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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 />FOR A 1 to 3 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />TYPE OR PRINT INFORMATION <br />NAME OF OR ANIZATIO <br />Uifle <br />t oiLian a5,5 <br />DATE ORGANIZED <br />I.� -17 -78 <br />NO. OF MEMBERS <br />5 <br />TAX EXEMPT NUMBER <br />803(1 3.25 <br />STREET ADDRESS <br />515 <br />L-HIP CMt &J 2a1( <br />CITY <br />Utf(Q (xluktda, <br />STATE <br />HU <br />ZIP CODE <br />5511) <br />NAM/5 OF PERSON MAKING APPLICATION <br />{gt ties <br />BUSINESS PHONE <br />102)L6/- 2/77 <br />HOME PHONE <br />(4^/) 405 -86,6,5' <br />DATES LI Qp�Ua R 1'464 SOLD? t11\ 3 DAYS) <br />Hurl "1 J <br />DOES ORGANIZATION ON HAVE A CHARTER <br />UI'1 C) r._l,{l. <br />640 GENERAL PURPOSE OF ORGANIZATION L \ <br />ORGANIZATION OFFICER'S NAME <br />£;ti ru,cz Ifia. <br />VeSil <br />ADDRESS <br />6x4/ 7 i a-A 5a:, Z--, <br />ADDRESS <br />ORGANIZATION OFFICER'S NAME <br />ORGANIZATION OFFICER'S NAME <br />ADDRESS <br />Location / / vc io 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 />''NO <br />Will the applicant carry liquor liability insurance? If so, <br />(Note. Insurance is not mandatory) <br />jlc Upmarn, b 130 Uias( u <br />the carrier's name and amount of coverage. <br />4 St Pau l WN 55110 Soloolrd <br />APPROVAL <br />,, ,,, l <br />CITY OF di,-1---H "`L" <br />DATE APPROVED <br />CITY FEE AMOUNT 1 9 <br />LICENSE DATES <br />DATE FEE PAID <br />APPROVED LIQUOR CONTROL DIRECTOR <br />5 <br />SIGNATURE CITY CLERK <br />Page <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 />