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PS- 09079 - 0118/851 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 />i FOR A 1 to 3 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />TYPE OR PRINT INFORMATION <br />NAME OF ORGANIZATION <br />St. John's Church Of Little Canada <br />DATE ORGANIZED <br />1851 <br />NO. OF MEMBERS <br />2,000 families <br />TAX EXEMPT NUMBER <br />8918317 <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 />CAtherine Collova <br />BUSINESS PHONE <br />6121 484 -2708 <br />HOME PHONE <br />16121 484 -8056 <br />DATES LIQUOR WILL BE SOLD? 11 TO 3 DAYS) <br />September 29. 1991 <br />DOES ORGANIZATION <br />[%Yes <br />HAVE A CHARTER <br />o No <br />ADDRESS <br />380 Little Canada Road <br />GENERAL PURPOSE OF ORGANIZATION <br />Religion <br />ORGANIZATION OFFICER'S NAME <br />Rev. Robert J. Fitzpatrick <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 />Chnrrh grounds — mitsidr. <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 />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) <br />yes <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 />2 <br />