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P3- 09079 -01 (8185) MINNESOTA DEPARTMENT OF PUBLIC SAFETY <br />PHONE612 -296 -6159 LIQUOR CONTROL DIVISION <br />333 SIBLEY • ST. PAUL, MN 55101 <br />h' ...,1 APPLICATION AND PERMIT <br />1/4 jai. }':::. <br />FOR A 1 to 3 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />TYPE OR PRINT INFORMATION <br />NAME OF ORGANIZATION <br />I.l?TL2 CANAA4 PEc1c4r :to 21f R. &Sod, <br />DATE ORGANIZED <br />4a t7/ 62 <br />NO. OF MEMBERS <br />7S <br />TAX EXEMPT NUMBER <br />029VV,2 <br />STREET ADDRESS <br />CIS ,c. L -277LE c,4N4A4 .e A <br />CIT <br />4171-4 CA,✓A4A <br />STATE <br />/71.✓ <br />ZIP CODE <br />SC/ 7 <br />NAME OF PERSON MAKING APPLICATION <br />0.02/ru lc" E1C <br />BUSINESS PHONE <br />1 ) G -)/ - Soy <br />HOME PHONE <br />I )9P2- ?7)V <br />DATES LIQUOR WILL BE SOLD? 11 TO 3 DAYS) <br />/4M G /2-- J"- /S / 993 <br />DOES 05GANIZATION HAVE A CHARTER <br />es CI No <br />9GENERAL PURPOSE OF ORGANIZATION <br />7l?aMa7C YON%?s 44-i S ✓Si <br />ORGANIZATION OFFICER'S NAME <br />SO}/r✓ k6 J_c' fR gs z&e:fu r <br />ADDRESS <br />?o'y PA» 'E Z. 0 e c---c-ii? <br />ORGANIZATION OFFICER'S NAME <br />NA; F- Sac/ /4 SEcZcTi9reV <br />ADDRESS <br />.Ps so "'tern,'+ &rrmy Lc m» 5" r217 <br />ORGANIZATION OFFICER'S NAME <br />% TAI AA F4h y 77 EA( 14I? <br />ADDRESS <br />.29.24 LARcf.11_ RA Lc n„-' Ss/ /. <br />Location where license will be used. If an outdoor area, describe. <br />Yr9Ofirvi,Z 1/9.eK C 7-7" Le: C4,vAdA <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 />/V o <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 />ES .CTATii: Oi= M Z'rr-, %- C6 FA 1 s.C:s'Ga x b R.1" <br />--Cc PI %IN <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 6 <br />