Laserfiche WebLink
6011 E.... Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division <br />y <br />a 444 Cedar St —Suite 133 <br />W St. Paul, MN 55101 -5133 <br />(651)296 -6439 TDD (651)282 -6555 <br />APPLICATION AND PERMIT <br />FOR A TEMPORARY ON -SALE LIQUOR LICENSE <br />TYPE OR PRINT INFORMATION <br />OFPUB�� <br />off, <br />*r <br />a <br />Or <br />NAME OF ORGANIZATION <br />4...,2n-rte CAnindG ktcIZa-1do 4'SSOL,, <br />DATE ORGANIZED <br />j2- /-7 -6 Z <br />TAX EXEMPT NUMBER <br />29er2- <br />STREET ADDRESS <br />-1 c E L. - 4-+-12 C4 , d& vo, <br />CITY <br />zl +f/e Cli�tad4 <br />STATE <br />rrrn/ <br />ZIP CODE <br />sue/ / —t <br />NAME OF PERSON MAKING APPLICATION <br />I( pN /dl t l(rec -4/74,1/ <br />BUSINESS PHONE <br />C ) <br />HOME PHONE <br />65I) 99'0— 3/(0.5 <br />DATES LIQUOR WILL BE SOLD <br />Z1 i , 2.7_ — 2-3 i 2000 <br />TYPE OF ORGANIZATION <br />O CLUB O CHARITABLE ORELIGIOUS OOTHER NONPROFIT <br />ORGANIZATION OFFICER'S NAME <br />RICK 6osS - pr-est den }— <br />ADDRESS <br />lze,kyon we l - ,C. /P7,/ ss/ /7 <br />ORGANIZATION OFFICER'S NAME / <br />Yc� 4-ie SacA,q — 5-ecr -a ltfy <br />ADDRESS <br />ZS 30 Mcillevren,1, S7^ L, c. nw-- 55//2 <br />ORGANIZATION OFFICER'S NAME <br />L-tti do , /tom , —. 772ea5L4 re/' <br />ADDRESS j <br />29z‘, La 1-x/.? 2d/ LtC . mi/ 559, 7 <br />Location where license will be used. If an outdoor area, describe <br />-YW2 L1i'4&2 CQNad Ea. `- -, M� .s-srl-) <br />....2w15--- .e d man S j G, C , 44 -✓ S5 11 a + La 4.? 6-e /V ciij <br />R -cgch I ov -PFe /Ce- UN/ i <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 applicant carry liquor liability iqsurance? If so, the carrier's name and amount of roverage. �7� <br />(NOTE: Insurance is not mandatory.) Ye. MA/ e„ olr1' Urlder,r +K1 / ScOC, 7✓v /i1(JZ) <br />r <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE <br />CITY /COUNTY <br />SUBMITTING TO ALCOHOL <br />DATE APPROVED <br />LICENSE DATES <br />& GAMBLING ENFORCEMENT <br />CITY FEE AMOUNT <br />DATE 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 />Panes 1FF <br />