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CITY OF ST ANTHONY <br /> DEPARTMENT OF LICENSING <br /> Date: II <br /> T"he following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICA.'1T: �k v%u Ra F g>e Z u- <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: <br /> AGE: _ <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I am ponsible for conduct of his/her group. <br /> 1 � <br /> Signature of ApplicAnt <br /> NAME OF GROUP: �- <br /> # IN GROUP: 3O <br /> LOCATION: ?*,j,1,o., - Lztnkn►S lt�K- <br /> DATE:_ 1����t`f1 y HOURS: L, - G-° <br /> TELEPHONE#: 3a7�- <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 /> y <br />