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,:4-,:4 Minnesota Department of Public Safety <br />wv :° +�6o Alcohol and Gambling Enforcement Division <br />-- 444 Cedar St —Suite 133 <br />w j. ? <br />St. Paul, MN 55101 -5133 <br />oyM <br />t41858 <br />.....:........ <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 />N(Oe,,,„, <br />��, • <br />*� <br />L a <br />Pj <br />{ <br />NAME OF ORGANIZATION <br />Little Canada Recreation Assoc. <br />DATE ORGANIZED <br />Juno, 1962 <br />TAX EXEMPT NUMBER <br />29426 <br />STREET ADDRESS <br />515 R Tittle Canada Rnad <br />CITY <br />Tittle Canada <br />STATE <br />MN <br />ZIP CODE <br />55117 <br />NAME OF PERSON MAKING APPLICATION <br />Tnhn Kris <br />BUSINESS PHONE <br />(R17) A.71 -7504 <br />HOME PHONE <br />C51 ) 482 -8774 <br />DATES LIQUOR WILL BE SOLD <br />January 23 and 24, 1999 <br />TYPE OF ORGANIZATION <br />❑RELIGIOUS ;OTHER NONPROFIT <br />• CLUB ❑CHARITABLE <br />ORGANIZATION OFFICER'S NAME <br />John Keis <br />ADDRESS <br />3004 Payna A\rrnnr T,jti-I Canada, MI 5St17 <br />ORGANIZATION OFFICER'S NAME <br />Katie Rnrha <br />ADDRESS <br />2530 McMenemy Road, Little Canada, MN 55117 <br />ORGANIZATION OFFICER'S NAME <br />Linda Fahey <br />ADDRESS <br />2926 LaBore Road, Little Canada, MN 55109 <br />Location where license will be used. If an outdoor area, describe <br />440 E. Little Canada Road <br />Little Canada, MN 55117 <br />Old Fire Hall <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 insurance? If so, the carrier's name and amount of coverage. <br />(NOTE: Insurance is not mandatory.) MN Assigned Risk <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 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 43 <br />