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CITY OF ST ANTHONY <br /> DEPARTI►1ENT OF LICENSING <br /> Date: <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT: 1�- t`�1 L <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: 3�?Q !E jv-r �k. I���• <br /> AGE: 3 <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I a sponsible fo nd ct of his/her group. <br /> SSignature of Applicant <br /> NAME OF GROUP: <br /> # IN GROUP: _30 - <br /> LOCATION: <br /> DATE:, —11 - a*5 HOURS: <br /> TELEPHONE#:� `{4 - /,-0 59 wk <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 />