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Mounds View Parks, Recreation and Forestry Department <br />2401 Highway 10 <br />Mounds View, MN 55112 <br />784-3055 <br />PARK RESERVATION PERMIT <br />Date of request: <br />Permission is hereby granted to: <br />for use of <br />Park and special facilities including <br />Date of rental: Time of rental: <br />This permit is issued with the understanding that: <br />Type of activity: <br />Name of responsible person Address <br />Phone <br />will be responsible for adherence to the Policies and Regulations for use of City Park <br />facilities: <br />This permit is conditioned upon the following fee schedule: <br />I. PARK RENTAL FEE/DEPOSIT <br />A. $20.00 resident fee <br />$ <br />B. $50.00 non-resident fee <br />$ <br />C. $50.00 key deposit (Lakeside/Silver View) <br />$ <br />D. $50.00 clean-up deposit (City Hall/Silver View/ <br />Lakeside) <br />$ <br />II. PICNIC KIT <br />A. $10.00 charge (available to Mounds View <br />residents only) <br />$ <br />TOTAL AMOUNT DUE: <br />$ <br />AMOUNT REFUNDABLE: $ PD BY: CHECK(S)# [ <br />& ] OR CASH [ ] <br />AGREED UPON BY: <br />(PARK USER) <br />DATE DEPOSIT CHECK RETURNED: <br />(P&R DEPT) <br />BY WHOM: <br />