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CITY OF ST ANTHONY <br /> DEPARTMENT OF LICENSING <br /> Date: v .2 <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICA.,NrT2/�t - <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: Cz, <br /> AGE: <br /> I certify that I am ajz&ident of St. Anthony or work in the City. <br /> I am responsible for conduct of his/her group. <br /> Signature of Applicant <br /> NAME OF GROUP• c�c�� �c�_!�< <br /> # IN GROUP: �y <br /> LOCATION, <br /> DATE: ',23 HOURS: x� <br /> TELEPH N , ­175`% --f52 j <br /> $50.00 CLEAN-UP DEPOSIT: <br /> (You are responsible for Park Clean-up, the deposit will be returned after inspection of the <br /> Park) <br /> RECEIVED BY: <br /> RETURNED: <br />