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CITY OF ST. ANTHONY �_ <br /> DEPARTMENT OF LICENSING DATE: <br /> ,rile following is appl_icaL ion for use of 3. 2 beer. in City Parks. <br /> FULL NAME Or APPLICANT: ��/nP� _L - (�( J�� (MUST WORK IN ST. ANTHONY OR <br /> LIVE IN ST. ANTHONY) <br /> ADDRESS <br /> AGE: <::2) <br /> I certify 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 /> gnature of-Applicant NAME OF GROUP : /7 �� F�C�11iY14� <br /> NO in Group: <br /> LOCATION : 0 o 7(;z <br /> DATE'I- y- <br /> $S0 . 00 Clean-up Deposit: TELEPHONE # : L )of <br /> Received Dy <br />