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Minnesota Department of Public Safety <br />r <br />Alcohol and Gambling Enforcement Division <br />fr Nal <br />445 <br />Minnesota Street, Suite 1600, St. Paul, MIV 55101 <br />651-201-7507 TTY 651-282-6555 <br />Alcol►ol & Gambling Enforcement <br />APPLICATION AND PERMIT FOR A 1 DAY <br />TO 4 DAY TEMPORARY ON -SALE LIQUOR LICENSE <br />Name of organization <br />Date of organization Tax exempt number <br />Festival in the Park of Mounds View <br />05/15/2021 <br />03-0508257 <br />Organization Address (No PO Boxes) <br />City State Zip Code <br />2401 Mounds View Blvd <br />I Mounds View MN 55112 <br />Name of person making application <br />Business phone Home phone <br />Kathryn Smith <br />763-780-0960 <br />763-780-0960 <br />Date(s) of event <br />Type of organization ❑ Microdistillery ❑ Small Brewer <br />August 16th and 17th <br />❑ Club ❑ Charitable ❑ Religious 7C❑ Other non-profit <br />Organization officer's name <br />City State Zip Code <br />Bethany Dickert <br />Mounds View MN 55112 <br />Organization officer's name <br />City State Zip Code <br />Michele Madsen <br />Mounds View MN <br />55112 <br />Organization officer's name <br />City State Zip Code <br />preston Schmidt <br />Mounds View <br />MN <br />55112 <br />Location where permit will be used. If an outdoor area, describe, <br />Silver View Park in a fenced off area <br />2700 County Rd I Mounds View, Mn 55112 <br />If the applicant will contractfor intoxicating liquor service give the name and address of the liquor license providing the service. <br />Maxx Bar and Grill <br />17646 Central Ave NE Ham Lake, Mn 55304 <br />If the applicant will carry liquor liability insurance please provide the carrier's name and amount of coverage. <br />APPROVAL <br />APPLICATION MUST BE APPROVED BY CITY OR COUNTY BEFORE SUBMITTING TO ALCOHOL AND GAMBLING ENFORCEMENT <br />C;ity� <br />City or County approving the license <br />_$120.00 <br />Fee Amount <br />Event in conjunction with a community festival P Yes I-1 No <br />13.111 <br />Current population of city <br />aat�pr� d <br />August 17, 2024 (one day only) <br />Permit Date <br />barb.benesch@moundsviewmn.org <br />City or County E-mail Address <br />Nyle Zikmund, City Administrator <br />Please Print Name of City Clerk or County Official Signature City Clerk or 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 EMAIL. E-MAIL THEAPPLICATION SIGNED BY <br />CITY/COUNTY TO AGE. TEMPORARYAPPLICA TION@STA TE.MN. US <br />