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One DayTemporary Consumption and Display Permit <br />Minnesota Department Of Public Safety <br />ALCOHOL AND GAMBLING ENFORCEMENT <br />444 Cedar Street - Suite 133 <br />St. Paul, MN 55101 -5133 <br />(651)296 -6439 TDD (651)282 -6555 <br />Page 1 of 2 <br />APPLICATION AND PERMIT <br />FOR A 1 DAY TEMPORARY CONSUMPTION & DISPLAY PERMIT <br />(City or county may not issue more than 10 permits in any one year) <br />TYPE OR PRINT INFORMATION <br />NAME OF ORGANIZATION 1-11,4 6' �„a�� i �^k°''`S C4:1&44 ORGANIZED 19 7 3 TAX <br />EXEMPT NUMBER 1oc, 6 ©X 3c1 <br />L' tv � P, 4i ►"N.-, s.sz.1 '-( <br />STREET ADDRESS CITY STATE <br />ZIP CODE <br />NAME OF PERSON MAKIN APPLICATION BUSINESS PHONE HOME <br />.PHONE S ki,s.,,, �(cE t 2 -a4- / _ <br />40/ Cal (4,S"I) `V -332 Lt'.c Lo' v-tavSal4 <br />DATE SET UPS WILL BE SOLD V364- CQ TYPE OF ORGANIZATION <br />CLUB CHARITABLE RELIGIOUS OTHE R nL Wa \1 S <br />NONPROFIT <br />(,5s) 4f3 - tte'to <br />ORGANIZATION OFFICER'S NAME 16"0 S S Ctr44 S S�DDRESS (:58 3- or'uaCO' ex )LI,A0‘ ,KRS,dt?rt. SSot4 <br />‘v-at-s3 <br />"W...,\6 ORGANIZATION OFFICER'S NAME 1- 0tY ill i''` ''' ADDRESS 70 0 / 1e'C-Q. I..iG i...j <br />Et / -c 61 et- C' i v c:....CIA• Orvl-3, -3 iN'\ x -5Th Zf • <br />co 5-V -� • <br />��lags <br />ADD SS ''11 e; 1 t1 , a,„,,, ,k1: <br />(.>ia `3f,3- 7�19 a <br />¶ t, qp ORGANIZATION OFFICER'S NAME <br />• <br />3 y� o j43 <br />Location where permit will be used. If an outdoor area, describe .3 <br />CV . s-h 1 V a /M.�u t tJ�0Ock <br />APROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR <br />CONTROL <br />CITY /COUNTY DATE APPROVED <br />CITY FEE AMOUNT PERMIT DATE <br />(Not to exceed $25) <br />htttx / /www.dns. state. mn. us/ alceamb /alcenf/forms /ldavtemn.htm1 6/12/01 <br />