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CITY OF ST. ANTHONY <br /> DEPARTMENT OF LICENSING <br /> The following is application for use of 3.2 beer <br /> FULL NAME OF APPLICANT: l Irl j (4UST WORK IN ST. ANTHONY OR <br /> LIVE IN ST. ANTHONY) <br /> ADDRESS: O �'� - C�-yam �' '�- �` - <br /> AGE: <br /> I certify that I am a resident of St. Anthony or work in City of St. Anthony. <br /> I am responsible for conduct of his/her group. <br /> 6d /Y <br /> gnature of Applicant L NAME OF GROUP <br /> Dl NO in Group: j5--p <br /> LOCATION: <br /> $50 .00 Clean-up Deposit: <br /> Received By Lf2� � <br />