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MAY- 9 -95 TUE 7:46 IDS FINANCIAL SERVICES FAX N0. 6712621 <br />P. 03 <br />• - <br />PS•09e 79 (SAO) Minnesota Department of Public Safety <br />LIQUOR CONTROL DIVISION <br />190 5th St. E.. St. Paul, MN 55101 <br />;' ,v. a (612) 2964430 TDD (612) 297 -2100 <br />Kea <br />'t � >'' 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 />L2rr ,E CA.Iram- Pxt lorran • ASSue <br />DATE ORGANIZED <br />/o2 /.7 //_ 2 <br />C <br />1x7 7'4% CAN-9d <br />NO. OF MEMBERS <br />-7 0 <br />4 <br />TAX EXEMPT <br />.•214/014 <br />STATE <br />miv <br />NUMBER <br />ZIP CODE <br />Ss -)['7 <br />STREET ADDRESS <br />3- /S ,£. 1- 7rrLet rAn.,4A,9 R 4 <br />NAME OF PERSON MAKING APPLICATION <br />:1-01,0 iv r. HErs <br />BUSINESS PHONE <br />i ) 67/ - .asoy <br />HOME PHONE <br />( i v(.2- env <br />DATES UOUOR WILL BE SOLO? (1 TO 3 DAYS) <br />MliZI- /n V• // <br />DOES ORGANIZATION HAVE A CHARTER <br />ease fNo <br />GENERAL PURPOSE OF ORGANIZATION <br />P2oinorr V0 LP/ ActZIa7 <br />ORGANIZATION OFFICER'S NAME <br />o//r-, -7" /(.e..7. r <br />ADDRESS <br />3o 9 Y PA yAvg- Ayr! L C nw Cr! <br />ORGANIZATION OFFICER'S NAME <br />ieAr_Ter rrfrk4 <br />ADDRESS <br />02,5 .26 AacmAmr.nV AG Met.. gr.. <br />ORGANIZATION OFFICER'S NAME <br />I. TA, 45 F9NAv <br />ADDRESS <br />.79.7 6 4A9RtiReLP ntn, Cc'"? <br />Location where license will be used. 11 an outdoor area, describe. <br />o�l1 <br />_ gg2yZ ? 70A21L AX TTI ? rA,y 4 M A/ c <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 />Al 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 />VE.S STA7Er- 0j- entNNF.cnrA At,C,esAi A se44. is PL./9N <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 Darts, 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 />7 <br />4 <br />