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CITY OF ST ANT BONY <br /> DEPARTMENT OF LICENSING <br /> Date: f <br /> The following is an application for u e of 3.2 b in City Parks. <br /> Cj <br /> FULL NAME OF APPLICANT: <br /> (Must work in St. Anthony or ve in St. Anthony) <br /> nA <br /> ADDRESS: -3 z d � 4 f L_�- D ��� I�- 0 L k _ <br /> AGE: <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I am 's ;onsible fo duct of his/her group. <br /> Si�nat re of A licant <br /> NAME OF GROUP: N r� C� <br /> # IN GROUP: 2� <br /> LOCATION:DATE- cv ,3 HOURS: : dZ r 3 0 <br /> TELEPH NE#: — <br /> H) <br /> -$50.00 CLEAN-UP DEPOSIT: — ��`,J - inspection of the <br /> (You are responsible for Park Cle posit will be returned after <br /> Park) <br /> RECEIVED BY: -%/ - <br /> RETURNED: <br />