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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 Ci rks. <br /> FULL NAME OF APPLICANT: /_ <br /> (Must work in St. 46 thony or ln,e in St. Anthony) <br /> AGE: <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I am responsible for con duc his/her group. <br /> ZSignatu�e of Applicant <br /> r <br /> NAME OF GROUP: <br /> # IN GROUP: <br /> LOCATION: <br /> DATE:dZ�4 _3, HOURS: <br /> TELEPH0f4E#: '22 / 1 LICC <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 /> • <br />