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INDEPENDENT,-SCHOOL DISTRICT NO. 282 <br /> Community Servloes Oepsrbt»nt <br /> 9301 Slhrer Lake Rd a 81. Anthony, MN ,6641e • Phaa; M-5021 <br /> Facilities Reservation Form Permit No. <br /> R. S. Fulmer <br /> Name ulme Nome Phone 340-9618 Bus. Phone 788-9393 <br /> Address 3720 Macalaster Dr NE Date 8-23-83 <br /> Name of Group or Organization Berger Transfer 8 Storage, Inc <br /> Intended Use Company Picnic \\ <br /> Date(s) wanted Octnber 18 On case of rain Oct 19) Day(s) Su Mi�Th F So (circle) <br /> Building: • <br /> High School Auditorium <br /> Park View Community Center. Cafeteria <br /> Wilshire Park Elem. School Classroom(s) p <br /> 1(X_Other Central Park Pavilion Gymnasium (If High School, circle one: <br /> OLD NEW ) <br /> Kitchen <br /> Other <br /> Doors to open am pm Expected attendance: 3M) <br /> Activity begins am 4-0 pm Admission: _X_Free Charge <br /> Activity ends am 9;OOpm Will merchandise be sold? NO <br /> Special arrangements needed (chairs. cooks. AV equipment, etc.): <br /> I hereby certify that I am an agent of the above named group or organization and am authorized to accept in their <br /> -name the responsibility for observ.anre.'of the rules-and regulations of the Board of Education..Independent School <br /> District #282. As a group or organizational agent, I will attend this function,and I will be solely responsible for giving <br /> any and all instructions to the custodians or other support personnel. Presentation of this permit to the custodian on <br /> duty is necessary for admittance for the initial date. In accepting this arrangement, rentee agrees to hold harmless <br /> I.S.D. 282 and its representatives from all claims incurred in use of the facility. Rentee waives all rights and claims for <br /> potential damages incurred in this rental arrangement. p <br /> (signature of responsible person) <br /> Bill to: __ Berger Transfer & Storage, Inc. 3720 Macalaster Dr NE, Minneapolis, MN 55421 <br /> (name) (address) <br /> ---------------------------------------------FOR OFFICE USE ONLY----- ----- <br /> Class _. Ins Approved by <br /> .Oats _466an_ <br /> Charges: Rental `77 �� Custodial <br /> Cooks -- -- - Other charges: <br /> Note: <br /> MMT§—Cawmwnlq Owrb..OMM Copy Caw&— - v Olew Cop► Pit=—Cu,lodae,copy GOLD—Avpftanft Con <br />