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CITY OF ST ANTHONY <br /> DEPARn. IENT OF LICENSING <br /> Date: <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT: ` z,!, P �� ��� <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 a '#r �ponsible or co duct of his/her group. S <br /> Sijnature of licant <br /> NAME OF GROUP: NE <br /> # IN GROUP: zjZ) <br /> LOCATION: <br /> DATE: HO S: �c <br /> TELEP ONE#: <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: m <br /> RETURNED: <br />