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Minnesota Department of Public Safety <br />ITN LIQUOR CONTROL DIVISION <br />444 Cedar St. /Suite 100L <br />St. Paul, MN 55101 -2156 <br />v Ale (612)296 -6439 I'DD (612)282 -6555 <br />aps.» <br />APPLICATION AND PERMIT <br />FOR A 1 TO 4 DAY TEMPORARY ON -SALE LIQUOR <br />(Organization or location limited to 3 permits in a 12 month period <br />TYPE OR PRINT INFORMATION <br />LICENSE <br />'Y,/\r. \. <br />*�� <br />"ila,,,„, <br />or <br />MBI# <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 Little Canada Road, <br />CITY <br />Little Canada <br />STATE <br />MN <br />ZIP CODE <br />55117 <br />NAME. OF PERSON MAKING APPLICATION <br />John T. Keis <br />BUSINESS PHONE <br />@12) 671 -2504 <br />HOME PHONE <br />(612) 482 -8774 <br />DATES LIQUOR WILL BE SOLD (1 to 4 days) <br />October 25, 1997 <br />TYPE OF ORGANIZATION <br />❑ CLUB ❑ CHARITABLE ❑ RELIGIOUS S OTHER NONPROFIT <br />ORGANIZATION OFFICER'S NAME <br />John Keis <br />ADDRESS <br />3094 Payne Avenue, Little Canada, MN 55117 <br />ORGANIZATION OFFICER'S NAME <br />Katie Socha <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 />St. John's School Gymnasium <br />2621 McMenemy Road <br />Little Canada, MN 55117 <br />Will the applicant contract for intoxicating liquor services? If so, give the name and address of the Liquor license 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) <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />CITY /COUNTY Rittl? Eana y, <br />amse oun <br />DATE APPROVED <br />LICENSE DATES <br />CITY FEE AMOUNT <br />DATE FEE PAID <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 65 <br />