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am" C / <br /> • CITY OF ST ANTHONY <br /> DEPARTMENT OF LICENSING <br /> Date: zz//"'Ilt <br /> The following is an application for use of 3.2 beer in City Parks. <br /> � G , <br /> FULL NAME OF APPLICANT: <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: 7 <br /> AGE: <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I am responsible for conduct of his/her group. <br /> • Signature of Applica <br /> NAME OF GROUP:L i Al <br /> # IN GROUP: <br /> LOCATION: <br /> DATE: — . — 9 6 HOURS: <br /> TELEPHONE#: -7 S <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 />