HomeMy WebLinkAboutItem 5 - LEJC Liquor License Application 2014 i
Minnesota Department of Public Safety
Alcohol and Gambling Enforcement Division
CIE 444 Cedar Street,Suite 222, St. Paul, MN 55101
651-201-7500 Fax 651-297-5259 TTY 651-282-6555
APPLICATION AND PERMIT FOR A 1 DAY
Alcohol&Gambling Enforcement TO 4 DAY TEMPORARY ON-SALE LIQUOR LICENSE
Name of exempt organization Date organized Tax t number
9 9 P
Lake Elmo Jaycees October 1970 0072528
F
Address City State Zip Code
PO Box 198 Lake Elmo Minnesota 55033
Name of person making application Business phone Home phone
Heather Noyes 1 651-438-5504 612-801-6145
Date(s)of event Type of organization
August 7-10,2014 Club ® Charitable Religious D Other non-profit
Organization officer's name City State Zip
x Sarah Carlson-President White Bear Lake Minnesota 55110
X Heather Noyes-Secretary South St.Paul IlMinnesota 1 55075
Add New Officer
Location where permit will be used. If an outdoor area,describe.
Lions Park.Lake Elmo,MN. We will have a beer trailer next to the concessions building.It will be behind counters and blocked off to
prevent unauthorized access.
If the applicant will contract for intoxicating liquor service give the name and address of the liquor license providing the service.
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If the applicant will carry liquor liability insurance please provide the carrier's name and amount of coverage.
Insurance By Design,LLC. 14041 Burnhaven Drive,Suite#101. Burnsville,MN 55337.$1,000,000.
APPROVAL
APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT
City/County Date Approved
City Fee Amount Permit Date
Date Fee Paid
Signature City Clerk or County Official Approved Director Alcohol and Gambling Enforcement
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
above. If the application is approved the Alcohol and Gambling Enforcement Division will return this application to be used as the
permit for the event.
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