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CITY OF ST ANTHONY <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: Z_1'tC'x-1 A) 6 �IA7 L aa, .)e, <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: l oZ c1d l 7S cal. k� <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 /> Signature of Ap ht <br /> NAME OF GROUP:_ <br /> # IN GROUP• <br /> LOCATION: f�-l_ <br /> DATE: - O HOURS: <br /> TELEPHONE#: 7$A— 9,5- 9 <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: - &- -�An- <br /> RETURNED: <br />