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Minnesota Department of Public Safety <br />.16.. LIQUOR CONTROL DIVISION <br />° *yy� 444 Cedar St. /Suite 100L <br />hdY -;y <br />St. Paul MN 55101 -2156 <br />x (612)296 -6439 TDD (612)282 -6555 <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 />; r" r- <br />4 *�a <br />or <br />MBI# <br />NAME OF ORGANIZATION <br />Saint John s Church of Little Canada <br />DATElORGANIZED <br />ES 233EXEMPT NUMBER <br />STREET ADDRESS <br />380 Little Canada Road . <br />CITY <br />St. Paul <br />STATE <br />Mn <br />ZIP CODE <br />55117 <br />NAME OF PERSON MAKING APPLICATION <br />Robert Fitzpatrick <br />BUSINESS PHONE <br />(612) 484 -2708 <br />HOME PHONE <br />( ) same <br />DATES LIQUOR WILL BE SOLD (1 to 4 days) <br />Sunday, September 29, 1996 <br />TYPE OF ORGANIZATION <br />❑ CLUB ❑ CHARITABLE X1 RELIGIOUS ❑ OTHER NONPROFIT <br />ORGANIZATION OFFICER'S NAME <br />Rev. Robert Fitzpatrick <br />ADDRESS <br />380 Little Canada Road <br />ORGANIZATION OFFICER'S NAME <br />ADDRESS <br />ORGANIZATION OFFICER'S NAME <br />ADDRESS <br />Location where license will be used. If an outdoor area, describe <br />church grounds and parking lot <br />Will the applicant contract for intoxicating liquor services? If so, give the name and address of the Liquor license 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) yes Catholic Mutual Insurance /Archdiocese of St. Paul /Mpls <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />CITY /COUNTY <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 52 <br />