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MAY -24 -94 TUE 9:57 IDS FINANCIAL SERVICES FAX N0, 6712621 <br />P. 02 <br />PS- 09079.01 (8/65) MINNESOTA DEPARTMENT OF PUBLIC SAFETY <br />PHONE 812- 296 -6159 LIQUOR CONTROL DIVISION <br />333 SIBLEY • ST. PAUL, MN 55101 <br />ii"., _ • g ° ' APPLICATION AND PERMIT <br />c,,; ; v FOR A 1 to 3 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />TYPE OR PRINT INFORMATION <br />NAME OF ORGANIZATION <br />rr.�,� CANA4A fl &1 ATF-a.r Ail car . <br />DATE ORGANIZED <br />ra1/42/aA <br />NO. OF MEMBERS <br />7S <br />TAX EXEMPT NUMBER <br />g9 Ye/ C <br />STREET ADDRESS <br />S / .f' ,f, c— T1 t4.vA4,9 mac' d) <br />DOES ORGANIZATION <br />0,Nes <br />CITY <br />4-17 7/...E t..9.4.!.44 <br />BUSINESS PHONE <br />( ) 4'71- a.1S09 <br />HAVE A CHARTER <br />0 N <br />ADDRESS <br />g699 IAY.ki r <br />ADDRESS <br />-?53O Mt.n4n2.‘sro <br />A. <br />GENERAL <br />JitomCI: <br />HOME PHONE <br />( ) <br />PURPOSE <br />4C <br />4C <br />STATE <br />M/1) <br />yls2• <br />OF <br />Yaa;af <br />.)IN <br />m.) <br />ZIP CODE <br />,.f'S/17 <br />t775+ <br />ORGANIZATION <br />46nv,rn <br />Ssr/'ly <br />Ssrr7 <br />NAME OF PERSON MAKING APPLICATION <br />3-6XAl T KEr f <br />DATES LIQUOR WILL RE SOLD? 11 TO 3 DAYS) <br />I.trv.0 11 se / -Z. )49i?' <br />ORGANIZATION OFFICER'S NAME <br />T3o,N KEtf Pili= SlOPNr <br />ORGANIZATION OFFICER'S NAME <br />k47'8 secAtg S�C,.flt.T.9seY <br />ORGANIZATION OFFICER'S NAME <br />L -7N4.9 1: Ali g V rite- A,';In,Q.e,2 <br />CA../.9b/4 <br />ADDRESS <br />d9�26 4.9dd.er '4C MN is-$)(1 <br />Location where license will be used. If an outdoor area, describe. <br />P/0/NJ,17' 2 PA,ZK A2 %r if' <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 />IJ U <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 />YE: -r STA %Y of 477 :4! A.(41 67A 4 cca. CaJ.0 <br />A <br />A J2i-S1t _-O J <br />4.4N <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 />3 <br />SIGNATURE CITY CLERK <br />Page <br />NOTE: Do not separate those 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 />