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CITY OF ST ANTH01Y <br /> DEPARTMENT OF LICENSING <br /> Date: <br /> The following is an application for u of 3.2 beer in City/'r}s. <br /> FULL NAME OF APPLICAlNNAME l <br /> (Must work in St. Anthony o ive in St. Anthony) <br /> ADDRESS- <br /> AGE: <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> responsible for�conduct of his/her group. <br /> • <br /> Signaturp4of Applicant <br /> NAME OF GRO P� ( � <br /> # IN GROUP: <br /> LOCATI <br /> DATE: � HOURS: 5• 'bm <br /> TELEPHONE#: I^ U <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: 1-27 <br /> RETURNED: <br />