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Minnesota Department of Public Safety <br />JL0 Alcohol and Gambling Enforcement Division <br />(D 445 Minnesota Street, Suite 1600, St. Paul, MN 55101 <br />651-201-7507 TTY 651-282-65 55 <br />4AICOhol 8,hlcahol8,Gambiing Enrarcement APPLICATION AND PERMIT FOR A 1 DAY <br />TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSIE <br />Name of organization Date of organization Tax exempt number <br />r <br />estival in the Park of Mounds View 3-0508257 <br />Organization Address (No PO Boxes) City State Zip Code 77 <br />401 Mounds View Blvd Mounds View MN _� 5112 <br />Name of pem <br />!Cathryn Smith <br />Business phone Home phone <br />- 790-0W <br />Date(s) of event <br />Type of organization Microdistillery Small Brewer <br />August 19th 2023 <br />L Club L Charitable ` Religious _ Other <br />non-profit <br />Organization officer's name <br />City State <br />Zip Code <br />Kathryn Smith <br />1 IMN <br />Organization officer's name <br />City State <br />Zip Cade <br />[Bethany Dickert <br />MN <br />Organization officees name <br />city state <br />Zi Cnde <br />nn Lindstrom <br />MN <br />Location where permit will be used. If an outdoor area, describe. <br />Silver View Park - Outdoor fenced off area <br />If the applicant will contract for intoxicating liquor service give the name and address of the liquor license providing the service. <br />Max Bar and Grill 17646 Central .Ave NE, Ham Lake, hIN 55304 <br />If the applicant will carry liquor liability insurance please provide the carrier's name and amount of coverage, <br />Securalnsurance <br />APPROVAL <br />APPLICATION MUST 8E APPPAM0 BYCrTY OR COUNTY B€FOW SUSMTTING To ALCOHOL AND CAM 8LING ENFORCEMENT <br />City of Mounds View <br />City or County approving the license <br />$120 <br />Fee Amount <br />Event in conjunction with a community festival [3N Yes E No <br />13,500 <br />Current population of city <br />06/26/2023 <br />Date Approved <br />08/19/2023 <br />Permit date <br />info_�mou ndsviewm n .oM <br />City or County Email Address_ <br />_ Nyie Zikmund, City Administrator <br />Please Print Name of City Clerk or County Officiai 51gnat►sre City Clerk of County official <br />CLERKS.NOTICE: Submit this form to Alcohol and Gambling Enforcement Division 30 days prior to event <br />No Temp Applications faxed or mailed. Only emailed. <br />ONE SUBMISSION PER EMAIL, APPLICATION ONLY. <br />PLEASE PROVIDE A VALID E-MAIL, ADDRESS FOR THE CITYICOUNTY AS ALL TEMPORARY <br />PERMIT APPROVALS WILL BE SENT BACK VIA ENTAIL. E-MAIL THE APPLICATION SIGNED BY <br />CITYICOUNTY TO AGE. TEMPORARYAPPLICATION@STA TE.MN. US <br />