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CITY OF ST. ANTHONY <br /> DEPARTMENT Or LICENSING DATE : - <br /> The following is application for use of 3. 21 beer. in City Parks. <br /> PULL NAME OF APPLICANT: 41 6) - (.Muv� INRSTIN HOMY OR <br /> LI ANTHONY) <br /> ADDRESS : > -=� f��J/9:� P_ <br /> AGE: <br /> I certify that I am a resident of St. Anthony or work in City of St. Anthony. <br /> I am responsible for conduct of his/her group. <br /> Signature o Applicant NAME OF GROUP <br /> NO in Group: <br /> LOCATION: <br /> DATE'j' <br /> $50. 00 Clean-up Deposit: <br /> TELEPHONE <br /> Received By . ;? , <br />