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PS- 0907901 (8/85) MINNESOTA DEPARTMENT OF PUBLIC SAFETY <br />PHONE612 -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 />LIZ/ ?LE C4N9b2 RMiea//- TVon/ ,AS To,- <br />DATE ORGANIZED <br />/91.2 <br />NO. OF MEMBERS <br />7S <br />TAX EXEMPT NUMBER <br />a9ya4 <br />STREET ADDRESS <br />S/S ,; A. 1774.1- CAN,9 -4 4 ,.Z,0 <br />CITY <br />, i-rrG/E CA -v9-.6 • <br />STATE <br />M4/ <br />ZIP CODE <br />SS'// i <br />NAME OF PERSON MAKING APPLICATION <br />1TziNA/ 7' /�E2r <br />BUSINESS PHONE <br />( ) 471--2 509 <br />HOME PHONE <br />( )y1..2-P7 -) y <br />DATES LIQUOR WILL BE SOLD? (1 TO 3 DAYS) <br />?A% /ZJ9�/ — f / /V19V <br />DOES ORGANIZATION HAVE A CHARTER <br />W/Ves 0 N <br />GENERAL PURPOSE OF ORGANIZATION <br />SuP?o,t Yo �7r/ ,467-1-4- <br />ORG NIZATION OFFICER'S NAME <br />TONNN KITS 79leAS1,A rivT <br />ADDRESS <br />30 9 H P/9 VNI ,Y.E LC• SSP7 <br />ORGANIZATION OFFICER'S NAME <br />Ad / n/ SOC!//i SE.c- Jer_r.9,2v <br />ADDRESS <br />..2.0 la M d'jEN my ,CC SS//7 <br />ORGANIZATION OFFICER'S NAME <br />,1..1/V 4A 7-x927 Y 72E/¢SH,2,c,2 <br />ADDRESS <br />29.2G .CA d 0 2 .6 L .0 • Ss /o 9 <br />Location where license will be used. If an outdoor area, describe. <br />i..c Pooa.,r,Z, MRK .4 5774E C4,✓6,64 <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 />ti0 <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 />mI/✓NrSOTA 3-o7n/ % ue.. biRtu 127, J °6 ASieC.74.7 -2Q+i <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 11 <br />:l. <br />