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• CITY OF ST ANTHONY <br /> DEPARnIENT OF LICENSING <br /> Date: ` �- `� 3 <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT: a -en <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: <br /> AGE: 7 S' <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 /> 2 "Im _ E ate, <br /> iSignature of Applicant <br /> NAME OF GROUP: <br /> # IN GROUP: -76— <br /> LOCAT%—z',DATE: HOURS: <br /> TELEPHONE#: 7,F1 — 7 7 Y 2_ <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 />