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Application for 1 to 4 Day Temporary On -Sale Liquor License <br />Minnesota Department of Public Safety <br />ALCOHOL AND GAMBLING ENFORCEMENT DIVISION <br />444 Cedar St., Suite 133, St. Paul, MN 55101 -5133 <br />(651)296 -9519 FAX (651)297 -5259 TTY (651)282 -6555 <br />Page 1 of 2 <br />APPLICATION AND PERMIT <br />FOR A 1 TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />(Organization or Location limited to 3 permits in a 12 month period) <br />TYPE OR PRINT INFORMATION <br />WNW OF onr r <br />r K 1° s 1-14017---4 <br />D <br />D TE ! �7 `) - <br />-� A <br />A 4 ' 7 <br />S' .ET, ap• C <br />• N .6, i' ✓ /3 • O APPLICATION B <br />BUSIN �. o.. 1 <br />1 '�� 5�0 3 <br />3 ��?� <br />. if an outdoor arca, <br />tiaminrawarawansairassinkilamoremm <br />11 1IL t A/Alii <br />Will the applicant contract for intoxicating liquor services? If so, give the nacre and addre s of the Liquor license providing the service. <br />Pie' <br />t4' <br />Will the applicant carry liquor liability' , ? Ifso, the »: `�sf s name and . „ , t . / /i,eVV /i <br />(NOTE: Insurance is not mandatory) L° ♦ i . `jd / <br />AP ' ROYAL _ �G�� '/ <br />APPLICATION M'CST BZ APPROVED BY CffY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />CITY /COUNTY <br />CITY Ithb. AMOUNT <br />DATE FEE PAID <br />SIGNATURE CITY CLERK OR COUNTY OFFICIAL <br />DATE APPROVED <br />LICENSE DATES <br />APPROVED LIQUOR CONTROL DIRECTOR <br />NOTE: Do not separate these two parts, send both parts to the address above and the orighiai signed by ibis *vision <br />will be returned a* the license. Submit to the City or County at least 39 days before the event. <br />PS- 0079(St <br />http://www.dps.state.mn.us/alcgamb/alcenf/forms/4daytemp.html <br />6/13/01 <br />