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PS-09079 (5/93) Minnesota Department of Public Safety LIQUOR CONTROL DIVISION 190 5th St. E., St. Paul, MN 55101 (612) 296 -6430 TDD (612) 297 -2100 APPLICATION AND PERMIT FOR A 1 to 3 DAY TEMPORARY ON -SALE LIQUOR LICENSE TYPE OR PRINT INFORMATION NAME OF ORGANIZATION Saint John's Church of Little Canada DATE ORGANIZED 1851 NO. OF MEMBERS 2,000 families TAX EXEMPT NUMBER ES 23330 STREET ADDRESS 380 Little Canada Road CITY St. Paul STATE Mn ZIP CODE 55117 NAME OF PERSON MAKING APPLICATION Robert Fitzpatrick BUSINESS PHONE 1612) 484 -2708 HOME PHONE ( 1 same DATES LIQUOR WILL BE SOLD? It TO 3 DAYS) Sunday, September 24, 1995 DOES ORGANIZATION HAVE A CHARTER ❑ Yes ❑ Nc GENERAL PURPOSE OF ORGANIZATION Religion ORGANIZATION OFFICER'S NAME Rev. Robert Fitzpatrick ADDRESS 380 Little Canada Road ORGANIZATION OFFICER'S NAME ADDRESS ORGANIZATION OFFICER'S NAME ADDRESS Location where license will be used. If an outdoor area, describe. church grounds and parking lot Will the applicant contract for intoxicating liquor services? If so, give the name and address of the Liquor licensee providing the services. _: • No Will the applicant carry liquor liability insurance? If so, the carrier's name and amount of coverage. (Note: Insurance is not mandatory) yes Catholic Mutual Insurance /Archdiocese of St. Paul /Mpls. APPROVAL CITY OF DATE APPROVED CITY FEE AMOUNT LICENSE DATES DATE FEE PAID APPROVED LIQUOR CONTROL DIRECTOR SIGNATURE CITY CLERK NOTE: Do not separate these two parts, send both parts to the address above and the original signed by this division will be returned as the license. Submit to the City Clerk at least 30 days before the event. Page 2