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CITY OF ST &NTHONY <br /> DEPARn, IENT OF LICENSING <br /> Date: <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL INTAME OF APPLICANT: X nLtc t4i C L I'&&I <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: 005('u - 3t1 Ct L.e_ lie <br /> AGE: <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I am responsible for conduct of his/her group. <br /> Signature of Applicant <br /> NAME OF GROUP: LEA Ui Cc.c-t I`c I L C <br /> # IN GROUP: &v <br /> LOCATION: ►4a «"--L. <br /> DATE: lr HOURS: <br /> TELEPHONE : `7 q 1 - Y 77 <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 />