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PS- 09079 -01 (8/85) 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 />LT77i -F CAA/AA/1 RECR,34rZ4 .V ASS°c <br />DATE ORGANIZED <br />/07//7/(,2 <br />NO. OF MEMBERS <br />7S <br />TAX EXEMPT NUMBER <br />.?99.76 <br />STREET ADDRESS <br />5/S E 4-1771.6 CA.v444 R <br />CITYY'' <br />J-ZT TGE CA,vA4,9 <br />STATE <br />114/ <br />ZIP CODE <br />Csii? <br />NAME OF PERSON MAKING APPLICATION <br />36HN IC.EZ( <br />BUSINESS PHONE <br />( ) 6 7/- -1S° y <br />HOME PHONE <br />I ) 912- 977 y <br />DATES LIQUOR WILL BE SOLD? (1 TO 3 DAYS) <br />34n, .2.2 f .2 3 )qg y <br />DOES ORGANIZATION HAVE A CHARTER <br />Wires 0 N <br />GENERAL PURPOSE OF ORGANIZATION <br />?J0,4.0 7C Yowfl/ ACT 2uIT <br />ORGANIZATION OFFICER'S NAME <br />UoNyv xErs (°/f2rt9.6,..; <br />ADDRESS <br />3o, 9 PA n',c 2. L MN SS/ /7 <br />ORGANIZATION OFFICER'S NAME <br />HATE_ So CJf/} SccRETAfY <br />ADDRESS <br />DS-36 mcmr-n-r &m'/ I. c 41 N S'S// <br />ORGANIZATION OFFICER'S NAME <br />2x./ AA rAHty 7ReAs.,e.612 <br />ADDRESS <br />079.76 i/9/3d,eC Ac- A1, SS// <br />Location where license will be used. If an outdoor area, describe. <br />CI-46 £ZTTar CAN 4a4 Ari2.E HAIL <br />.c /yo 4ITTZS C.44.444 V <br />L Z77 Air C4'44,9 mn/ S-S // 7 <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 />N /CI S .TA 7c` ar MI ''dPSa74 /1sS:.GA/;A ,en)c pi M.' <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 31 <br />7 <br />