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Miasmata Department of Public Safety <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br />444 Cedar Street Suite 222, St. Paul MN 55101 -5133 <br />(65 t) 201.7507 Fax (651) 297.5259 TTY (651) 282.6555 <br />W W W.DPS.STATEMN.US <br />APPLICATION AND PERMIT <br />FOR A 1 '1'O 4 DAY TEMPORA1tY ON -SALE LIQUOR LICENSE <br />r ePii OR PRINT INFORMATION <br />NAME OF ORGANIZATION <br />Saint John'rs Chuteh of Lit tie Canada <br />DATE, ORGANIZED <br />1851 <br />TAX EXEMPT NUMBER <br />ES 23330 <br />STREET ADDRESS <br />380 Little Canada Road East <br />CITY <br />Little Canada <br />STATE <br />Mn <br />ZIP CODE <br />55117 <br />NAME OF PERSON MAKING APPLICATION <br />Rev. Thomas BalluEf <br />BUSINESS PHONE <br />(151) 484 —'l70$ <br />HOME PHONE <br />( ) <br />DATES LIQUOR WILL SE SOLD <br />Saturday_ February 27, <br />TYPE OP ORGANIZATION <br />s .• :tV .t.. KILT:% - • we 0" ... • l Yit. “t <br />ADDRESS <br />ORGANIZATION OFFICERS NAME <br />ORGANIZATION OPPlCEk'S NAME <br />ADDRESS <br />ORGANIZATION OFFICER'S NAME <br />ADDRESS <br />Localioa license will be used. Wan outdoor Area, describe <br />school gymnasium-, -/ apaahectl dinner <br />Will tno applicant eonhaet for intoxicating liquor scrtdce? If so, give the name and address of the liquor licensee providing the service. <br />no <br />Will the applicant °arty liquor' liability insurance? If sat please provide the carrier's name and amountofcoverage. <br />yes Catholic Mutual <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY <br />ENFORCEMENT <br />CITY /COUNTY <br />BEFORE SURMY't <br />. DATE APPROVED <br />LICENSE DATES <br />"'I'1NG <br />TO ALCOHOL & GAMBLING <br />CITY .PEE AMOUNT <br />DATE FEB PAIN <br />SICNATURR CAW CLERK OR COUNTY OFFICIAL. ATPROYICA gmI;(,1T01tALCOaOL AND GA WILING laNFO1tCI:MRN'r <br />NUiE: Snbnnv tbls tm of Yo t114 cNy or county 3o days prior to m'ont. Forward application aignnd' by city undlnr county to Ilia address <br />above, If theapplicadmt is approved the Alcohol nut Cam ding hHforcemn t Division will return ode applICNion to he Heel AS the LiMnee for the Weal <br />P1-09079 (12 /0')) <br />Pelai CtitegazAA. o/ -3I -14 a G .ash I oryLaMill <br />