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Ps.09079.01 leiesl MINNESOTA DEPARTMENT OF PUBLIC SAFETY <br />PHONE612- 296 -6159 LIQUOR CONTROL DIVISION <br />333 SIBLEY • ST. PAUL, MN 55101 <br />APPLICATION AND PERMIT <br />a� FOR A 1 to 3 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />TYPE OR PRINT INFORMATION <br />NAME OF ORGANIZATION <br />Little Canada Recreation Association, Inc. <br />DATE ORGANIZED <br />12 -17 -62 <br />NO. OF MEMBERS <br />79 <br />TAX EXEMPT NUMBER <br />947A <br />STREET ADDRESS <br />515 East Little Canada Road <br />CITY <br />Little Canada <br />STATE <br />MN <br />ZIP CODE <br />55117 <br />NAME OF PERSON MAKING APPLICATION <br />M. Steven Morelan <br />BUSINESS PHONE <br />(612) 450 -5096 <br />HOME PHONE <br />6121 4R3 -1777 <br />DATES LIQUOR WILL BE SOLD? (1 TO 3 DAYS) <br />June 13 -14, 1992 <br />DOES ORGANIZATION HAVE A CHARTER <br />R Yes 0 N <br />GENERAL PURPOSE OF ORGANIZATION <br />Promote vrnrth artivi tips <br />ORGANIZATION OFFICER'S NAME <br />M. Steven Morelan, President <br />ADDRESS <br />109 E. Bluwood Ave . Litt1e Canada 55117 <br />ORGANIZATION OFFICER'S NAME <br />Jim Cronick, Secretary <br />ADDRESS <br />869 E. County Rd. D, Vadnais Heights 55109 <br />ADDRESS <br />2926 LaBore Rd., Little Canada 55109 <br />ORGANIZATION OFFICER'S NAME <br />Linda Fahey, Treasurer <br />Location where license will be used. If an outdoor area, describe. <br />Pioneer Park, Little Canada <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 />MN Liquor Liability Assigned Risk Plan 50/100/10 <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 16 <br />