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CITY OF ST &NTHONY <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:'S /��v�72GGZ <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS:__?q0 2 OreOf �2 <br /> AGE: <br /> I certify Fth am a resident of St. Anthony or work in the City. <br /> I am re le r c nduct of his/her group. <br /> ignature of Applicant <br /> NAME OF GROUP: <br /> # IN GROUP: <br /> LOCATION: JL4� �� ��-- <br /> DATE:— G-&-9? HOURS: ivy- —9 71�1 <br /> TELEPHONE#: 3 <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: ao? <br /> RETURNED: <br />