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CITY OF ST ANTHONY <br /> DEPART.IIENT OF LICENSING <br /> Date: IM L O `t� <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT: _?A, J-.Qa e;o <br /> (IN4ust work in St. Anthony or live in St. Anthony) <br /> ADDRESS: 3qD-1 <br /> AGE: 9 <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 /> u <br /> Signature of Applicant <br /> NAME OF GROUP: _kbe4r , Cec idsi <br /> # IN GROUP: Z57 <br /> LOCATION: l Av.I, <br /> DATE: M ne. if 09 LA HOURS: It <br /> TELEPHONE#: <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 />