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CITY OF ST. ANTHONY <br /> DEPARTMENT OF LICENSING <br /> The following i,s application for use of 3. 2 beer in City Parks. <br /> FULL NAME OF APPLICANT: /OI>J/ To (MUST WORK IN ST. ANTHONY OR LIVE <br /> IN ST. ANTHONY) <br /> ADDRESS: 2 60/ :5:,2 f�(�_ ltl , <br /> AGE <br /> I certify that I am a resident of St. Anthony or work in City of St. Anthony. <br /> I am responsible for conduct of his/her group. <br /> Signature of applican NAME OF GROUP 61�7 1 <br /> NO . Z1b <br /> LOCATION <br /> $50. 00 Cleanup Deposit So <br /> Received by. : <br /> RALPH W. OR LINDA L. HAYNE 7235 <br /> H-500-730-886-280 - H-500-522497-762 <br /> 5214 E. BALD EAGLE BLVD. 426-4147 75-897960 <br /> WHITE BEAR LAKE, MN 5511110 .'. 19 <br /> PAY TO T G7—t--- (� ,w � y $ <br /> ORD F <br /> K DOLLARS <br /> B Bank I its Beer Lake <br /> 'i"' rrtsi ns m <br /> First BenkWhite ear Bsr•aor Lako,National Association <br /> ® 4700 Clark Ave. <br /> ae Bear Lehe,MN 5511 n r <br /> MEMO <br /> 0009600989 Sao 4813- 2 S8 5 bii° ? 23S <br />