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PS-09079.01(8/851 MINNESOTA DEPARTMENT OF PUBLIC SAFETY <br />PHONE 612- 296 -6159 LIQUOR CONTROL DIVISION <br />333 SIBLEY • ST. PAUL, MN 55101 <br />APPLICATION AND PERMIT <br />FOR A 1 to 3 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />TYPE OR PRINT INFORMATION <br />NAME OF ORGANIZATION <br />/�GG %%%� <br />7i(:' G-rtk.� /CCi'YG'�<,'- ,�•�... �Sr-cii.7'77,• ^. /c <br />DATE ORGANIZED <br />C ' <br />l %S:S <br />N0. OF MEMBERS <br />TAX EXEMPT NUMBER <br />STREET ADDRESS /�� <br />/G C' /5/ze1 L'CC ci ✓7 i <br />CITY j/ ,/� 1 <br />4i /i /C Cinu'i 4 <br />STATE <br />1/// <br />ZIP CODE <br />_5 S%/7 <br />NAME OF ERSON MAKING APP CATION <br />kO ke -r7- X. -ScrLZf <br />B INESS ?HONE <br />(6/1 ) L. e 71'/.5— <br />HOME PHONE <br />(62/Z) 913 )05-5" <br />DATES LIQUOR ILL BE SOLD? 11 TO 3 DAYS) <br />✓Y! y ; / / U 9 , <br />DOES ORGANIZATION HAVE A CHARTER <br />24s ❑ No <br />GENERAL PURPOSE OF ORGANIZATION <br />\/( UL Spcwk At- 1-)1.4 ir e <br />ORGANIZATIO FFICER'S NAKIE <br />-e -GS' ire/Cy e.L «w <br />ADDRESS <br />' <br />ioi r.tv,d 4. 6,c/1,441._ nitii 5-5), 7 <br />ORGANIZATION OFFICER'S NAME <br />2 C <br />. /vcLC- 1?a -.L,, <br />ADDRESS <br />"� <br />6 -? a / ' /12 .k.., 557e9' <br />ADDRESS n <br />�C 9 C r t o . ed Vdcf , i is AM) Ss i/; <br />ORGANIZATION OFFICER'S NAME <br />�J ,r Crmt IC K <br />Location where license /will be used. If an outdoor area, describe. C /� <br />..51.. LT 65cDtS \ : Lan-. in_ le Oi.- Lc. r:. (7JC -C `7 rPL) <br />/Z1I <br />.2 6.a-, Me• //tele. E'6eti) !e- cc . 4 /11-.110_ G: ff24-cl « 5 S' 17 ✓ <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 />i9/0 <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 />,ti`l <br />APPROVAL <br />LITTLE CANADA <br />CITY OF <br />DATE APPROVED <br />CITY FEE AMOUNT <br />LICENSE DATES <br />DATE FEE PAID <br />• <br />y/� mod` /•� <br />APPROVED LIQUOR CONTROL DIRECTOR <br />i IG AAT E CITV ERK <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 />age <br />