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CITY OF ST. ANTHONY <br /> DEPARTMENT OF LICENSING DATE . <br /> 'thc following is application for us o.f 3. 2 beer. in City Parks. <br /> PULL NAME OF APPLICANT: <br /> AZ 15 (�c�G -��e— (,MUST WORK IN ST. ANTHONY OR <br /> LIVE IN ST. ANTHONY) <br /> 2 u � <br /> ADDRESS: J VU Cru-C+ GL A ' <br /> AGE:r. 6L <br /> I certify that I am a resident of St. Anthony or work in City of St. Anthony. <br /> I am res ons 'ble for conduct of his/her group. <br /> NAME OF GROUP: � l L <br /> Signa ure o p i.Apcant .. (� <br /> NO in Group: Cf y <br /> LOCATION: nw �� �J►II�.. <br /> DATE .. . 1711.1 QU <br /> T <br /> $50. 00 Clean-up Deposit: TELEPHONE # <br /> Received By yes- & c��/ <br />