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CITY Or ST. ANTHONY <br /> DEPARTMENT OF LICENSING TODAY 'S DATE: / 9/ <br /> '!'lie following is application for use of 3. 2 Deer. in Ci •y Parks. <br /> PULL NAME OF APPLICANT: 1 (MUST WORK IN ST. ANTHONY OR <br /> LIVE IN ST. ANTHONY) <br /> ADDRESS: C C' CZ's c'. / • t�� <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 /> Sig atu r ee o pp scant NAME OF GROUP: ,/ �*-�--- <br /> NO in Groupp: 3,S <br /> LOCATION: ( i - <br /> DATE'I-`'(3, _�, /l 5/ <br /> -7 <br /> $50.00 Clean-up Deposit: TELEPHONE # <br /> Received <br />