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• CITY OF ST &NTHONY <br /> DEPARTMENT OF LICENSING <br /> Date: j/o 9 <br /> The following is an application for use of 3.2 beer in City Parks. <br /> FULL NAME OF APPLICANT: L 1'C cl i ti <br /> (Must work in St. Anthony or live in St. Anthony) <br /> ADDRESS: ,3UO Fa5S R6, /V. EEL <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 /> ai� X). <br /> • Signature of Applicant <br /> NAME OF GROUP: ZLt lb �/ 0-4j/ L°- <br /> # IN GROUP: <br /> LOCATION: - 1 <br /> DATE: -9 7 HOURS: MOM <br /> TELEPHONE#: -7 tff- 956.E Hd O 7 6%y/ <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.,L <br /> RETURNED: <br />