Laserfiche WebLink
Application for 1 to 4 Day Temporary On -Sale Liquor License <br />cfge <br />Minnesota Department of Public Safety <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br />444 Cedar St., Suite 133, SL Paul, MN 55101 -5133 <br />(651)296 -9519 FAX (651)297 -5259 TTY (651)282-6555 <br />Page of 2 <br />APPLICATION AND PERMIT <br />FOR A 1 TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />(Organi¢ntioa or ioation tiwited to 3 permits in a 12 month period) <br />TYPE OR PRIM? INFORMATION <br />NAME OF ORGANIZA TION D <br />DATE ORGANIZED T <br />TAX EXEMPT NUMBER <br />STREET ADDRESS C <br />CITY 0 <br />5T MA 4 <br />4-4'01 y <br />NAME OF PERSON MAKING APPLICATION B <br />BUSINESS PHONE H <br />HOty PHONE <br />7p}n) A. 14/- r,NfA, O <br />OM 631-4-4) 1 <br />1941741 V-7 211 <br />DATES LIQUOR WILL BE SOLD (1 to 4 days) T <br />TYPE OF ORGANIZATION <br />14-fL 'G 5 "2.0,0 3 j <br />jirCLUB 0 CHARITABLE 0 RELIGIOUS 0 OTHElt NONPRQFT <br />ORGANIZATION %SEWCERS NAME A <br />ADDRESS <br />7tYVH AP T <br />T?.� Jr /� E CJ%lC�� �i�il <br />ORGANIZATIONOFCER'S NAME S <br />SS / <br />%W'co t'4• f 3 <br />313 Stier [.Jc.p»a Co-12T Cigettr fl T r <br />ORGANIZATION OFFICER'S NAME A <br />ADDS 1 <br />i nrs`re ucxttsc w1U De 16104. If an tnttdonr area, <br />— 7 /71( - C'ia <br />/'17J✓ 4 S'o i <br />i1 <br />Will the applicant wotract Iix inimicatiag liquor =ties? Lisa, give the Dense and address d the Liquor license providing the <br />Will the applicant any liquor Liability in aace? Um. the maid s *aim and mow al:overage. <br />(NOTE; Iniiraatce is not mandatory") Ner <br />APPROVAL <br />APPL.ICAT <br />N ;11 UST <br />CI T YlCOUNTY <br />CITY FEE AMOUNT <br />DATE FEE PAID <br />E APPROVED BY CITY OR COUNTY BEFORE SUBMITYING TO LIQUOR CONTROL <br />DATE APPROVED <br />LICENSE DATES <br />SIONATUR( CI -F. C'1 12, RK OR COUNTY OFFICIAL <br />APPROVED LIQUOR CONTROL DIRECTOR <br />NOTE: Do not separate these two parts, send both parts to the address above and the original signed by this division <br />Kill be returned as the license. Submit to the City or Count) at least 30 drys before the event. <br />PS- 09079(13195 <br />http: / /www.dps. state. nut. us / alcgamb /alcenf/forms/4daytemp.html <br />2/10/2003 <br />f %'M: <br />SS a it <br />SS'v/ <br />5.504 <br />