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CITY OF ST. ANTHONY <br /> DEPARTMENT OF LICENSING <br /> The following is application for use o 3. 2 beer City Parks. <br /> FULL NAME OF APPLICANT: (!9 ORK IN ST. ANTHONY OR <br /> LIVE I ST. ANTHONY) <br /> ADDRESS: ` �-- ' �'`� — 3 D/ <br /> AGE: <br /> I certi�y th t I am a residen of St. Anthony or work in City of St. Anthony. <br /> I am responsible for conduct of his/her group. <br /> Signature o App c.an� t NAME OF GROUP: � C <br /> 9 <br /> NO in Group: C1 1 <br /> LOCATION: <br /> $50.00 Cleari-up Deposit: /L iV <br /> � �� <br /> Received By , <br />