, give the name and address of the liquor licensee providing the service. <br />Will the <br />(NOTE: <br />applicant carry liquor liability insurance? If so, the carrier s name and amount of coverage. <br />Insurance is not mandatory.) MN Joint Underwriting Association <br />CITY <br />CITY <br />DATE <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL & GAMBLING ENFORCEMENT <br />/COUNTY Little Canada DATE APPROVED <br />FEE AMOUNT Waived LICENSE DATES <br />FEE PAID <br />SIGNATURE CITY CLERK OR COUNTY OFFICIAL APPROVED Alcohol & 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 be returned as the license. Submit to the city or County at least 30 days before the event. <br />PS -09079 (6/98) <br />PAGE 164 <br />