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CITY OF ST. ANTHONY <br /> DEPARTMENT OF LICENSING DATE : 9 (� <br /> The following is application for use of 3. 2 beer. in City Parks. <br /> FULL NAME OF APPLICANT: ��- - � (MUST WORK IN ST. ANTHONY OR <br /> LIVE IN ST. ANTHONY) <br /> ADDRESS: 3/0C>AGE:a <br /> I certify that I am reside t of St. Anthony or work in City of St. Anthony. <br /> I am responsible for conduct of his/her group. <br /> Signature o Ap icant NAME OF GROUP: _5� t S, <br /> NO in Group: 5n t <br /> LOCATION: <br /> DATE'I- iia. '�i P? y6 <br /> $50 . 00 Clean-up Deposit: TELEPHONE # : <br /> Received By Z) <br />