Laserfiche WebLink
Minnesota Department of Public Safety <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br />444 Cedar Street Suite 222, St. Paul MN 55101 -5133 <br />(651) 201 -7507 Fax (651) 297 -5259 TTY (651) 282 -6555 <br />W W W.DPS.STATE.MN.US <br />APPLICATION AND PERMIT <br />FOR A 1 TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />TYPE OR PRINT INFORMATION <br />NAME OF ORGANIZATION <br />Saint John's Church of Little Canada <br />DATE ORGANIZED <br />1851 <br />TAX EXEMPT NUMBER <br />ES 23330 <br />STREET ADDRESS <br />380 Little Canada Road East <br />CITY <br />Little Canada <br />STATE <br />Minnesota <br />ZIP CODE. <br />55117 <br />NAME OF PERSON MAKING APPLICATION <br />Rev. Thomas Balluf£ <br />BUSINESS PHONE <br />651)484 -2708 <br />140ME PHONE <br />( ) same <br />DATES LIQUOR WILL BE SOLD <br />October 5. 2013 <br />TYPE OF ORGANIZATION <br />CLUB tonxitrx RELIGIOUS, <br />QI¢7 IXt3tOX!)X XNr <br />ORGANIZATION OFFICER'S NAME <br />ADDRESS <br />ORGANIZATION OFFICER'S NAME <br />ADDRESS <br />ORGANIZ.A'1TON OFFICER'S NAME <br />ADDRESS <br />Location license will be used. If an outdoor area, describe <br />school gymnasium — spaghetti dinner <br />Will the applicant contract for intoxicating liquor service? If so, give the name and address of the liquor licensee providing the service. <br />no <br />Will the applicant carry liquor liability insurance? If so, please provide the carrier's name and amount of coverage. <br />yes • Catholic Mutual <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY <br />ENFORCEMENT <br />CITY /COUNTY <br />BEFORE SUBMITTING <br />DATE APPROVED <br />LICENSE DATES <br />TO ALCOHOL R GAMBLING <br />CITY FEE AMOUNT <br />DATE FEE PAID <br />SIGNATURE CITY CLERIC OR COUNTY OFPICIAL APPItOVEI) DIRECTOR ALCOliOI, AND GAMBLING ENFORCE11411Nt <br />Submit this form to the elty or county 30 days prior to event. Forward application signed by city and/or county to the address <br />above. If the application is Approved the Alcohol and Gambling Enforcement Division will return this application to be used As the License for the event <br />PS-09079 (12109) <br />