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• CITY OF ST ANTHONY <br /> DEPARTMENT OF LICENSING <br /> Date: 40 lq� <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME Th <br /> ( ust wor in St. AnthonC or live in St. Anthony <br /> ADDRESS:A 0 7 <br /> AGE:�� <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I am/r ponsible fo conduct of his/her group. <br /> -A Ilk <br /> Signat re of Ap icant <br /> NAME OF GROUP: 10 <br /> # IN GROUP: - �k) <br /> LOCATION l — <br /> DATE: HOURS: - ;0 0 <br /> TELEPHONE#: �281 KV-5S C w ) M8 - /33� <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 />