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• CITY OF ST kNTHO\1' <br /> DEPARTMENT OF LICENSING <br /> Date: 3d-:4 <br /> The following is an application for use of. 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT: <br /> (Must work in St. Anth or live in "thorny) <br /> ADDRESS: — 27 L , <br /> AGE: <br /> I certify that I am a resident of St. Anthony o work in the City. <br /> I am responsible for conduct of his/her group. G � <br /> • S' ture of App nt <br /> NAME OF GROUP: <br /> # IN GROUP: <br /> LOCATION: <br /> DATE: HOURS: <br /> TELE ONE#: 4/2 .4 `'/7/ ' <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 />