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CITY OF ST. ANTHONY <br /> DATE: <br /> DEPARTMENT OF LICENSING <br /> 'ne Collowing is application for use of 3. 2 beer in city Parks. <br /> FULL NAME OF APPLICANT: (MUST WORK IN ST. ANTHONY OR <br /> LIVE IN ST. ANTHONY) <br /> ADDRESS: <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 ot Applicant NAME OF GROUP: <br /> NO in Group: y S� <br /> LOCATION: 19 TaL <br /> DATEI - O <br /> $50.00 Clean-up Deposit: TELEPHONE # : 7 7�Z- <br /> Received By <br /> i <br />