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JUL -11 -95 TUE 12:53 IDS FINANCIAL SERVICES FAX NO. 6712621 P. 05 <br />Minnesota Department of Public Safety <br />LIQUOR CONTROL DIVISION <br />190 5th St. i:., St. Paul, MN 55101 <br />(612) 296 -6430 TDD (612) 297 -2100 <br />APPLICATION AND PERMIT <br />FOR A 1 to 3 DAY TEMPORARY ON-SALE LIQUOR LICENSE <br />TYPE OR PRINT INFORMATION <br />NAME OF <br />ORGANIZATION <br />4 : ✓ L.1 t I2A/A�/} 3 _g_t - is FS o r <br />STREET <br />DATE ORGANIZED <br />«J, 7,/ 2 <br />NO. OF MEMBERS <br />7 0 <br />TAX EXEMPT NUMBER <br />9 roe e <br />ADDRESS _ <br />r <br />/..t ,G % l c/ C iv /)�, <br />NAME <br />CITY <br />.C.T. ti A/4 A /'L <br />..2 <br />STATE <br />Mild <br />ZIP CODE <br />7 <br />OF PERSON MAKING APPLICATION <br />CTh -9/V ; /t'cSS' <br />DATES <br />DOE$ OBOANIZAT1ON <br />I CTes <br />BUSINESS PHONE <br />r ) G7/ _.?S"<-,y <br />HAVE A CHARTER <br />CNo <br />GENERAL <br />I)F'o.,e:c <br />HOME PHONE <br />( ) <br />PURPOSE <br />vg..) •e,.),/ <br />OF ORGANIZATION <br />Yo <br />.is // <br />/9c7.? <br />LIQUOR WILL BE SOLO? (1 TO 3 DAYS) <br />/- 9Zt.Carr 1.2 `v. /3 /99.5 <br />ORGANIZATION <br />OFFICER'S NAME <br />ORGANIZATION OFFICER'S NAMES <br />A%17-aI SaCP<9 <br />/-s/ I.L77 <br />ADDRESS <br />--r 09c/ p�Y/VF /�L'r: ,�, C M,y/ r5-//? <br />ADDRESS <br />..1S30 mcn9r47 rmt 2C n - 5-s //7 <br />ADDRESS <br />.- ,-2 e <br />ORGANIZATION OFFICER'S NAME <br />1,S.v4 d9 64;,, y <br />Location where license will be used. If an outdoor area, describe. <br />S c4 N.^. � ?4,4,L' L is rd., CA .4144 inn/ S"S,/ % <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 />A • 0 <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 />W.-- .1" ,C 7--.1 The 0f• ".7.V NGTO 74 Art TC.tirh PC./?/.. <br />.arX <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 />war. Do not separate these two parts eland b h <br />will be returned as the license. Submit to the City Clerk eatdleast 30 days before the original <br />vent�gned by this division <br />Page 11 <br />