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CITY OF ST. ANTHONY <br /> DEPARTMENT OF LICENSING DATE : <br /> The following is IpplicaLiOn for Z;;i? City Parks . <br /> FULL NAME OF APPLICANT• ` (MUST WORK IN ST. ANTHONY OR <br /> LIVE IN ST. ANTHONY) <br /> ADDRESS�pD <br /> AGE: <br /> I certi-L-y that I am a resident of St. Anthony or work in City of St. Anthony. <br /> I am responsible for conduct) of his/her group. <br /> LSigna re of Applicant NAME OF GROUP : v v <br /> NO in Group: <br /> LOCATION : Q / <br /> DATE I ' D <br /> $50 . 00 Clean-up Deposit: TELEPHONE <br /> Received By 3 �G' C/ <br />