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CITY OF ST ANTHON-Y <br /> DEPARTTMENT OF LICENSING <br /> Date: <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT: \J a i) ( %N Ll���°L` <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: <br /> AGE: <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I am responsible for conduct of his/her group. <br /> ignature of Applicant <br /> NAME OF GROUP. LL l -c A) 141 L�� <br /> # IN GROUP: r61 o . <br /> LOCATION: c-Lk\7k-ct`1 '1X`4/,'`4/,' i D 11 <br /> DATE: 2 9 3 HOUR_ S: Z ' crC, _ -7 = 6 <br /> TELEPHONE,*: 7 <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 /> • <br />