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® CITY OF ST kNTHONY <br /> DEPARnIENT OF LICENSING <br /> Date: 7' <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT: R t c.1-mt20 - FGi <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: c;;2 "�Od A/�,1J2/� 1�K-`­ <br /> AGE: e-13 <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> i <br /> I am responsible for conduct of his/her group. <br /> • Signature of Appl' n <br /> NAME OF GROUP: <br /> # IN GROUP: /S-0 <br /> LOCATION: CC-, c F_1g L <br /> DATE: S-a y 9(a HOURS:0 9oc)-_a100 <br /> TELEPHONE#: 7 S 8- S48 8 S1 <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 />