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PS- 09079(5/93) LIQUOR- DIVISION <br />Mil 444 CEDAR ST -SUITE 100 L etY <br />LIG ST. PALL PIN 55101 -2156 ION <br />1 <br />, ' — (612) 296 -6430 TDD (612) 297 -2100 <br />F <br />.. 4/ APPLICATION AND PERMIT <br />FOR A 1 to* DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />TYPE OR PRINT INFORMATION <br />NAME OF ORGANIZATION <br />L.t7i,cE 04,»4 -A4- r^vcc,2FA ?It.v ASSOcrA72o.✓ <br />DATE ORGANIZED <br />01 ;7 /6 -,:Z <br />NO. OF MEMBERS <br />10 <br />TAX EXEMPT NUMBER <br />02(Y yv2 6 <br />STREET ADDRESS <br />g/ s .0 4I 7 74.0 04A., 444 R. a <br />CITY <br />41:77- 4C CAivy AA <br />STATE <br />/hN <br />ZIP CODE <br />$'S // O <br />NAME OF PERSON MAKING APPLICATION <br />BUSINESS PHONE <br />HOME PHONE <br />DATES LIQUOR WILL BE SOLD? (1 TO 3 DAYS) <br />74X../ -'lo v- 41 /996 <br />DOES ORGANIZATION HAVE A CHARTER <br />24es ❑Nc <br />GENERAL PURPOSE OF ORGANIZATION <br />17/4:xoi r YutiTy Ac:SVii+ <br />ORGANIZATION OFFICER'S NAME <br />3o Ha/ Xf_7S <br />ADDRESS <br />3n elVJ •AY' t AvP A.C- . no/✓ SS //J <br />ORGANIZATION OFFICER'S NAME <br />X.4 -/ZZ- r0C/71. 4 <br />ADDRESS <br />ass6 MCM<t4/ CsMY 4C nnN SSi/7 <br />ORGANIZATION OFFICER'S NAME <br />2%-,-)A/4 1.4ti.cy <br />ADDRESS <br />.2 3,2G )4 304/_. n?11 I, c- MN SSioo <br />Location where license will be used. If an outdoor area, describe. <br />V4/0 c C r 7Lr CAA i Ah,9 k (c -A r2,_/ H9«) <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 />No <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 />\fr-- -r t fA/G O/- Mi N, ✓i Snj q 4IsszCNra R2.,1" K. P4fJN <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 58 <br />