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• CITY OF ST ANTHONY <br /> DEPARTMENT OF LICENSING <br /> Date: �A <br /> The following is an application for use of 3.2-beer in City Parks. <br /> FULL NAME OF APPLICANT: <br /> (Must work in cS�t. Anthony or live in St. Anthony) <br /> ADDRESS: <br /> a 9 D � a /I,I/G 4 '(k �J <br /> AGE: <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I r7esponsible for conduct of his/her group. <br /> a <br /> • ignature of Applicant <br /> NAME OF GROUP: �'c < C , <br /> # IN GROUP: O <br /> )LOCATION: W1 vZ 1<. <br /> /_3-9 DATE: - HOURS: /2 =JD-PM <br /> TELEPHONE#: fat -`7 v2�i`7 <br /> LI <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: ,r/ <br /> RETURNED: <br />