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AM <br />• G <br />MINNESOTAOEPARYMENYOE PUBIC SAM <br />• <br />Alcohol & Gambling Enforcement <br />Name of organization <br />Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division <br />444 Cedar Street, Suite 222, St. Paul, MN 55101 <br />651 - 201 -7500 Fax 651- 297 -5259 TTY 651 -282 -6555 <br />APPLICATION AND PERMIT FOR A 1 DAY <br />TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />Little Canada Canadian Days, Inc. <br />Address <br />515 Little Canada Rd E <br />Name of person making application <br />City <br />Date organized <br />12/17/1978 <br />Little Canada <br />Susan Nelson <br />Date(s) of event <br />August 1 -3, 2014 <br />Organization officer's name <br />State <br />Tax exempt number <br />Minnesota <br />Business phone <br />N/A <br />Zip Code <br />55117 <br />Home phone <br />651- 483 -4541 <br />Type of organization <br />0 Club ❑ Charitable 0 Religious <br />City State <br />John Goswitz, President <br />Little Canada <br />Susan Nelson, Secretary <br />Little Canada <br />Lynda Beaudoin <br />Little Canada <br />Add New Officer <br />Locat on where permit will be used. If an outdoor area, describe. <br />Spooner Park, 350 Et Rd, Little Canada, MN 55117 <br />I3 <br />Other non - profit <br />Zip <br />Minnesota <br />Minnesota <br />Minnesota <br />55117 <br />55117 <br />55113 <br />If the applicant will contract for intoxicating liquor service give the name and address of the liquor license providing the service. <br />N/A <br />If the applicant will carry liquor liability insurance please provide the carrier's name and amount of coverage. <br />Founders Insurance Co. $1,000,000 /$1,000/000 <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />City /County Date Approved <br />City Fee Amount Permit Date <br />Date Fee Paid <br />Signature City Clerk or County Official Approved Director Alcohol and Gambling Enforcement <br />NOTE: Submit this form to the city or county 30 days prior to event. Forward application signed by city and /or county to the address <br />above. If the application is approved the Alcohol and Gambling Enforcement Division will return this application to be used as the <br />permit for the event, <br />Page 1 of 1 <br />