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CITY OF ST ANTIi011' <br /> DEPART'N1ENT OF LICENSING <br /> r <br /> Date: l ? 5 <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL> L NAME OF APPLICANT: �2 F?e" & //� /'1 GcLI <br /> (Must work in St. Anthony 4 live in St. Anthony) <br /> r ADDRESS: <br /> AGE:�L <br /> I certify that I am a esident of St. Anthonyor work in the City. <br /> I am responsi e for conuct o is: oup. <br /> �� <br /> 4na- ' of Applicant <br /> NAME OF GROUP: I-I o0 2 ,I w' <br /> # IN GROUP: 5c, <br /> LOCATION: z o{ c a i r k <br /> DATE: )­4V-- 'J3 HOURS: ( G) ' 3'-3o- "T.30 <br /> TELEPHONE#: 9 5i - ILL <br /> LL <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: <br /> RETURNED: <br /> .,f <br />