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APPLICATION AND 'prom <br />FOR A 1 TO 4 DAY ISMPORARY ON -SALE LIQUOR Limn <br />(Omni:cation or location limited to 3 permits in a 12 month period) <br />NAME OP ORGANIZATIQN <br />ship LAt :T Li dry <br />DATE ORGANIZED <br />3•- IF- 7-1 <br />TAXEXEMPT RUMEX <br />ZZ ^720too V. <br />st'RSrvrADDRESS <br />9t.2 M - e T. <br />CTfY <br />LA cio LA tGd <br />STATE <br />WI 1c1 <br />ZIP CODE <br />• <br />NAME OFPERSON MAKING APPLICATION <br />w-t Z. I- €OO.en_s /s 5 <br />BUSINESS P • _, <br />err - •'7522 <br />]i'OMB PHONE <br />bat . -Ate,.. • 7. <br />DATES Q IJOR V ALLBE SOLD 1 to 4 days) <br />M A Q�>a re ; c s 4- <br />TYPE OF ORGANIZATION <br />Cain D CHARITABLE a RELIGIOUS o OTRRRNQN OFrT <br />ORGWEATION OFFICER'S NAME <br />-v►� e' ,rs presj <br />ADDRESS <br />Scow -- <br />ADDRESS <br />-7 -. <br />, <br />LC rk. PLC sue L . L4P__ w <br />Vick c..k ; c L i-n 1- -C • <br />ORQAFIZA TJON OPFICEICS <br />A` t,O Les e C.Src\ <br />ORGANIZATION OFFICER'S NAM <br />CO /c er. LAD % f.. C `rreg. <br />ADDRESS <br />7 ?9 <br />V , ►c Z c Lamy,., e• L . L. <br />Location w be used. Ifni orloo( area, i1 OCthc <br />Rw <br />171 E M cT• <br />Will to appiicaot oontraatfor inteticating liquorservice3? Tao, gin!** name sad Wm* of thcLigpat loan* providing tie service. <br />0 <br />;'III tbaapplicant cony liquorleft insure the orrice s name stud mama o!coverage. <br />(NOTE: Inmrocae is not mandatory) )S <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO LIQUOR CONTROL <br />CITY/COUNTY <br />CITY FEE AMOUNT <br />DATE ME PAID <br />SIONATURB CITY CLERIC OR COUNTY OPTICAL <br />DATE APPROVED <br />LICENSE DATES <br />APPROVED LIQUOR CONTROL DIRECTOR <br />NOTEt Do not separate: these two parts, send both parts Lathe address above and the o iZhnai signed by ebl* dMaion • <br />• will be returned as the limase. $ubmft to the City or County at leafs 30 days before the met. <br />PS- 09079(5193) <br />