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PS-09079- <br />PHONE <br />TYPE <br />01(8/851 MINNESOTA DEPARTMENT OF PUBLIC SAFETY <br />612- 296 -6159 LIQUOR CONTROL DIVISION <br />333 SIBLEY • ST. PAUL, MN 55101 <br />cyr�ra`t 'tA <br />,� APPLICATION AND PERMIT <br />si FOR A 1 to 3 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />OR PRINT INFORMATION <br />NAME OF ORGANIZATION <br />DATE ORGANIZED <br />NO. OF MEMBERS <br />TAX EXEMPT NUMBER <br />STREET ADDRESS <br />CITY <br />STATE <br />ZIP CODE <br />NAME OF PERSON MAKING APPLICATION <br />BUSINESS PHONE <br />1 1 <br />HOME PHONE <br />1 1 <br />DATES LIQUOR WILL BE SOLD? 11 TO 3 DAYS) <br />DOES ORGANIZATION HAVE A CHARTER <br />❑ Yes D No <br />GENERAL PURPOSE OF ORGANIZATION <br />ORGANIZATION OFFICER'S NAME <br />ADDRESS <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 />Will the applicant contract for intoxicating liquor services? If so, give the name and address of the Liquor licensee providing <br />the services. <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 />CITY OF <br />DATE APPROVED <br />CITY FEE AMOUNT <br />LICENSE DATES <br />DATE FEE PAID <br />APPROVED LIQUOR CONTROL DIRECTOR <br />SIGNATURE CITY CLERK <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 Clerk at least 30 days before the event. <br />PAGE -9- <br />