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CITY OF ST A.'VTHONY <br /> DEPARTMENT OF LICENSING <br /> Date: <br /> The following is an application for use of 3.2.beer in City Parks. <br /> FULL NAME OF APPLICANT: <br /> (Must work in St. Anthon or live in St. Ant ny) <br /> ADDRESS: <br /> AGE: &-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 /> • Sign re of Applicant <br /> NAME OF GROUP: <br /> # IN GROUP: <br /> LOCATION: ' <br /> DATE: a HOURS: 4— <br /> TELEP ONE#: 7ei- 16 -_ <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 />