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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 /> r <br /> FULL NAME OF APPLICANT: <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: c3j <br /> V <br /> AGE: 0' <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 /> r <br /> Signature o Applicant <br /> NAME OF GROUP: 7�/t- -4�cgir <br /> # IN GROUP: 3 Sr <br /> LOCATIOIJ: s-ev,` e <br /> DATE: 8 It(a 9)" - HOURS: LlfM— <br /> TELEPHONE#: �,35 —445-Y4 <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 />