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CITY OF ST ANTHONY <br /> DEPARTMENT OF LICENSING <br /> Date: <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT: Su L/A) ( „, rr <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: j4d rd 'h(7 -14 <br /> AGE: <br /> I certify that I am a resident of St. Anthony or work in the City. <br /> I am res onsible for conduct of his/her group. <br /> Sign ture of Applicant <br /> NAME OF GROUP: h/(4 <br /> # IN GROUP: <br /> LOCATION: P/I la/ ,-1A <br /> DATE: O S: - 9;30 PM <br /> TELEPH <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 /> • <br />