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Name of organization <br />Minnesota Department of Public Safety <br />Alcohol and Gambling Enforcement Division <br />445 Minnesota 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 />Date organized <br />ISt. John the Eyangelist Little Canada <br />Address <br />January 1, 1949 <br />2621 McMenemy St <br />Name of person making application <br />City <br />Little Canada <br />Ryan McTeague <br />Date(s) of event <br />April 24, 2015 <br />Organization officer's name <br />State <br />Minnesota <br />Tax exempt number <br />23330 <br />Business phone <br />651-247-3440 <br />Type of organization <br />0 Club ❑ Charitable <br />City <br />Mary Kay Rowan <br />Little;'Cdnaaa: <br />Little Canada <br />Zip Code <br />55117 <br />Home phone <br />651-330-8981 <br />® Religious 0 Other non-profit <br />State Zip <br />Ni�nnebota'`;`. <br />Minnesota 55117 <br />Location where permit will be used. If an outdoor area, describe, <br />Church and school gathering space, lunchroom, gymnasium and outdoors near the entrance and playground area. <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 applitant will carry liquor liability insurance please provide the carrier's name and amount of coverage. <br />Yes. Self-insured through archdiocese of St. Paul/Minneapolis. Program administered by Catholic Mutual <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />Little Canada <br />City/County <br />Waived <br />N/A <br />Date Approved <br />City Fee Amount Permit Date <br />Date Fee Paid City/County E-mail Address <br />Signature City Clerk or County Official Approved Director Alcohol and Gambling Enforcement <br />CLERKS NOTICE: Submit this form to Alcohol and Gambling Enforcement Division 30 days prior to event, <br />PLEASE PROVIDE A VALID E-MAIL ADDRESS FOR THE CITY/COUNTY AS ALL TEMPORARY PERMIT APPROVALS WILL BE SENT <br />BACK VIA EMAIL. E-MAIL THE APPLICATION SIGNED BY CITY/COUNTY TO AGE.TEMPORARYAPPLI-SAEEQNrTSTATE,MN•US <br />Page 1 of 1 <br />2 <br />