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CITY OF ST. ANTHONY <br /> DEPARTMENT OF LICENSING <br /> 'ne following is appl:i.caL-;i.on for use of 3. 2 beer. in City P�►rks. <br /> FULL NAME OF APPLICANT: S '--x11Ut� -�L-- (MUST WORK IN ST. ANTHONY OR <br /> LIVE IN ST. ANTHONY) <br /> ADDRESS: -3 Y <br /> AGE:_ <br /> I certify that I am a resident of St. Anthony or work in City of St. Anthony. <br /> I am r spo s le for conduct of his/her group. <br /> i <br /> S gnature o Ai�plicaiit <br /> NAME OF GROUP <br /> NO in Group: �v <br /> LOCATION:014P?rt/ /'9n/G ' ""c ,d, <br /> DATE'S . . . . .J c.�-.-� Z c v <br /> i $50 .00 Clean-up Deposit: <br /> Received By <br />,t <br />'t <br /> 4 , <br />�N <br />