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le <br />Name of organization <br />Little Canada Canadian Days, Inc. <br />Address <br />515 Little Canada Rd E <br />Name of person making application <br />Susan Nelson <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 />Date organized <br />12/17/1978 <br />City <br />Date(s) of event <br />Organization officer's name <br />State <br />Business phone <br />N/A <br />Tax exempt number <br />Zip Code <br />55117 <br />Home phone <br />651-483.4541 <br />Type of organization <br />0 Club E Charitable 0 Religious E. Other non-profit <br />City State Zip <br />witz, <br />Susan Nelson, Secretary <br />Little Canada <br />Little Canada <br />Minnesot <br />Location where permit will be used. If an outdoor area, describe. <br />Spooner Park, 350 Eli Rd, Little Canada, MN 55117 <br />Mi e.sota" <br />551 <br />55117 <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 />