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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 Ci Parks. <br /> FULL NAME OF APPLICANT• <br /> (Must work in St. Anthony orlive in St. Anthony) <br /> ADDRESS: 3 6 0;9- - 7 22• <br /> AGE: <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 /> Signatu a of Applicant <br /> NAME OF GROUP: <br /> # IN GROUP: '5 <br /> LOCATION: <br /> DATE: 6 -2- - 9 4 HOURS:x>s a .n 7z�5 7 /'•� <br /> TELEPHONE#: '/ F 3 <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 />