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CITY OF ST ANTHONY <br /> DEPARTMENT OF LICENSING <br /> Date: -/7— S-3 <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT:� <br /> SU-50—ti A_ <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: 3 vo w V"P c,) ALE' <br /> AGE: 'SSG <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I am esponsible for conduct of his/her group. <br /> Signature of Applicant <br /> NAME OF GROUP:Cdr Les `< <br /> # IN GROUP: <br /> LOCATION: �e.h tea- Q i/-� !4�'c�r fle-_ ✓1 <br /> DATE: /T/9G HOURS: /D — 27P_ <br /> TELEPHONE#: <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 />